Wu M L, Whittemore A S, Paffenbarger R S, Sarles D L, Kampert J B, Grosser S, Jung D L, Ballon S, Hendrickson M, Mohle-Boetani J
Department of Health Research and Policy, Stanford University School of Medicine, CA.
Am J Epidemiol. 1988 Dec;128(6):1216-27. doi: 10.1093/oxfordjournals.aje.a115076.
In two case-control studies conducted in the six-county San Francisco Bay Area, 111 women diagnosed with epithelial ovarian carcinoma in 1974-1977 and 188 women diagnosed in 1983-1985 were interviewed concerning their menstrual, sexual, and reproductive histories. For comparison, interviews were conducted with 752 control women admitted to the same hospitals within six months of the cases; for cases diagnosed in the later period, interviews were also conducted with an additional 259 population-based controls selected by random digit dialing. Controls were matched to cases by age and race. Qualitative and quantitative findings were similar for the two studies. In the combined data, cases were more likely than their matched controls to have been nulliparous, to have undergone menarche at an early age, and to have refrained from using oral contraceptives. Menopause occurred slightly later for cases than for controls, but the differences were not statistically significant. Neither age at first term pregnancy (20 or more weeks gestation) nor number of term pregnancies was predictive of ovarian cancer risk. The protection afforded by oral contraceptive use was independent of parity, and it increased with increasing duration of use. There were no trends in risk with time since last oral contraceptive use or with time since first use, after adjustment for duration of use. These observations suggest that oral contraceptive use decreases risk for ovarian cancer, rather than merely indicates fertility, which may itself decrease risk of developing the disease. The authors combined reproductive characteristics and oral contraceptive use to estimate a woman's total duration of ovulation, which was positively associated with ovarian cancer risk (p less than 0.001 for trend). These observations support the concept that the greater the duration of ovulation or accompanying endocrinologic phenomena, the greater a woman's risk for ovarian cancer.
在旧金山湾区六县开展的两项病例对照研究中，对1974年至1977年确诊为上皮性卵巢癌的111名女性以及1983年至1985年确诊的188名女性进行了访谈，询问她们的月经、性和生殖史。作为对照，对在病例确诊后六个月内入住同一家医院的752名对照女性进行了访谈；对于后期确诊的病例，还对另外259名通过随机数字拨号选取的社区对照进行了访谈。对照按年龄和种族与病例匹配。两项研究的定性和定量结果相似。在合并数据中，病例比匹配的对照更有可能未生育、初潮年龄早且未使用口服避孕药。病例的绝经时间比对照略晚，但差异无统计学意义。首次足月妊娠（妊娠20周或更长时间）的年龄和足月妊娠次数均不能预测卵巢癌风险。使用口服避孕药提供的保护与生育状况无关，且随着使用时间的延长而增加。在调整使用时间后，自上次使用口服避孕药以来的时间或自首次使用以来的时间与风险均无趋势关系。这些观察结果表明，使用口服避孕药可降低卵巢癌风险，而不仅仅是表明生育能力，生育能力本身可能会降低患该病的风险。作者综合生殖特征和口服避孕药的使用情况来估计女性的总排卵时间，总排卵时间与卵巢癌风险呈正相关（趋势p值小于0.001）。这些观察结果支持了这样一种概念，即排卵或伴随的内分泌现象持续时间越长，女性患卵巢癌的风险就越大。
