Woolen Sean A, Lazar Ann A, Smith-Bindman Rebecca
Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, USA.
Department of Preventive and Restorative Dental Sciences, University of California San Francisco, San Francisco, USA.
J Gen Intern Med. 2022 Aug;37(10):2526-2532. doi: 10.1007/s11606-022-07414-7. Epub 2022 Feb 2.
Risk of ovarian cancer in women with frequent perineal talcum powder product is not well understood. Prior systematic reviews focused on ever use. The purpose of this study is to estimate the association between frequent (at least 2 times per week) perineal talcum powder use and ovarian cancer.
A systematic review and meta-analysis was conducted according to meta-analysis of observational studies in epidemiology guidelines. Study protocol was prospectively registered at PROSPERO (registration number CRD42020172720). Searches were performed in PubMed, Embase, Web of Science, and Cochrane Central Register of Controlled Trials databases from their inception to August 2, 2021. Case-control and cohort studies were included if they reported frequent perineal talcum powder use and an adjusted odds ratio or hazard ratio for ovarian cancer. Review for inclusion, data extraction, and quality assessment (using the Newcastle-Ottawa Scale [NOS]) were performed independently by two reviewers. Pooled adjusted odds ratios with 95% confidence intervals were generated from the random effects model. Heterogeneity was quantified with I statistic. Funnel plot and Eger's test were performed to assess publication bias. Subgroup and sensitivity analyses were performed for testing the robustness of the overall findings.
Initial database searches returned 761 unique citations and after review, eleven studies describing 66,876 patients, and 6542 cancers were included (Cohen's κ = 0.88). Publication quality was high (median NOS = 8, range: 4 to 9). Frequent talcum powder use was associated with an elevated risk of ovarian cancer (adjusted pooled summary odds ratio 1.47 (95% CI 1.31, 1.65, P<0.0001). There was no evidence of bias and low heterogeneity (I= 24%, P=0.22). There was no meaningful difference limiting analysis to publications with a NOS quality score of 8 or 9 or limiting studies based on study design.
This review suggests an increased risk of ovarian cancer associated with frequent perineal powder exposure of 31-65%.
经常使用会阴滑石粉产品的女性患卵巢癌的风险尚未得到充分了解。先前的系统评价关注的是曾经使用过的情况。本研究的目的是评估频繁（每周至少2次）使用会阴滑石粉与卵巢癌之间的关联。
根据流行病学观察性研究的荟萃分析指南进行系统评价和荟萃分析。研究方案已在国际前瞻性系统评价注册库（PROSPERO）前瞻性注册（注册号CRD42020172720）。从各数据库建库至2021年8月2日，在PubMed、Embase、科学网和Cochrane对照试验中心注册库中进行检索。纳入报告了频繁使用会阴滑石粉以及卵巢癌调整后比值比或风险比的病例对照研究和队列研究。两名评价员独立进行纳入审查、数据提取和质量评估（使用纽卡斯尔-渥太华量表[NOS]）。采用随机效应模型生成合并调整后比值比及95%置信区间。用I统计量对异质性进行量化。绘制漏斗图并进行Egger检验以评估发表偏倚。进行亚组分析和敏感性分析以检验总体研究结果的稳健性。
初步数据库检索返回761条独特引文，经审查后，纳入了11项研究，共涉及66876例患者和6542例癌症病例（Cohen's κ = 0.88）。发表质量较高（NOS中位数 = 8，范围：4至9）。频繁使用滑石粉与卵巢癌风险升高相关（调整后合并汇总比值比为1.47（95%CI 1.31, 1.65，P<0.0001）。没有证据表明存在偏倚，异质性较低（I = 24%，P = 0.22）。将分析限制在NOS质量评分8或9的出版物或根据研究设计限制研究，没有发现有意义的差异。
本综述表明，频繁会阴接触滑石粉会使卵巢癌风险增加31%-65%。
