Previous investigators have suggested that screening-related biases may explain associations between postmenopausal hormone use and breast cancer. To investigate these biases, we studied postmenopausal women in the Nurses' Health Study from 1988 to 1994. Hormone use is associated with increased subsequent screening. Among women not screened in the previous 2 years, the probability difference, comparing current hormone users with others, for having mammography in the following 2 years is 19.5%; among women previously screened, the difference is 4.9%. These differences persist after control for other factors. If the increase in screening is causal, screening by mammogram could be intermediate in the causal pathway to breast cancer diagnosis. To deal with this problem, we restrict attention to a subset of the cohort in which the effect of postmenopausal hormone use on screening is small (women previously screened). In this subset, the rate ratio comparing breast cancer rates among current postmenopausal hormone users with others is 1.28. In a sensitivity analysis, the bias could not by itself plausibly account for the associations in our data. Our data provide evidence of an association between postmenopausal hormone use and breast cancer that is not solely the product of a detection bias.

译文

先前的研究人员认为,与筛查相关的偏见可能解释了绝经后激素使用与乳腺癌之间的关联。为了调查这些偏见,我们在护士健康研究1988年1994年中研究了绝经后妇女。激素的使用与后续筛查的增加有关。在过去2年中未进行筛查的女性中,将当前的激素使用者与其他人进行比较,在接下来的2年中进行乳房x线检查的概率差异为19.5%; 在先前筛查的女性中,差异为4.9%。在控制了其他因素之后,这些差异仍然存在。如果筛查的增加是有原因的,则通过乳房x线照片进行筛查可能是乳腺癌诊断的因果途径的中间环节。为了解决这个问题,我们将注意力集中在绝经后激素使用对筛查的影响很小的队列中的一个子集 (以前筛查过的女性)。在这个子集中,比较当前绝经后激素使用者与其他人的乳腺癌发病率的比率是1.28的。在敏感性分析中,偏差本身无法合理地解释我们数据中的关联。我们的数据提供了绝经后激素使用与乳腺癌之间关联的证据,而这不仅是检测偏倚的产物。

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