Ness R B, Grisso J A, Cottreau C, Klapper J, Vergona R, Wheeler J E, Morgan M, Schlesselman J J
Graduate School of Public Health, University of Pennsylvania, Pittsburgh 15261, USA.
Epidemiology. 2000 Mar;11(2):111-7. doi: 10.1097/00001648-200003000-00006.
Previous epidemiologic observations consistently suggest that suppression of ovulation, tubal ligation, and hysterectomy reduce the risk of ovarian cancer and that perineal talc use increases the risk. We examined these and other risk factors in the context of a new hypothesis: that inflammation may play a role in ovarian cancer risk. Ovulation entails ovarian epithelial inflammation; talc, endometriosis, cysts, and hyperthyroidism may be associated with inflammatory responses of the ovarian epithelium; gynecologic surgery may preclude irritants from reaching the ovaries via ascension from the lower genital tract. We evaluated these risk factors in a population-based case-control study. Cases 20-69 years of age with a recent diagnosis of epithelial ovarian cancer (767) were compared with community controls (1,367). We found that a number of reproductive and contraceptive factors that suppress ovulation, including gravidity, breast feeding, and oral contraception, reduced the risk of ovarian cancer. Environmental factors and medical conditions that increased risk included talc use, endometriosis, ovarian cysts, and hyperthyroidism. Gynecologic surgery including hysterectomy and tubal ligation were protective. Tubal ligation afforded a risk reduction even 20 or more years after the surgery. The spectrum of associations provides support for the hypothesis that inflammation may mediate ovarian cancer risk.
以往的流行病学观察结果一致表明，抑制排卵、输卵管结扎和子宫切除术可降低卵巢癌风险，而会阴部使用滑石粉则会增加风险。我们在一个新的假说背景下研究了这些及其他风险因素：炎症可能在卵巢癌风险中起作用。排卵会引发卵巢上皮炎症；滑石粉、子宫内膜异位症、囊肿和甲状腺功能亢进可能与卵巢上皮的炎症反应有关；妇科手术可能会阻止刺激物从下生殖道上行至卵巢。我们在一项基于人群的病例对照研究中评估了这些风险因素。将20至69岁近期诊断为上皮性卵巢癌的病例（767例）与社区对照（1367例）进行比较。我们发现，一些抑制排卵的生殖和避孕因素，包括妊娠、母乳喂养和口服避孕药，可降低卵巢癌风险。增加风险的环境因素和医疗状况包括使用滑石粉、子宫内膜异位症、卵巢囊肿和甲状腺功能亢进。包括子宫切除术和输卵管结扎在内的妇科手术具有保护作用。输卵管结扎即使在手术后20年或更长时间也能降低风险。这些关联情况为炎症可能介导卵巢癌风险这一假说提供了支持。
