Breast cancer and abortion: collaborative reanalysis of data from 53 epidemiological studies, including 83,000 women with breast cancer from 3.6 countries
Breast cancer and abortion: collaborative reanalysis of data from 53 epidemiological studies, including 83,000 women with breast cancer from 3.6 countries
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DOI：
10.1016/s0140-6736(04)15835-2
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发表时间：
2004-03-27
期刊：
影响因子：
168.9
通讯作者：
Reeves, G
中科院分区：
文献类型：
--
作者：
Beral, V;Bull, D;Reeves, G
背景乳腺癌的激素因素合作小组汇集了世界范围内的流行病学证据乳腺癌和以前的自发性和人工流产之间的可能关系。方法对16个国家进行的53项研究中的个别妇女的数据与自由堕胎法进行了检查和集中分析。乳腺癌的相对风险比较有过一次流产的怀孕与从未有过的怀孕的影响，计算，按研究，诊断年龄，产次和第一胎年龄分层。由于过去人工流产漏报的程度可能受到妇女是否被诊断患有乳腺癌的影响，研究结果-包括总共44 000名乳腺癌妇女-使用了关于流产的前瞻性信息（即，在诊断乳腺癌之前记录的信息）与研究结果分开考虑-包括39000名患有这种疾病的妇女，结果乳腺癌的总体相对风险，比较有一个或多个怀孕的前瞻性记录，以自然流产结束与妇女没有这样的记录，是0. 98（95% CI 0.92-1-04，p=0.5）。相应的人工流产的相对风险为0.93（0.89-0.96，p=0.0002）。在有自然流产或人工流产的前瞻性记录的妇女中，乳腺癌的风险根据任何一种类型的流产的数量或时间没有显着差异。来自少数研究的已发表的人工流产结果与这些结果一致，这些研究具有前瞻性记录的信息，但无法纳入本文。人工流产的总体结果在前瞻性研究和回顾性研究之间存在显著差异（相对风险异质性检验：χ（1）（2），=33.1，p
Background The Collaborative Group on Hormonal Factors in Breast Cancer has brought together the worldwide epidemiological evidence on the possible relation between breast cancer and previous spontaneous and induced abortions.Methods Data on individual women from 53 studies undertaken in 16 countries with liberal abortion laws were checked and analysed centrally. Relative risks of breast cancer-comparing the effects of having had a pregnancy that ended as an abortion with those of never having had that pregnancy-were calculated, stratified by study, age at diagnosis, parity, and age at first birth. Because the extent of under-reporting of past induced abortions might be influenced by whether or not women had been diagnosed with breast cancer, results of the studies-including a total of 44 000 women with breast cancer-that used prospective information on abortion (ie, information that had been recorded before the diagnosis of breast cancer) were considered separately from results of the studies-including 39 000 women with the disease-that used retrospective information (recorded after the diagnosis of breast cancer).Findings The overall relative risk of breast cancer, comparing women with a prospective record of having had one or more pregnancies that ended as a spontaneous abortion versus women with no such record, was 0.98 (95% Cl 0.92-1-04, p=0.5). The corresponding relative risk for induced abortion was 0.93 (0.89-0.96, p=0.0002). Among women with a prospective record of having had a spontaneous or an induced abortion, the risk of breast cancer did not differ significantly according to the number or timing of either type of abortion. Published results on induced abortion from the few studies with prospectively recorded information that were not available for inclusion here are consistent with these findings. Overall results for induced abortion differed substantially between studies with prospective and those with retrospective information on abortion (test for heterogeneity between relative risks: chi(1)(2),=33.1, p