Therapeutic and Diagnostic Factors as Related to Cancer

这个项目的一个主要重点是确定外源性激素与随后的癌症风险的关系。采用与检查外源性激素对乳腺癌风险的影响类似的方法，在一项大型筛查计划的背景下进行的分析显示，更年期激素的使用与卵巢癌的风险有关。这些分析表明，随着激素使用年限的增加，风险增加，特别是当使用的制剂是非对立雌激素时。与子宫内膜癌的关系正在通过更多的随访数据进行追踪。 同样令人感兴趣的是隆胸与随后的癌症风险的关系。乳腺癌的风险一直令人担忧，因为乳房植入物可能会干扰病变的乳房X光摄影。然而，在我们进行的一项大型回顾研究中，我们没有发现乳腺癌风险发生变化的证据。这些患者通常也没有经历其他癌症部位的变化，尽管在肺癌和脑癌的风险中观察到了升高，其原因尚不清楚。在一项死亡率分析中，植入患者自杀死亡的风险显著增加，但其他死亡原因与普通人群相似。目前正在进行与乳房植入物相关的结缔组织疾病风险分析。此外，我们正在继续跟踪死亡率队列，以确定之前观察到的模式是否持续。 一项回溯性队列研究也在进行中，以检查不同不孕症原因和不同相关治疗方法对癌症风险的影响。这项研究包括对早在1960年S时期确诊的患者的病历进行详细提取，并通过问卷调查获得最新的健康信息。这项研究的一个优势是收集了关于不孕不育原因的详细信息。这种HASL能够分析特定的内分泌异常如何与癌症风险相关。此外，还进行了分析，以确定是否与促排卵药物有关。在与丹麦调查人员合作进行的另一项调查中，对使用促排卵药物后怀孕的儿童的癌症风险进行了评估。初步分析显示，儿童患癌症的风险没有变化。 许多医疗条件被认为是乳腺癌、子宫内膜癌和卵巢癌风险的诱因，但这些研究中的大多数都依赖于患者对这些既往疾病的报告。为了更准确地了解这些既往疾病的性质，我们在丹麦进行了一项大型病例队列研究，其中包括查阅医疗记录中包含的条件的详细信息。正在进行的分析正在根据先前诊断的细节评估癌症风险的关系。

A major emphasis of this project has been to define the relationship of exogenous hormones to subsequent cancer risk. Using a similar approach as had been used to examine the effects of exogenous hormones on breast cancer risk, analyses within the context of a large screening program showed an association of menopausal hormone use with the risk of ovarian cancer. These analyses showed risk to increase with years of use of hormones, particularly when the preparation used was unopposed estrogens. Relationships with endometrial cancer are being pursued with additional follow-up data. Also of interest is the relationship of breast implants to subsequent cancer risk. Breast cancer risk has been of concern, given that breast implants can interfere with the mammographic visualization of lesions. However, in a large retrospective study that we conducted, we found no evidence for an alteration in breast cancer risk. These patients also generally did not experience alterations in other cancer sites, although elevations were observed in the risk of lung and brain cancers, the explanation for which remains unclear. In a mortality analysis, implant patients had signficantly elevated risks of death from suicide, but other causes of death were similar to the general population. Currently underway are analyses of risk of connective tissue diseases related to breast implants. In addition, we are continuing to follow the cohort for mortality to determine whether previously observed patterns persist. A retrospective cohort study is also being conducted to examine the effects on cancer risk of different causes of infertility and of different associated therapies. This study involves detailed abstraction of medical records of patients diagnosed as long ago as the 1960's and administration of questionnaires to obtained updated health information. A strength of the study is the detailed information collected on causes of infertility. This hasl enabled analyses related to how specific endocrinologic abnormalities relate to cancer risk. In addition, analyses have been undertaken to determine whether there is a link with ovulation-stimulating drugs. In a separate investigation, conducted in collaboration with investigators in Denmark, cancer risk among children conceived following use of ovulation-stimulating drugs has been assessed. Preliminary analyses show no alteration in childhood cancer risk. A number of medical conditions have been suggested as predisposing to the risk of breast, endometrial and ovarian cancers, but most of these studies have relied on patients reports of these prior conditions. To obtain more precise information on the nature of these prior medical conditions, we have conducted a large case-cohort study in Denmark that involves access to details of the conditions as contained in medical records. Ongoing analyses are assessing relationships of cancer risk according to details of the prior diagnoses.