Grevers Xin, Grundy Anne, Poirier Abbey E, Khandwala Farah, Feldman Matthew, Friedenreich Christine M, Brenner Darren R
Department of Cancer Epidemiology and Prevention Research (Grevers, Grundy, Poirier, Khandwala, Feldman, Friedenreich, Brenner), CancerControl Alberta, Alberta Health Services; Department of Oncology and Department of Community Health Sciences (Friedenreich, Brenner), Cumming School of Medicine, University of Calgary, Calgary, Alta.
CMAJ Open. 2016 Dec 12;4(4):E754-E759. doi: 10.9778/cmajo.20160046. eCollection 2016 Oct-Dec.
Hormonal contraceptives and hormone replacement therapies are classified as carcinogenic to humans (group 1) by the International Agency for Research on Cancer. We sought to estimate the proportion and total number of cancers attributable to the use of oral contraceptives and hormone therapy in Alberta in 2012.
Population attributable risks were used to estimate the proportion of attributable cases for each associated cancer site. Relative risk estimates were obtained from the most relevant and recent epidemiologic literature. Prevalences of the use of oral contraceptives and hormone therapy in Alberta were collected from Alberta's Tomorrow Project. Specific cancer incidence data were obtained from the Alberta Cancer Registry for the year 2012.
Overall, 6.3% of breast cancers ( = 135) diagnosed in Alberta in 2012 were estimated to be attributable to the use of oral contraceptives, and the exposure potentially prevented about 57.3% of endometrial cancers ( = 276) and 29.1% of ovarian cancers ( = 52). About 15.5% of breast cancers ( = 258) and 8.9% of ovarian cancers ( = 13) were estimated to be attributable to the use of hormone therapy, whereas 11.3% of endometrial cancers ( = 48) were possibly prevented by the exposure.
Based on our estimates, oral contraceptive use resulted in a net protective effect among the cancer sites studied, thus reducing the cancer burden in Alberta in 2012. The use of hormone therapy was estimated to increase the cancer burden in the province, therefore the risk and benefit of hormone therapy should be carefully considered before use.
激素避孕药和激素替代疗法被国际癌症研究机构列为对人类致癌（第1组）。我们试图估算2012年艾伯塔省因使用口服避孕药和激素疗法导致的癌症比例及总数。
采用人群归因风险来估算每个相关癌症部位的归因病例比例。相对风险估计值来自最相关和最新的流行病学文献。艾伯塔省口服避孕药和激素疗法的使用流行率从艾伯塔省明日项目中收集。2012年特定癌症发病率数据从艾伯塔癌症登记处获取。
总体而言，2012年在艾伯塔省诊断出的乳腺癌中，估计有6.3%（n = 135）可归因于口服避孕药的使用，这种暴露可能预防了约57.3%的子宫内膜癌（n = 276）和29.1%的卵巢癌（n = 52）。估计约15.5%的乳腺癌（n = 258）和8.9%的卵巢癌（n = 13）可归因于激素疗法的使用，而11.3%的子宫内膜癌（n = 48）可能因这种暴露而得到预防。
根据我们的估计，口服避孕药的使用在所研究的癌症部位产生了净保护作用，从而降低了2012年艾伯塔省的癌症负担。激素疗法的使用估计会增加该省的癌症负担，因此在使用激素疗法之前应仔细考虑其风险和益处。
