UCL Great Ormond Street Institute of Child Health, London, UK.
Institute of Cancer Research, London, UK.
BMJ. 2018 Jul 11;362:k2644. doi: 10.1136/bmj.k2644.
To investigate the risks of ovarian, breast, and corpus uteri cancer in women who have had assisted reproduction.
Large, population based, data linkage cohort study.
All women who had assisted reproduction in Great Britain, 1991-2010, as recorded by the Human Fertilisation and Embryology Authority (HFEA).
HFEA fertility records for cohort members were linked to national cancer registrations.
Observed first diagnosis of ovarian, breast, and corpus uteri cancer in cohort members were compared with age, sex, and period specific expectation. Standardised incidence ratios (SIRs) were calculated by use of age, sex, and period specific national incidence rates.
255 786 women contributed 2 257 789 person years' follow-up. No significant increased risk of corpus uteri cancer (164 cancers observed 146.9 cancers expected; SIR 1.12, 95% confidence interval 0.95 to 1.30) was found during an average of 8.8 years' follow-up. This study found no significantly increased risks of breast cancer overall (2578 2641.2; SIR 0.98, 0.94 to 1.01) or invasive breast cancer (2272 2371.4; SIR 0.96, 0.92 to 1.00). An increased risk of in situ breast cancer (291 253.5; SIR 1.15, 1.02 to 1.29; absolute excess risk (AER) 1.7 cases per 100 000 person years, 95% confidence interval 0.2 to 3.2) was detected, associated with an increasing number of treatment cycles (P=0.03). There was an increased risk of ovarian cancer (405 291.82; SIR 1.39, 1.26 to 1.53; AER 5.0 cases per 100 000 person years, 3.3 to 6.9), both invasive (264 188.1; SIR 1.40, 1.24 to 1.58; AER 3.4 cases per 100 000 person years, 2.0 to 4.9) and borderline (141 103.7; SIR 1.36, 1.15 to 1.60; AER 1.7 cases per 100 000 person years, 0.7 to 2.8). Increased risks of ovarian tumours were limited to women with endometriosis, low parity, or both. This study found no increased risk of any ovarian tumour in women treated because of only male factor or unexplained infertility.
No increased risk of corpus uteri or invasive breast cancer was detected in women who had had assisted reproduction, but increased risks of in situ breast cancer and invasive and borderline ovarian tumours were found in this study. Our results suggest that ovarian tumour risks could be due to patient characteristics, rather than assisted reproduction itself, although both surveillance bias and the effect of treatment are also possibilities. Ongoing monitoring of this population is essential.
探讨辅助生殖女性的卵巢癌、乳腺癌和子宫体癌风险。
大型基于人群的数据分析链接队列研究。
英国所有接受过辅助生殖的女性，1991-2010 年，由人类受精和胚胎管理局（HFEA）记录。
对队列成员的 HFEA 生育记录进行了与国家癌症登记的链接。
在队列成员中首次诊断出卵巢癌、乳腺癌和子宫体癌的观察结果与年龄、性别和特定时期的预期进行了比较。使用年龄、性别和特定时期的国家发病率计算标准化发病比（SIR）。
255786 名女性贡献了 2257789 人年的随访。在平均 8.8 年的随访中，未发现子宫体癌风险显著增加（164 例癌症观察到 146.9 例癌症预期；SIR 1.12，95%置信区间 0.95 至 1.30）。本研究未发现总体乳腺癌（2578 例 2641.2 例；SIR 0.98，0.94 至 1.01）或浸润性乳腺癌（2272 例 2371.4 例；SIR 0.96，0.92 至 1.00）的风险显著增加。发现原位乳腺癌的风险增加（291 例 253.5 例；SIR 1.15，1.02 至 1.29；绝对超额风险（AER）每 100000 人年 1.7 例，95%置信区间 0.2 至 3.2），与治疗周期数量的增加相关（P=0.03）。卵巢癌风险增加（405 例 291.82 例；SIR 1.39，1.26 至 1.53；AER 5.0 例每 100000 人年，3.3 至 6.9），包括浸润性（264 例 188.1 例；SIR 1.40，1.24 至 1.58；AER 3.4 例每 100000 人年，2.0 至 4.9）和交界性（141 例 103.7 例；SIR 1.36，1.15 至 1.60；AER 1.7 例每 100000 人年，0.7 至 2.8）。卵巢肿瘤风险的增加仅限于患有子宫内膜异位症、低产次或两者兼有的女性。本研究未发现仅因男性因素或不明原因不孕而接受治疗的女性任何卵巢肿瘤的风险增加。
在接受辅助生殖的女性中，未发现子宫体癌或浸润性乳腺癌的风险增加，但本研究发现原位乳腺癌和浸润性及交界性卵巢肿瘤的风险增加。我们的结果表明，卵巢肿瘤风险可能是由于患者特征，而不是辅助生殖本身，尽管监测偏倚和治疗效果也可能是原因。对这一人群的持续监测至关重要。
