Department of Traditional Chinese Medicine, Beijing Hospital, National Center of Gerontology, Beijing, P.R.China.
Center for Evidence-based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, P.R.China.
PLoS One. 2020 Mar 5;15(3):e0229899. doi: 10.1371/journal.pone.0229899. eCollection 2020.
To investigate that whether an association between marital status and the female breast cancer risk exists.
The MEDLINE, EMBASE and PsycINFO databases were searched from their inception to July 2019. The Newcastle-Ottawa Scale was used to rate the methodological quality of included studies. Study data were pooled using random-effects meta-analyses to compare the breast cancer risk between unmarried, widowed, divorced or lifelong single women and married women. This study is registered with PROSPERO (number CRD42018112368).
Forty-nine publications were included in the meta-analysis. Compared with married women, unmarried and lifelong single women had an elevated risk of breast cancer, and the pooled ORs of case-control studies were 1.20 (95% CI: 1.07 to 1.35) and 1.24 (95% CI: 1.05 to 1.45), respectively. In the subgroup analyses under these two comparisons, hospital-based estimates and multivariate-adjusted estimates demonstrated a strong association, while population-based estimates and age-adjusted estimates produced nonsignificant results. The pooled OR of cohort studies examining the effect of being a lifelong single woman was 1.10 (95% CI: 1.04 to 1.16). Heterogeneity was moderate to substantial across case-control studies (I2: 46% to 82%), which may be partially explained by differences in geographic regions, publication years and control types. Possible publication bias was indicated by the funnel plot and Egger's test (P = 0.03).
Marital status may correlate with the risk of developing female breast cancer. However, suboptimal selection of controls, insufficient exploration of confounding effects, inadequate ascertainment of marital status, and possible publication bias may have limited the quality of the available evidence. Overall, conclusions that marital status is an independent risk factor for breast cancer could not be drawn, and further prospective rigorous cohort studies are warranted.
探讨婚姻状况与女性乳腺癌风险之间是否存在关联。
检索 MEDLINE、EMBASE 和 PsycINFO 数据库，检索时间从建库至 2019 年 7 月。使用纽卡斯尔-渥太华量表（Newcastle-Ottawa Scale）对纳入研究的方法学质量进行评分。采用随机效应荟萃分析比较未婚、丧偶、离婚或终身单身女性与已婚女性的乳腺癌风险。本研究已在 PROSPERO（注册号：CRD42018112368）注册。
共有 49 篇文献纳入荟萃分析。与已婚女性相比，未婚和终身单身女性乳腺癌发病风险升高，病例对照研究的汇总 OR 分别为 1.20（95%CI：1.07 至 1.35）和 1.24（95%CI：1.05 至 1.45）。在这两种比较的亚组分析中，基于医院的估计和多变量调整的估计显示出较强的相关性，而基于人群的估计和年龄调整的估计则无显著相关性。研究终身单身女性影响的队列研究的汇总 OR 为 1.10（95%CI：1.04 至 1.16）。病例对照研究的异质性为中度至高度（I2：46% 至 82%），这可能部分归因于地理区域、发表年份和对照类型的差异。漏斗图和 Egger 检验提示可能存在发表偏倚（P = 0.03）。
婚姻状况可能与女性乳腺癌发病风险相关。然而，对照选择不当、混杂因素影响未充分探讨、婚姻状况确定不充分以及可能存在发表偏倚，可能限制了现有证据的质量。总体而言，不能得出婚姻状况是乳腺癌独立危险因素的结论，需要进一步开展前瞻性严格的队列研究。
