CHARACTERISTICS RELATING TO OVARIAN-CANCER RISK - COLLABORATIVE ANALYSIS OF 12 UNITED-STATES CASE-CONTROL STUDIES .2. INVASIVE EPITHELIAL OVARIAN CANCERS IN WHITE WOMEN
CHARACTERISTICS RELATING TO OVARIAN-CANCER RISK - COLLABORATIVE ANALYSIS OF 12 UNITED-STATES CASE-CONTROL STUDIES .2. INVASIVE EPITHELIAL OVARIAN CANCERS IN WHITE WOMEN
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DOI：
10.1093/oxfordjournals.aje.a116427
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发表时间：
1992-11-15
影响因子：
5
通讯作者：
ITNYRE, J
中科院分区：
文献类型：
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作者：
WHITTEMORE, AS;HARRIS, R;ITNYRE, J
在1956-1986年期间进行的12项美国病例对照研究中，收集了2197名白人卵巢癌患者和8893名白人对照者的数据，用于评估浸润性上皮性卵巢癌与生殖和月经特征、外源性雌激素使用和既往盆腔手术的关系。随着怀孕次数的增加（无论结果如何）以及母乳喂养和口服避孕药使用时间的延长，风险明显降低。卵巢功能障碍导致不孕和恶性肿瘤是这些趋势的一个不太可能的解释，有几个原因：1)趋势是明显的，甚至在高度分娩；2)未生育妇女的风险不因婚姻状况或妊娠而变化；3)已婚妇女的风险与最长妊娠尝试时间或临床诊断为不孕症的病史关系不大。使用生育药物的妇女和未采取避孕措施的绝经前性行为总持续时间较长的妇女的风险增加；这些关联在无配偶者中尤为明显。在月经初潮年龄、绝经年龄或雌激素替代治疗持续时间方面没有一致的风险趋势。输卵管结扎或子宫切除术并保留卵巢的病史与卵巢癌风险降低相关。这些观察结果表明，怀孕、母乳喂养和口服避孕药的使用诱导了防止卵巢恶性肿瘤的生物学变化，在未生育妇女中，最多只有一小部分卵巢癌风险是由于不孕造成的，而任何与不孕相关的风险增加可能是由于使用了生育药物。
Data collected from 2,197 white ovarian cancer patients and 8,893 white controls in 12 US case-control studies conducted in the period 1956-1986 were used to evaluate the relation of invasive epithelial ovarian cancer to reproductive and menstrual characteristics, exogenous estrogen use, and prior pelvic surgeries. Clear trends of decreasing risk were evident with increasing number of pregnancies (regardless of outcome) and increasing duration of breast feeding and oral contraceptive use. Ovarian dysfunction leading to both infertility and malignancy is an unlikely explanation for these trends for several reasons: 1) The trends were evident even among the highly parous; 2) risk among nulliparous women did not vary by marital status or gravidity; and 3) risk among ever-married women showed little relation to length of longest pregnancy attempt or history of clinically diagnosed infertility. Risk was increased among women who had used fertility drugs and among women with long total duration of premenopausal sexual activity without birth control; these associations were particularly strong among the nulligravid. No consistent trends in risk were seen with age at menarche, age at menopause, or duration of estrogen replacement therapy. A history of tubal ligation or of hysterectomy with ovarian conservation was associated with reduced ovarian cancer risk. These observations suggest that pregnancy, breast feeding, and oral contraceptive use induce biological changes that protect against ovarian malignancy, that, at most, a small fraction of the excess ovarian cancer risk among nulliparous women is due to infertility, and that any increased risk associated with infertility may be due to the use of fertility drugs.