Neoplasia with use of intrauterine devices
Neoplasia with use of intrauterine devices
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DOI：
10.1016/j.contraception.2007.01.002
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发表时间：
2007-06-01
期刊：
影响因子：
2.9
通讯作者：
Peterson, Herbert B.
中科院分区：
文献类型：
--
作者：
Curtis, Kathryn M.;Marchbanks, Polly A.;Peterson, Herbert B.
背景资料：宫内节育器（IUD）预防妊娠的机制之一是在子宫内膜中产生无菌炎症反应。此外，释放孕酮的IUD或宫内系统（IUS）将孕激素或孕酮释放到子宫中。这两种机制可能会影响用户的风险neoplasia.Study设计：我们检索了PubMed数据库的研究宫内节育器的使用和肿瘤的风险进行了1960年和2006年9月之间，并发表在所有语言。我们排除了病例报告和病例系列。对于曾经使用宫内节育器和子宫内膜癌风险之间的关联，我们进行了一项荟萃分析，使用贝叶斯随机效应模型来解释研究间heterogeneity.Results：我们没有发现任何证据表明使用宫内节育器会增加肿瘤形成的风险。9项病例对照研究和1项队列研究发现，使用过宫内节育器的子宫内膜癌风险降低（合并校正比值比=0.6，95%置信区间= 0.4-0.7）。未观察到与IUD使用特征、IUD类型和癌症组织学类型相关的趋势。四项病例对照研究发现宫内节育器的使用与宫颈癌风险之间没有关联。一项研究发现，与芬兰的一般人群相比，释放左炔诺孕酮的IUS使用者的乳腺癌发病率没有增加。最后，三项研究发现宫内节育器的使用和发生葡萄胎或恶性subsequents.Conclusions之间没有关联：使用宫内节育器似乎不会增加肿瘤的风险。虽然几乎所有的研究都发现宫内节育器的使用与子宫内膜癌的风险降低有关，但仍不清楚这种关联是否是因果关系。(C)2007年爱思唯尔公司All rights reserved.
Background: One of the mechanisms by which intrauterine devices (IUDs) prevent pregnancy is the creation of a sterile inflammatory response in the endometrium. Additionally, hormone-releasing IUDs or intrauterine systems (IUSs) release progestins or progesterone into the uterus. Both of these mechanisms may affect users' risk for neoplasia.Study Design: We searched the PubMed database for studies on IUD use and risk for neoplasia conducted between 1960 and September 2006 and published in all languages. We excluded case reports and case series. For the association between ever using an IUD and risk for endometrial cancer, we conducted a meta-analysis using a Bayesian random-effects model to account for between-study heterogeneity.Results: We found no evidence of increased risk for neoplasia with IUD use. Nine case-control studies and one cohort study found reduced risks for endometrial cancer with having ever used an IUD (pooled adjusted odds ratio=0.6, 95% confidence interval= 0.4-0.7). No trend in associations was observed with characteristics of IUD use, type of IUD and histologic type of cancer. Four case-control studies found no association between IUD use and risk for cervical cancer. One study found no increased incidence of breast cancer among levonorgestrel-releasing IUS users as compared with the general population in Finland. Finally, three studies found no association between IUD use and occurrence of hydatidiform moles or malignant sequelae.Conclusions: Use of an IUD does not appear to increase the risk for neoplasia. While nearly all studies found that IUD use was associated with a decreased risk for endometrial cancer, it remains unclear whether this association is causal. (C) 2007 Elsevier Inc. All rights reserved.