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体外受精对患乳腺癌风险的影响。

In vitro fertilization impact on the risk of breast cancer.

作者信息

Mihai Ana-Maria, Ianculescu Laura Maria, Creţoiu Dragoş, Suciu Nicolae

机构信息

Alessandrescu-Rusescu National Institute for Mother and Child Health, Bucharest, Romania.

Ponderas Academic Hospital, Regina Maria Private Healthcare Network, Bucharest, Romania.

出版信息

Arch Clin Cases. 2024 Oct 9;11(3):73-82. doi: 10.22551/2024.44.1103.10292. eCollection 2024.

DOI:10.22551/2024.44.1103.10292
PMID:39479256
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11520175/
Abstract

Breast cancer, with its increasing incidence and high mortality rates, remains a major global health challenge, significantly impacting individuals, families, and societies. Understanding the multifactorial risk factors contributing to its development is crucial for effective prevention and management. Hormonal factors play a significant role in breast cancer development. Given that ovarian steroid hormones influence breast function, any gonadotropin hormone or fertility drug that stimulates ovulation may also impact breast tissue. Contrary to the findings of studies with smaller sample sizes, concerns have emerged regarding the potential increased risk of breast cancer following in vitro fertilization (IVF) treatments. This article explores the potential risk of breast cancer associated with hormonal cycles during IVF, supported by a literature review and a case study conducted in a tertiary hospital in Bucharest, Romania. The case involves a 38-year-old patient with a history of hormonally treated endometriosis and five IVF cycles, who presented for mammographic and ultrasound screening. The screening revealed multicentric and multifocal BIRADS-5 lesions, with histopathological and immunohistochemical analysis confirming invasive breast carcinoma of no special type with ductal carcinoma in situ, HER2 positive (3+), estrogen receptor and progesterone receptor negative, and a Ki-67 proliferation index of 50%.

摘要

乳腺癌发病率不断上升且死亡率居高不下,仍然是一项重大的全球健康挑战,对个人、家庭和社会都产生了重大影响。了解导致其发生的多因素风险因素对于有效的预防和管理至关重要。激素因素在乳腺癌的发生中起着重要作用。鉴于卵巢甾体激素会影响乳腺功能,任何刺激排卵的促性腺激素或生育药物也可能影响乳腺组织。与样本量较小的研究结果相反,体外受精(IVF)治疗后乳腺癌潜在风险增加的担忧已经出现。本文通过文献综述以及在罗马尼亚布加勒斯特一家三级医院进行的案例研究,探讨了体外受精期间与激素周期相关的乳腺癌潜在风险。该案例涉及一名38岁患者,有激素治疗子宫内膜异位症病史且经历过五次体外受精周期,前来进行乳房X光和超声筛查。筛查发现多中心和多灶性BIRADS-5病变,组织病理学和免疫组织化学分析证实为非特殊类型浸润性乳腺癌伴原位导管癌,HER2阳性(3+),雌激素受体和孕激素受体阴性,Ki-67增殖指数为50%。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/27d7/11520175/29c9d213eb5e/acc-11-03-10292-g007.jpg
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本文引用的文献

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Infertility and risk of postmenopausal breast cancer in the women's health initiative.妇女健康倡议中的不孕与绝经后乳腺癌风险。
Breast Cancer Res Treat. 2024 Jun;205(3):497-506. doi: 10.1007/s10549-024-07257-2. Epub 2024 Mar 9.
2
Fertility treatment and breast-cancer incidence: meta-analysis.生育治疗与乳腺癌发病风险:荟萃分析。
BJS Open. 2022 Jan 6;6(1). doi: 10.1093/bjsopen/zrab149.
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Understanding breast cancer as a global health concern.理解乳腺癌作为一个全球健康问题。
Br J Radiol. 2022 Feb 1;95(1130):20211033. doi: 10.1259/bjr.20211033. Epub 2021 Dec 14.
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Breast Cancer-Epidemiology, Risk Factors, Classification, Prognostic Markers, and Current Treatment Strategies-An Updated Review.乳腺癌——流行病学、危险因素、分类、预后标志物及当前治疗策略——最新综述
Cancers (Basel). 2021 Aug 25;13(17):4287. doi: 10.3390/cancers13174287.
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Past, Present, and Future of Gonadotropin Use in Controlled Ovarian Stimulation During Assisted Reproductive Techniques.促性腺激素在辅助生殖技术控制性卵巢刺激中的过去、现在与未来
Cureus. 2021 Jun 15;13(6):e15663. doi: 10.7759/cureus.15663. eCollection 2021 Jun.
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In-Vitro Fertilization Impact on the Risk of Breast Cancer: A Review Article.体外受精对乳腺癌风险的影响:一篇综述文章。
Iran J Public Health. 2021 Mar;50(3):438-447. doi: 10.18502/ijph.v50i3.5583.
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Advanced Approaches to Breast Cancer Classification and Diagnosis.乳腺癌分类与诊断的先进方法
Front Pharmacol. 2021 Feb 26;11:632079. doi: 10.3389/fphar.2020.632079. eCollection 2020.
8
Mammographic breast density, its changes, and breast cancer risk in premenopausal and postmenopausal women.乳腺 X 线摄影术乳房密度、变化及其与绝经前和绝经后妇女乳腺癌风险的关系。
Cancer. 2020 Nov 1;126(21):4687-4696. doi: 10.1002/cncr.33138. Epub 2020 Aug 7.
9
Cancer in IVF patients treated at age 40 years and older: long term follow-up.40 岁及以上接受体外受精治疗的患者的癌症:长期随访。
Reprod Biomed Online. 2020 Mar;40(3):369-373. doi: 10.1016/j.rbmo.2019.11.015. Epub 2019 Nov 30.
10
Strong Evidences of the Ovarian Carcinoma Risk in Women after IVF Treatment: A Review Article.体外受精治疗后女性患卵巢癌风险的有力证据:一篇综述文章。
Iran J Public Health. 2019 Dec;48(12):2124-2132.