Infertility as a Cancer Risk Factor - A Review
Infertility as a Cancer Risk Factor - A Review
复制标题
DOI：
10.1016/j.placenta.2008.08.007
复制
发表时间：
2008-10-01
期刊：
影响因子：
3.8
通讯作者：
Antonazzo, P.
中科院分区：
文献类型：
--
作者：
Cetin, I.;Cozzi, V.;Antonazzo, P.
卵巢癌、子宫内膜癌和乳腺癌与几个危险因素有关，如低产次、不孕不育、月经初潮早和更年期晚。这些危险因素通常在不孕症患者中共存，一些研究表明，不同的不孕症原因可能参与了癌症风险的发生。特别是病例对照和队列研究，调查了排卵障碍、子宫内膜异位症和不明原因不孕症在增加这种疾病风险方面的可能作用。大多数研究表明，不育患者患浸润性卵巢癌的风险总体上没有增加，尽管未生育一直与卵巢肿瘤发生率的增加有关，特别是在有子宫内膜异位症病史的患者中，尤其是交界性和子宫内膜样癌。不同的研究报告称，不孕不育的女性没有患乳腺癌的风险。然而，受不孕症影响的女性患子宫内膜癌的风险可能更高，特别是如果受到排卵障碍的影响。此外，不孕不育现在经常使用医疗设备进行治疗，这些设备本身可以改变荷尔蒙环境，并成为癌症发展过程中细胞变化的辅助因素。然而，尽管早期的研究表明不孕症药物与卵巢癌风险的增加有关，但随后的研究主要是令人放心的，尽管建议的药物治疗的类型和持续时间可能会增加恶性肿瘤的风险。有报道称，接受不孕不育治疗的患者患子宫内膜癌的风险增加，正如克罗米芬和他莫西芬的相似结构所预期的那样。由于乳腺癌被广泛认为是由激素引起的，因此生育药物可能会促进癌症的作用已经被假设。然而，许多大型研究都未能找到与乳腺癌相关的风险。总而言之，目前还没有关于不孕不育及其治疗对癌症风险的确切影响的确切答案，但研究结果总体上是令人放心的。关于在更大人群上进行生育药物治疗的进一步研究，可能会在未来提供更长的随访时间和更准确的数据，对混杂因素进行更好的调整。(C)2008爱思唯尔有限公司。保留所有权利。
Ovarian, endometrial and breast cancers are associated with several risk factors, such as low parity, infertility, early age at menarche, and late age at menopause. Frequently most of these risk factors coexist in infertile patients and some studies suggested that the different infertility causes can be involved in cancer risk development. In particular case-control and cohort studies investigated the possible role of ovulatory disorders, endometriosis and unexplained infertility in increasing the risk of this disease. Most studies have shown no overall increased risk in invasive ovarian cancer in subfertile patients, although nulliparity has been consistently associated with increased rates of ovarian tumor, in particular with borderline and endometrioid cancers in patients with a history of endometriosis. Different studies reported that infertile women are not at risk for breast cancer. However, women affected by infertility may be more at risk for endometrial cancer, particularly if affected by ovulatory disorders.Moreover, infertility is now often treated with medical devices that could by themselves modify the hormonal environment and be cofactors in the cellular changes towards cancer development. However, although early studies suggested that infertility medications were associated to increased risk in ovarian cancer, subsequent studies have been mainly reassuring, although suggesting that type and duration of medical treatment can increase the malignancy risk.An increased risk of endometrial cancer in patients undergoing infertility treatment has been reported, as expected by the similar structure shared by clomiphene and tamoxiphene. Since breast cancer is widely recognized as having a hormonal etiology, a possible role of fertility medications to promote cancer has been hypothesized. However, many large studies were not able to find an associated risk of breast cancer.In conclusion, nowadays, firm answers about the precise effects of infertility and its treatment on cancer risk are not available but findings are generally reassuring. Further studies about fertility drug treatments on larger populations may offer in the future longer follow-up and more precise data with better adjustments for confounding factors. (C) 2008 Elsevier Ltd. All rights reserved.