Metabolic Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, NIH, DHHS, 9609 Medical Center Drive, Bethesda, MD, 20892-9774, USA.
University of Virginia School of Medicine, Charlottesville, VA, USA.
Cancer Causes Control. 2021 Jun;32(6):587-595. doi: 10.1007/s10552-021-01410-8. Epub 2021 Mar 10.
Since the 1960s, increasing oral contraceptive (OC) use has mirrored decreasing ovarian cancer incidence. The impact of intrauterine devices (IUDs) on cancer risk is less well established. With improved access and increased options, we must consider how changing usage can affect cancer risks.
Nationally representative data from the National Health and Nutrition Examination Survey (NHANES, 1999-2016) and the National Survey for Family Growth (NSFG, 2006-2017) were used to evaluate contraceptive use over time in premenopausal women (NHANES n = 13,179; NSFG n = 26,262). Trends were assessed overall and by race, age, pregnancy history, education, and body mass index.
The average annual absolute increase in self-reported IUD use was 0.81% (NSFG), while OC use decreased 0.49% in NSFG and 0.47% in NHANES. This represents a significant decrease in OC use in NSFG [annual percent change (APC) - 2.2% (95% CI - 3.4, - 1.0%), p < 0.01]. Trends in OC use varied somewhat by pregnancy history in NHANES (p-interaction = 0.054). In contrast, IUD use increased 6.2% annually [(1.4, 11.2%), p = 0.03] and varied significantly by pregnancy history (p-interaction < 0.01). Nulligravid women increased IUD use 11.0% annually [(2.6, 20.1%), p = 0.02] compared to women with prior pregnancy at 5.2% [(0.4, 10.2%), p = 0.04]. In 2015-2017, IUD use was 76.5% hormonal (71.1, 81.8%) and 22.9% copper (17.4, 28.3%) with greater hormonal IUD use in obese women [89.4%, (82.9, 95.9%)].
Increasing IUD use outpaced declining OC use in premenopausal US women. There may be a resulting decreased gynecologic cancer risk as more women gain access to potentially risk-reducing contraceptives.
自 20 世纪 60 年代以来，口服避孕药（OC）的使用增加与卵巢癌发病率的下降相吻合。宫内节育器（IUD）对癌症风险的影响则不太明确。随着可及性的提高和选择的增加，我们必须考虑使用方式的变化如何影响癌症风险。
利用全国健康和营养调查（NHANES，1999-2016 年）和全国家庭成长调查（NSFG，2006-2017 年）的全国代表性数据，评估绝经前妇女（NHANES n=13179；NSFG n=26262）中避孕方法的随时间变化情况。通过种族、年龄、妊娠史、教育程度和体重指数对趋势进行了评估。
自我报告的 IUD 使用的平均年绝对增长率为 0.81%（NSFG），而 OC 的使用在 NSFG 中减少了 0.49%，在 NHANES 中减少了 0.47%。这代表着 NSFG 中 OC 使用的显著减少[年度百分比变化（APC）-2.2%（95%CI-3.4，-1.0%），p<0.01]。NHANES 中，OC 使用的趋势因妊娠史而异（p 交互作用=0.054）。相比之下，IUD 的使用每年增加 6.2%[(1.4，11.2%)，p=0.03]，且因妊娠史而异（p 交互作用<0.01）。与有过妊娠史的妇女相比，初产妇的 IUD 使用量每年增加 11.0%[(2.6，20.1%)，p=0.02]，而有过妊娠史的妇女则增加 5.2%[(0.4，10.2%)，p=0.04]。2015-2017 年，IUD 的使用率为 76.5%（71.1，81.8%）为激素型，22.9%（17.4，28.3%）为铜型，肥胖女性中激素型 IUD 的使用率更高[89.4%（82.9，95.9%）]。
美国绝经前妇女中 IUD 的使用增加速度超过了 OC 使用的下降速度。随着更多女性获得潜在的降低癌症风险的避孕方法，可能会降低妇科癌症的风险。
