Cancer Risk in Women Using the Levonorgestrel-Releasing Intrauterine System in Finland
Cancer Risk in Women Using the Levonorgestrel-Releasing Intrauterine System in Finland
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DOI：
10.1097/aog.0000000000000356
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发表时间：
2014-08-01
影响因子：
7.2
通讯作者：
Pukkala, Eero
中科院分区：
文献类型：
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作者：
Soini, Tuuli;Hurskainen, Ritva;Pukkala, Eero
目的：探讨芬兰绝经前使用左炔诺孕酮宫内缓释系统与癌症发病率之间的关系，特别关注子宫内膜腺癌。 方法：1994 年至 2007 年使用左炔诺孕酮宫内缓释系统治疗月经过多的所有 30-49 岁芬兰女性 (n=93,843) 均来自国家癌症研究所报销登记处并链接到芬兰癌症登记处数据。将左炔诺孕酮宫内缓释系统使用者的癌症发病率与一般人群进行比较。结果：在对855,324名女性的随访中，左炔诺孕酮宫内缓释系统使用者中总共发现了2,781例癌症病例。第一次购买左炔诺孕酮宫内缓释系统后，子宫内膜腺癌的标准化发病率（观察与预期比率）为 0.50（95% 置信区间 [CI] 0.35-0.70；观察到的病例为 34 例，预期病例为 68 例）；两次购买后，子宫内膜腺癌的标准化发病率为 0.25（95% CI 0.05-0.73；观察到的 3 例病例与预期病例为 12 例）。卵巢癌的标准化发病率为 0.60（95% CI 0.45-0.76；观察到 59 例，预期病例 99 例），胰腺癌为 0.50（95% CI 0.28-0.81；观察到 15 例，预期病例 30 例），肺癌为 0.68（95% CI 0.49-0.91；观察到 43 例，预期病例 63 例）。所有左炔诺孕酮宫内缓释系统使用者的乳腺癌标准化发病率为 1.19（95% CI 1.13-1.25；观察病例 1,542 例，预期病例 1,292 例）。 结论：左炔诺孕酮宫内缓释系统可能对子宫内膜恶变具有保护作用。使用左炔诺孕酮宫内缓释系统治疗育龄期月经过多与子宫内膜癌、卵巢癌、胰腺癌和肺癌的发病率低于预期有关。使用左炔诺孕酮宫内缓释系统与乳腺癌发病率高于预期相关。
OBJECTIVE: To examine the association between premenopausal use of the levonorgestrel-releasing intrauterine system and cancer incidence in Finland with a special focus on endometrial adenocarcinoma.METHODS: All Finnish women aged 30-49 years using a levonorgestrel-releasing intrauterine system for treatment of menorrhagia in 1994-2007 (n=93,843) were identified from the National Reimbursement Registry and linked to the Finnish Cancer Registry data. The incidence of cancers in levonorgestrel-releasing intrauterine system users was compared with that in the general population.RESULTS: A total of 2,781 cancer cases were detected in levonorgestrel-releasing intrauterine system users during the follow-up of 855,324 women-years. The standardized incidence ratio (observed-to-expected ratio) for endometrial adenocarcinoma was 0.50 (95% confidence interval [CI] 0.35-0.70; 34 observed compared with 68 expected cases) after the first levonorgestrel-releasing intrauterine system purchase and 0.25 (95% CI 0.05-0.73; three observed compared with 12 expected cases) after two purchases. The standardized incidence ratio for ovarian cancer was 0.60 (95% CI 0.45-0.76; 59 observed compared with 99 expected cases), for pancreatic cancer 0.50 (95% CI 0.28-0.81; 15 observed compared with 30 expected cases), and for lung cancer 0.68 (95% CI 0.49-0.91; 43 observed compared with 63 expected cases). The standardized incidence ratio for breast cancer among all levonorgestrel-releasing intrauterine system users was 1.19 (95% CI 1.13-1.25; 1,542 observed compared with 1,292 expected cases).CONCLUSION: The levonorgestrel-releasing intrauterine system may have a protective effect against endometrial malignant transformation. Using the levonorgestrel-releasing intrauterine system for treatment of menorrhagia during reproductive years was associated with a lower incidence of endometrial, ovarian, pancreatic, and lung cancers than expected. Levonorgestrel-releasing intrauterine system use was associated with a higher than expected incidence of breast cancer.