Kottler M L, Gorins A
Centre des Maladies du Sein, Hôpital Saint-Louis, Paris.
Rev Fr Gynecol Obstet. 1991 Jan;86(1):21-6.
The role of oral contraceptives in the development of breast cancer has given rise and still gives rise to many debates, accentuated by the economic and social impact of contraception. Several problems can the brought forward: can oral contraceptives (OC) play a role in the development of breast cancer? Can they aggravate it? Can they prevent it? We have various means at our disposal to help us in answering those difficult questions: fundamental studies, mechanisms of action of steroid hormones in the development of the mammary gland, comprehension of the mechanisms of carcinogenesis, epidemiological studies which enable us to define the notion of relative risk. At present, there is no emergence of the notion of an aggravation of the risk of breast cancer linked with the intake of oral contraceptives. However, it must be reminded that the use of oral contraceptives is still recent if we take into account the existence of a latency period before an eventual harmful effect appears and the fact that the oestro-progestative compositions have been greatly modified in those last few years. However, the present studies are centred on the populations said to be "at risk". The results of studies on women who have taken an OC before their first pregnancy or before the age of 25 still remain contradictory. Those of women with a family history of breast cancer or hyperplastic lesions are reassuring but need to be confirmed. Finally, a protective effect of a contraceptive composition is yet to be demonstrated.
口服避孕药在乳腺癌发生发展中的作用已经引发且仍在引发诸多争论，避孕措施所产生的经济和社会影响更是加剧了这些争论。可以提出几个问题：口服避孕药（OC）会在乳腺癌发生中起作用吗？会使其恶化吗？能预防乳腺癌吗？我们有多种方法可用于帮助回答这些难题：基础研究、甾体激素在乳腺发育中的作用机制、对致癌机制的理解、能让我们界定相对风险概念的流行病学研究。目前，尚未出现与口服避孕药摄入相关的乳腺癌风险增加的概念。然而，必须提醒的是，如果考虑到在最终有害影响出现前存在潜伏期以及近年来雌孕激素成分已大幅改变这一事实，口服避孕药的使用时间仍较短。不过，目前的研究集中在所谓“有风险”的人群。对在首次怀孕前或25岁前服用过OC的女性的研究结果仍然相互矛盾。对有乳腺癌家族史或增生性病变女性的研究结果令人安心，但仍需得到证实。最后，一种避孕成分的保护作用仍有待证实。
