Neoplasia and dysplasia of the cervix uteri and contraception: a possible protective effect of the diaphragm.
Neoplasia and dysplasia of the cervix uteri and contraception: a possible protective effect of the diaphragm.
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DOI：
10.1038/bjc.1978.198
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发表时间：
1978-08
影响因子：
8.8
通讯作者：
Doll, R
中科院分区：
文献类型：
--
作者：
Wright, N H;Vessey, M P;Kenward, B;McPherson, K;Doll, R
在牛津计划生育协会避孕研究的17032名妇女中，有65名在1977年9月1日之前活检证实宫颈肿瘤（包括不典型增生）。膜片使用者的发病率（每1000名妇女观察年0.17人）远低于口服避孕药使用者和宫内节育器使用者（分别为0.95和0.87人）。这种差异不能用混杂变量来解释，也不能归因于诊所内使用隔膜的人进行宫颈涂片检查的频率较低。从52名宫颈肿瘤患者和139名对照组中获得了有关第一次性交年龄、性伴侣数量和门诊外宫颈涂片频率的详细信息。与其他两种避孕方法的使用者相比，使用隔膜的人更不可能在早期有过性行为，而且性伴侣也少得多。然而，在对这些变量的影响进行调整后，使用隔膜的人发生宫颈肿瘤的风险仍然只有其他方法的人的四分之一。在不同避孕方法的使用者之间涂抹的模式差别不大。在这项研究中，吸烟成为子宫颈肿瘤的主要“危险因素”。这可能意味着吸烟习惯反映了与我们无法测量的疾病产生相关的性行为的某些重要方面。
Among the 17,032 women included in the Oxford-Family Planning Association contraceptive study, 65 developed biopsy proven cervical neoplasia (including dysplasia) prior to 1 September 1977. The incidence rate in diaphragm users (0.17 per 1000 woman-years of observation) was much lower than the rates in oral contraceptive users or intrauterine device users (0.95 and 0.87 respectively). This difference could not be explained in terms of confounding variables, nor was it attributable to a lower frequency of cervical smearing among diaphragm users within the clinics. Detailed information about age at first intercourse, numbers of sexual partners and the frequency of cervical smearing outside the clinics was obtained from 52 of the women with cervical neoplasia and 139 matched controls. Diaphragm users were less likely to have had coitus at an early age and had had materially fewer sexual partners than users of the other two methods of contraception. After adjusting for the effects of these variables, however, the risk of cervical neoplasia in diaphragm users was still only about one quarter that in the users of the other methods. Patterns of smearing varied little between users of the various contraceptive methods. Smoking emerged as a major "risk factor" for cervical neoplasia in this study. This probably implies that the smoking habit reflects some important aspect of sexual behaviour relevant to the production of the disease that we have been unable to measure.