La Vecchia C, Franceschi S, Bruzzi P, Parazzini F, Boyle P
Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy.
Drug Saf. 1990 Nov-Dec;5(6):436-46. doi: 10.2165/00002018-199005060-00004.
An overview of the available epidemiological evidence on the connection between oral contraceptives and cancer or vascular disease is presented, including the observation that epidemiological studies have produced important indications for changing both the composition and prescription patterns of oral contraceptives to avoid a large proportion of vascular side effects. Further, the evidence is remarkably clear and consistent in relation to the elevated risks of cervical neoplasms and, although based on a limited number of small studies, of primary liver cancer; protection against endometrial and ovarian cancers up to middle age; and the absence of association with malignant melanoma. There are still uncertainties regarding breast cancer, mainly related to the role of time factors, and the potential persisting risk related to long term use at younger age: published studies, in fact, show elevated risks for long term use in women below age 35 or perhaps up to age 45, but no evidence of association in middle age. Since breast cancer and ovarian cancer account for most of the mortality burden in women up to age 50 or 55 in developed countries, a clarification of the risk relationship for these 2 neoplasms will determine most of the quantitative evaluation on positive or adverse effects of oral contraceptives. The impact of other neoplasms and of cardiovascular disease, on the basis of current oral contraceptive composition, is comparatively limited, if not negligible.
本文概述了口服避孕药与癌症或血管疾病之间关联的现有流行病学证据,包括观察到流行病学研究已产生重要迹象,表明需要改变口服避孕药的成分和处方模式,以避免大部分血管副作用。此外,关于宫颈癌风险升高的证据非常明确且一致,虽然原发性肝癌的证据基于少数小型研究;在中年之前可预防子宫内膜癌和卵巢癌;且与恶性黑色素瘤无关联。乳腺癌方面仍存在不确定性,主要与时间因素的作用以及年轻时长期使用可能存在的持续风险有关:事实上,已发表的研究表明,35岁以下或可能直至45岁的女性长期使用口服避孕药风险升高,但中年女性无关联证据。由于在发达国家,乳腺癌和卵巢癌占50岁或55岁以下女性死亡负担的大部分,明确这两种肿瘤的风险关系将决定口服避孕药正效应或负效应的大部分定量评估。基于目前口服避孕药的成分,其他肿瘤和心血管疾病的影响相对有限,甚至可以忽略不计。