Public Health and Health Policy
Public Health and Health Policy. 2026; 1: (1) ; 10.12208/j.phhp.20260006 .
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浙江中医药大学附属四省边际中医院（衢州市中医医院）中心实验室 浙江衢州
*通讯作者： 祝红红,单位：浙江中医药大学附属四省边际中医院（衢州市中医医院）中心实验室 浙江衢州; ；
全球乳腺癌发病率从20世纪70年代开始上升并持续至今，这种持续上升趋势是由于可控病因不明确而造成乳腺癌的有效一级预防措施缺乏。本文综述了经20多年以来论证的乳腺癌病因学理论：环境致癌物暴露与外源性激素使用在乳腺细胞癌变过程中的协同增效作用及其机理，也就是说环境致癌物暴露与外源性激素使用的协同增效作用是导致乳腺癌发病率持续上升的主要原因。此理论为乳腺癌防治提供了研究方向和理论指导，也在实践上为降低乳腺癌发病率提供可操作的有效一级预防策略：对妇女应进行戒烟或避免接触二手烟、厨房油烟和其它环境致癌物等的健康宣教，吸烟妇女如果发现乳房结节就应该戒烟或避免继续接触二手烟及其它潜在的环境致癌物和或停止使用外源性激素以预防乳腺癌的发生；同时吸烟或被动吸烟等长期接触环境致癌物的妇女使用避孕药和激素替代疗法时应慎重。把此理论应用于人群中将有助于降低乳腺癌发病率和死亡率，在公共卫生中具有重大实践意义。
Breast cancer incidence started increasing in 1970s and has been continuously increasing so far, which is due to lack of known causes that lead to no conductible methods for the primary prevention of breast cancer. This study reviewed a theory for the etiology of breast cancer pandemic which had been verified for more than 20 years: Synergism between environmental carcinogen exposure and exogenous hormone use in the breast carcinogenesis and their inside biological mechanisms, that is to say synergism between environmental carcinogen exposure and exogenous hormone use can be explained as the main cause of breast cancer pandemic. This theory provides theoretic direction for the future research on breast cancer prevention and treatment and also provides conductible and effective primary-prevention methods to lower the breast cancer incidence in the public health practice: Women should be given health education of quitting smoking and avoiding secondhand smoke, cooking fume and other environmental carcinogens; if smoking women are diagnosed with breast nodules, they should be advised to quit smoking and or stop exposing to secondhand smoke and other environmental carcinogens and using exogenous hormone to prevent breast cancer incidence; and women with long-term exposure to environmental carcinogens including smoking, secondhand smoke and cooking fume should be cautious to be given prescriptions of oral contraceptives and hormone replacement therapy in the clinic. To apply this theory in the population shall help decrease breast cancer incidence and mortality which has huge public health significance.
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