Jensen Allan, Sharif Heidi, Olsen Jørgen H, Kjaer Susanne Krüger
Institute of Cancer Epidemiology, Danish Cancer Society, Copenhagen, Denmark.
Am J Epidemiol. 2008 Jul 1;168(1):49-57. doi: 10.1093/aje/kwn094. Epub 2008 Apr 29.
Infertility is considered to influence the risk of breast cancer and gynecologic cancers. To assess this association, the authors used data from a large cohort of 54,362 women with a diagnosis of infertility who were referred to Danish fertility clinics between 1963 and 1998. Through 2003, 1,975 cancers were identified by linkage to the Danish Cancer Registry. Cancer risk was assessed through standardized incidence ratios (SIRs) and corresponding 95% confidence intervals, using general and parity-specific cancer incidence rates in the general population of Denmark as a reference. After adjustment for parity status, significantly increased SIRs were observed for breast (SIR = 1.08, 95% confidence interval: 1.01, 1.16) and ovarian (SIR = 1.46, 95% confidence interval: 1.24, 1.71) cancer. The risk of breast cancer increased with follow-up time. Similar risk patterns were observed for the different histologic types of breast cancer and all nonmucinous types of ovarian cancer, whereas the risk of mucinous ovarian cancers seemed not to be increased. These data thus suggest higher risks of breast and ovarian cancer among infertile women. However, since these results could not distinguish the effects of underlying infertility from the effects of fertility treatment, additional studies are needed to disentangle the effects of these two factors.
不孕症被认为会影响患乳腺癌和妇科癌症的风险。为评估这种关联,作者使用了来自一大群54362名被诊断为不孕症女性的数据,这些女性在1963年至1998年间被转诊至丹麦的生育诊所。到2003年,通过与丹麦癌症登记处的数据关联,共识别出1975例癌症病例。癌症风险通过标准化发病比(SIRs)及相应的95%置信区间进行评估,以丹麦普通人群的总体及按生育状况分类的癌症发病率作为参照。在对生育状况进行调整后,观察到乳腺癌(SIR = 1.08,95%置信区间:1.01,1.16)和卵巢癌(SIR = 1.46,95%置信区间:1.24,1.71)的SIRs显著升高。乳腺癌风险随随访时间增加。对于不同组织学类型的乳腺癌以及所有非黏液性卵巢癌,观察到类似的风险模式,而黏液性卵巢癌的风险似乎并未增加。因此,这些数据表明不孕女性患乳腺癌和卵巢癌的风险更高。然而,由于这些结果无法区分潜在不孕症的影响与生育治疗的影响,需要进一步研究以厘清这两个因素的影响。