Brinton Louise A, Krüger Kjaer Susanne, Thomsen Birthe L, Sharif Heidi F, Graubard Barry I, Olsen Jørgen H, Bock Johannes E
Division of Cancer Epidemiology, National Cancer Institute, Bethesda, Maryland, USA.
Fertil Steril. 2004 Apr;81(4):1083-91. doi: 10.1016/j.fertnstert.2003.08.042.
To assess childhood cancer risk among children conceived following the use of ovulation-stimulating drugs.
Record linkage study.
Infertility patients and their offspring as identified through medical records.
PATIENT(S): Cohort of 30,364 Danish women evaluated for infertility beginning in the early 1960s.
MAIN OUTCOME MEASURE(S): Standardized incidence ratios (SIRs) compared cancer incidence in the children to the Danish population. Case-cohort techniques calculated rate ratios (RRs) according to prior maternal drug exposures.
RESULT(S): A total of 51 cancers were identified among the study children, resulting in an SIR of 1.14 (95% confidence interval [CI] 0.8-1.5). Usage of any fertility drug was associated with an RR of 0.82 (95% CI 0.4-1.6) and clomiphene citrate with an RR of 0.77 (95% CI 0.4-1.6). Tumors occurring early in life and nonhematopoietic malignancies (including neuroblastomas) were not associated with drug usage. Nonsignificant elevations in the risk of cancers occurring later in life, especially childhood hematopoietic malignancies (RR for use of any ovulation-stimulating drugs of 2.30, 95% CI 0.8-6.6), may have been related to underlying reasons for medication usage.
CONCLUSION(S): Although the findings of this study are reassuring, additional adequately powered studies should continue monitoring the effects of ovulation-stimulating drugs on specific tumors, including hematopoietic malignancies.
评估使用促排卵药物后受孕儿童患癌症的风险。
记录链接研究。
通过病历识别的不孕症患者及其后代。
自20世纪60年代初开始接受不孕症评估的30364名丹麦女性队列。
标准化发病比（SIRs），将儿童癌症发病率与丹麦人群进行比较。病例队列技术根据母亲先前的药物暴露情况计算率比（RRs）。
在研究儿童中总共发现了51例癌症，标准化发病比为1.14（95%置信区间[CI]0.8 - 1.5）。使用任何生育药物的率比为0.82（95%CI 0.4 - 1.6），枸橼酸氯米芬的率比为0.77（95%CI 0.4 - 1.6）。早年发生的肿瘤和非造血系统恶性肿瘤（包括神经母细胞瘤）与药物使用无关。晚年发生的癌症风险有非显著性升高，尤其是儿童造血系统恶性肿瘤（使用任何促排卵药物的率比为2.30，95%CI 0.8 - 6.6），这可能与用药的潜在原因有关。
尽管本研究结果令人安心，但更多有足够效力的研究应继续监测促排卵药物对特定肿瘤（包括造血系统恶性肿瘤）的影响。
