RECENT TRENDS IN INCIDENCE OF AND MORTALITY FROM BREAST, OVARIAN AND ENDOMETRIAL CANCERS IN ENGLAND AND WALES AND THEIR RELATION TO CHANGING FERTILITY AND ORAL-CONTRACEPTIVE USE
RECENT TRENDS IN INCIDENCE OF AND MORTALITY FROM BREAST, OVARIAN AND ENDOMETRIAL CANCERS IN ENGLAND AND WALES AND THEIR RELATION TO CHANGING FERTILITY AND ORAL-CONTRACEPTIVE USE
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DOI：
10.1038/bjc.1995.360
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发表时间：
1995-08-01
影响因子：
8.8
通讯作者：
SWERDLOW, AJ
中科院分区：
文献类型：
--
作者：
SILVA, ID;SWERDLOW, AJ
生殖相关因素在乳腺癌、卵巢癌和子宫内膜癌的病因学中起主要作用。妊娠史影响这些癌症的风险，口服避孕药的使用改变卵巢癌和子宫内膜癌的风险，尽管其对乳腺癌风险的影响不太确定。我们分析了英格兰和威尔士这些癌症的发病率和死亡率的近期趋势，并评估了它们是否可以通过生育率和口服避孕药使用的变化来解释。在1962- 1987年期间，乳腺癌（每年增加0.95%）和卵巢癌（每年增加0.76%）的总发病率显著增加，但子宫内膜癌的发病率几乎没有增加（每年增加0.13%）。近年来，每种癌症在年轻人中的发病率都有所下降，而在老年人中则有大幅增加。死亡率数据显示了类似的时间趋势。在按出生队列进行的分析中，每种癌症的发病率在世纪之前出生的连续队列中急剧增加，在之后出生的队列中缓慢增加，在20世纪20年代出生的人中达到最大值，在之后出生的人中下降。在世纪之交之前出生的妇女发病率的增加标志着其生育率的下降。20世纪20年代以后出生的妇女风险的下降并没有伴随着生育率的显著增加，而是与口服避孕药的引入和使用的增加相吻合。对于卵巢癌和子宫内膜癌，这与口服避孕药保护作用的个人研究的有力证据一致。对于乳腺癌，最近下降的原因尚不清楚。这与最近提出的口服避孕药具有长期保护作用的建议是雅阁的，需要进一步研究。然而，也有可能是其他风险因素的变化，如膳食脂肪摄入量和月经初潮年龄，可能导致了这些癌症风险最近的下降。
Reproductive-related factors play a major role in the aetiology of cancers of the breast, ovary and endometrium. Pregnancy history influences the risk of each of these cancers, and oral contraceptive use modifies the risks of ovarian and endometrial cancers, although its effect on breast cancer risk is less certain. We analysed recent time trends in the incidence and mortality of these cancers in England and Wales and assessed whether they can be explained by changes in fertility and oral contraceptive use. During 1962-87, there were significant increases in the overall incidence of breast cancer (0.95% increase per annum) and ovarian cancer (0.76% per annum) but little increase in endometrial cancer (0.13% per annum). At young ages incidence of each of the cancers has declined in recent years, whereas at older ages there have been substantial increases. Mortality data show similar time trends. In analyses by birth cohort, incidence of each of the cancers increased steeply for successive cohorts born before the turn of the century, and more slowly for cohorts thereafter, reaching a maximum for those born in the 1920s, and decreased for those born subsequently. The increases in incidence for women born before the turn of the century paralleled marked declines in their fertility. The fall in risk for women born after the 1920s was not accompanied by significant increases in their fertility, but coincided with the introduction and increase in use of oral contraceptives. For ovarian and endometrial cancers this accords with strong evidence from person-based studies of the protective effect of oral contraceptives. For breast cancer, the reasons for the recent decline are not clear. It would accord with recent suggestions of a long-term protective effect of oral contraceptives, on which further studies are needed. It is also possible, however, that changes in other risk factors such as dietary fat intake and menarcheal age might have contributed to the recent declines in the risk of these cancers.