Rohan T E, Miller A B
Department of Public Health Sciences, University of Toronto, Canada.
Int J Cancer. 1999 Jul 19;82(2):191-6. doi: 10.1002/(sici)1097-0215(19990719)82:2<191::aid-ijc7>3.0.co;2-f.
The purpose of the cohort study reported here was to investigate the association between oral contraceptive use and risk of benign breast disease (BBD), overall and by histological subtype, within the 56,537 women in the Canadian National Breast Screening Study (NBSS) who completed self-administered lifestyle and dietary questionnaires. The NBSS is a randomized controlled trial of screening for breast cancer in women aged 40-59 at recruitment. Cases were the 2,116 women in the dietary cohort who were diagnosed with biopsy-confirmed incident BBD. For comparative purposes, a subcohort consisting of a random sample of 5,681 women (including 197 subjects with incident BBD) was selected from the full dietary cohort. After exclusions for various reasons, the analyses were based on 2,116 cases and 5,338 non-cases. There was an inverse association between use of oral contraceptives and risk of all types of BBD combined. The reduction in risk was confined largely to proliferative forms of BBD (BPED), and in particular, to those forms of BPED without histological atypia, in whom there was a progressive reduction in risk with increasing duration of use (the IRR (95% CI) for use of more than 7 years was 0.64 (0.47-0.87)); risk of BPED with atypia was increased somewhat in association with oral contraceptive use (the IRR (95% CI) for use of more than 7 years was 1.43 (0.68-3.01 )), but not in a dose-dependent manner. The results were similar when examined separately in the screened and control arms of the NBSS and for screen-detected and interval-detected BPED.
本文所报告的队列研究旨在调查在加拿大全国乳腺筛查研究（NBSS）中完成自我管理的生活方式和饮食问卷的56,537名女性中，口服避孕药的使用与良性乳腺疾病（BBD）风险之间的总体关联以及按组织学亚型划分的关联。NBSS是一项针对招募时年龄在40 - 59岁女性的乳腺癌筛查随机对照试验。病例为饮食队列中2116名经活检确诊为新发BBD的女性。为作比较，从整个饮食队列中选取了一个由5681名女性组成的子队列（包括197名新发BBD受试者）。在因各种原因排除后，分析基于2116例病例和5338例非病例。口服避孕药的使用与所有类型BBD合并风险之间存在负相关。风险降低主要局限于增殖性BBD（BPED）形式，特别是那些无组织学异型性的BPED形式，其风险随着使用时间延长而逐渐降低（使用超过7年的IRR（95%CI）为0.64（0.47 - 0.87））；有异型性的BPED风险在一定程度上因口服避孕药的使用而增加（使用超过7年的IRR（95%CI）为1.43（0.68 - 3.01）），但并非呈剂量依赖性。在NBSS的筛查组和对照组以及筛查发现和间隔期发现的BPED中分别进行检查时，结果相似。
