Liang A P, Levenson A G, Layde P M, Shelton J D, Hatcher R A, Potts M, Michelson M J
JAMA. 1983 Jun 3;249(21):2909-12.
Animal studies have yielded conflicting results on the carcinogenicity of long-acting progestins. Since more than 1.5 million women worldwide are currently receiving injections of a contraceptive progestin, depot medroxyprogesterone acetate, this is potentially an important public health problem. We obtained information on the occurrence of breast, uterine, and ovarian cancer among 5,000 black women attending a metropolitan hospital's family planning clinic who had received injections of medroxyprogesterone for contraception (between 1967 and 1976). The women were followed up for four to 13 years after their initial medroxyprogesterone injection. We compared the observed number of cancer cases in these women with the expected number based on annual age-, race-, and sex-specific rates derived from National Cancer Institute data. During more than 40,000 woman-years of observation, we found no evidence of an increased risk of developing cancer of the breast, uterine corpus, or ovary in these women. After adjusting for possible underascertainment of cancer because of incomplete follow-up, we found the relative risk for medroxyprogesterone users to be 0.7 for breast cancer (95% confidence limits, 0.3 to 1.4), 1.2 (95% confidence limits, 0.1 to 6.7) for cancer of the uterine corpus, and 0.8 (95% confidence limits, 0.1 to 4.6) for ovarian cancer.
动物研究在长效孕激素的致癌性方面得出了相互矛盾的结果。由于目前全球有超过150万女性正在接受一种避孕孕激素——醋酸甲羟孕酮长效注射剂，这可能是一个重要的公共卫生问题。我们获取了在一家大城市医院计划生育诊所就诊的5000名黑人女性的乳腺癌、子宫癌和卵巢癌发病信息，这些女性曾接受醋酸甲羟孕酮注射用于避孕（时间在1967年至1976年之间）。这些女性在首次注射醋酸甲羟孕酮后接受了4至13年的随访。我们将这些女性中观察到的癌症病例数与基于美国国家癌症研究所数据得出的按年龄、种族和性别划分的年度发病率所预期的病例数进行了比较。在超过40000人年的观察期内，我们没有发现这些女性患乳腺癌、子宫体癌或卵巢癌风险增加的证据。在对因随访不完全可能导致的癌症漏报情况进行调整后，我们发现使用醋酸甲羟孕酮的女性患乳腺癌的相对风险为0.7（95%置信区间，0.3至1.4），患子宫体癌的相对风险为1.2（95%置信区间，0.1至6.7），患卵巢癌的相对风险为0.8（95%置信区间，0.1至4.6）。
