THERAPEUTIC AND DIAGNOSTIC FACTORS AS RELATED TO CANCER RISK

与癌症风险相关的治疗和诊断因素

• 批准号: 6289550
• 负责人: LOUISE BRINTON
• 金额: --
• 依托单位: DIVISION OF CANCER EPIDEMIOLOGY AND GENETICS
• 依托单位国家: 美国
• 资助国家: 美国
• 起止时间: 至
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/6289550
• 关键词: breast implants; breast neoplasms; cancer risk; clinical research; colorectal neoplasms; estrogens; female reproductive system neoplasm; fertility promoting drug; hormone related neoplasm /cancer; hormone therapy; human mortality; human subject; human tissue; iatrogenic disease; liver neoplasms; longitudinal human study; multiple myeloma; nondrug contraceptive; oral contraceptives; ovary neoplasms; uterus neoplasms; women's health

A major emphasis of this program of research has been to define the relationship of exogenous hormones to subsequent cancer risk. Previous research has demonstrated an increased risk of incident breast cancer following usage of menopausal estrogens. However, women who use replacement estrogens at the time of diagnosis of a breast cancer appear to experience reductions in breast cancer mortality. An analysis within the context of a large screening program showed that this was not due to earlier detection of tumors among hormone users. Analyses of hormone replacement therapy within both the screening program and a record linkage study in Sweden showed that the combined estrogen-progestin regimen increased risk beyond that associated with estrogens alone. In the screening study, increases in risk were evident for both early and late- stage disease and were greater for progesterone receptor- positive than negative tumors. Relationships of hormone use with other cancers (including endometrial and lung) are also being explored. Effects of oral contraceptives on cancer risk have also been pursued in several investigations. In a study of cervical adenocarcinomas, use of oral contraceptives appeared to increase the risk of in situ tumors. Also underway is a retrospective cohort study to evaluate cancer risk following different types of infertility and exposure to ovulation- stimulating drugs. In a comparison study in Denmark, cancer risks among children conceived following use of these drugs is being pursued. Also under analysis are data from a recently completed retrospective cohort study of women who received augmentation mammoplasties. A recent review of the literature indicated concern about possible relationships with breast cancer, sarcomas, and several hematopoietic malignancies, including multiple myeloma. For breast cancer, there are concerns regarding effects on both incidence as well as prognosis, since breast implants have been shown to interfere with the ability to mammographically visualize lesions. A study of women who experienced breast reduction operations has also been completed. Analyses are currently underway to examine whether the amount of tissue removed during the operation relates to subsequent reductions in breast cancer risk. Finally, efforts are being made to assess risk of several cancers in relation to different types of gynecologic operations. Of interest are not only operations involving ovarian ablation but also those with more subtle effects, such as tubal ligation. Although this procedure has been linked with substantial decreases in the risk of ovarian cancers, its effects on other tumors (e.g., breast) are less well known. Preliminary analyses within the context of a population-based case-control study do not confirm an etiologic role for the procedure in breast cancer. Human Subjects & Human Subjects: Interview, Questionaires, or Surveys Only

这项研究计划的一个主要重点是确定外源性激素与随后癌症风险的关系。以前的研究已经证明，使用绝经期雌激素后，乳腺癌发病的风险增加。然而，在诊断乳腺癌时使用替代雌激素的妇女似乎经历了乳腺癌死亡率的降低。在一个大型筛查项目的背景下进行的分析表明，这不是由于激素使用者中肿瘤的早期检测。在筛查项目和瑞典的一项记录连锁研究中对激素替代疗法的分析表明，联合雌激素-孕酮方案增加的风险超过了单独使用雌激素的风险。在筛查研究中，早期和晚期疾病的风险增加都很明显，孕激素受体阳性肿瘤的风险大于阴性肿瘤。激素使用与其他癌症（包括子宫内膜癌和肺癌）的关系也在探索中。口服避孕药对癌症风险的影响也在几项调查中进行了研究。在一项关于宫颈腺癌的研究中，使用口服避孕药似乎会增加原位肿瘤的风险。同时正在进行的是一项回顾性队列研究，以评估不同类型的不孕症和暴露于促排卵药物后的癌症风险。在丹麦进行的一项比较研究中，正在追踪使用这些药物后怀孕的儿童患癌症的风险。同时分析的数据来自最近完成的一项回顾性队列研究，研究对象是接受隆乳术的女性。最近的一项文献综述表明，关注与乳腺癌、肉瘤和几种造血系统恶性肿瘤（包括多发性骨髓瘤）的可能关系。对于乳腺癌，人们担心对发病率和预后的影响，因为乳房植入体已被证明会干扰乳房X线检查显示病变的能力。一项关于经历过缩胸手术的妇女的研究也已完成。目前正在进行分析，以检查手术期间切除的组织数量是否与随后乳腺癌风险的降低有关。最后，正在努力评估与不同类型的妇科手术有关的几种癌症的风险。值得关注的不仅是涉及卵巢切除的手术，还有那些影响更微妙的手术，如输卵管结扎术。尽管这种方法与卵巢癌风险的大幅降低有关，但它对其他肿瘤（例如，乳房）不太为人所知。基于人群的病例对照研究的初步分析未证实该手术在乳腺癌中的病因作用。人类受试者和人类受试者：仅访谈、问卷调查或调查