Invasive cervical cancer and combined oral contraceptives.
Invasive cervical cancer and combined oral contraceptives.
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侵袭性宫颈癌和复方口服避孕药。
DOI：
10.1136/bmj.290.6476.1210
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发表时间：
1985
期刊：
影响因子：
--
通讯作者：
R. Doll
中科院分区：
文献类型：
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作者：
R. Doll
世界卫生组织关于肿瘤和类固醇避孕药的合作研究报告（3月30日，第961页）是目前相当长的一系列报告中最新的一篇，这些报告提供证据表明，服用口服避孕药多年或经常吸烟或两者兼而有之的妇女患宫颈癌（或其癌前病变）的风险更高。认为口服避孕药和吸烟可能导致这种疾病的原因被一些实验室的证据支持,但即便如此,大部分的人有太多的流行病学研究的经验可能会同意报告的作者,结果也可能是由于使用口服避孕药之间的混淆,吸烟,和性行为影响女性或他们的合作伙伴。一些报告的研究（包括世卫组织的合作研究）试图允许这种混淆，所有或几乎所有的研究都发现，通过这样做，风险大大降低，在这些情况下，很难确定，如果所作的允许是完美的，相对风险的小幅增加可能不会完全消除。因此，观察到的关联的因果性质必须保持怀疑。然而，毫无疑问的是，英国大约在1960年发生了一些变化，这导致了1935年以后出生的妇女宫颈癌发病率的逐步增加。这在人口普查和调查办公室公布的全国人口动态统计数据中得到了非常清楚的显示，
SIR,-The report of the WHO Collaborative Study on Neoplasia and Steroid Contraceptives (30 March, p 961) is the latest in what is now a fairly long series of reports providing evidence that the risk of developing cervical cancer (or its premalignant predecessors) is somewhat greater in women who have taken oral contraceptives for several years or have been regular cigarette smokers or both. The idea that oral contraceptives and cigarette smoking might both contribute to the cause of this disease is supported by some laboratory evidence, but even so most of those who have had much experience of epidemiological research are likely to agree with the authors of the WHO report that the results could also have been due to confounding between the use of oral contraceptives, cigarette smoking, and sexual behaviour of either the affected women or their partners. Several of the reported studies (including the WHO collaborative study) have attempted to allow for such confounding, and all, or nearly all, have found that by so doing the risk is materially diminished, and in these circum-stances it is difficult to be sure that if the allowance made had been perfect a small increase in relative risk might not have been eliminated altogether. The causal nature of the observed associations must therefore remain in doubt.What is not in doubt, however, is that some change took place in about 1960 in Britain which has led to a progressive increase in the incidence of cervical cancer in women born after about 1935. This is shown very clearly in the national vital statistics published by the Office of Population Censuses and Surveys,