Holly E A, Cress R D, Ahn D K
Department of Epidemiology and Biostatistics, School of Medicine, University of California, San Francisco 94143, USA.
Am J Epidemiol. 1995 May 15;141(10):943-50. doi: 10.1093/oxfordjournals.aje.a117361.
Oral contraceptive use and reproductive factors were investigated in a population-based case-control study of 452 women aged 25-59 years who were diagnosed with cutaneous malignant melanoma during the period 1981-1986 and 930 controls. Ever use of oral contraceptives was reported by 72 percent of melanoma patients and 79 percent of control subjects in this San Francisco Bay Area study, although duration of use was slightly longer for women with superficial spreading melanoma (5.5 years) than for controls (4.3 years). While some subgroups had elevated or reduced odds ratios, no consistent association was observed between cutaneous melanoma risk and oral contraceptive use when use was examined by duration, latency, age at diagnosis, age at first use, and time period of first use. Neither number of live births nor age at birth of the first child was associated with risk for cutaneous melanoma; nor was a history of miscarriage, induced abortion, or endometriosis. No association was observed with regularity of menstrual periods or with use of fertility drugs or hormones to regulate menstrual periods. Women who reported experiencing hyperpigmentation of facial skin during a prior pregnancy had a lowered risk for all cutaneous melanoma (odds ratio (OR) = 0.64, 95% confidence interval (CI) 0.44-0.93) and superficial spreading melanoma (OR = 0.54, 95% CI 0.36-0.83). This effect was more pronounced for light-complexioned women (for superficial spreading melanoma, OR = 0.37, 95% CI 0.20-0.70) than for women with a dark or medium complexion (for superficial spreading melanoma, OR = 0.84, 95% CI 0.48-1.5). Women who reported use of acne medication also had a reduced risk of superficial spreading melanoma (OR = 0.55, 95% CI 0.35-0.84). These results indicate an overall lack of effect of oral contraceptives on cutaneous melanoma risk in this population of women. The reduced melanoma risks associated with hyperpigmentation during a prior pregnancy and use of acne medication (or related hormonal indications for its use) should be studied further.
在一项基于人群的病例对照研究中，对452名年龄在25至59岁之间、于1981年至1986年期间被诊断为皮肤恶性黑色素瘤的女性以及930名对照者的口服避孕药使用情况和生殖因素进行了调查。在这项旧金山湾区研究中，72%的黑色素瘤患者和79%的对照者报告曾使用口服避孕药，不过，浅表扩散型黑色素瘤女性的使用时长（5.5年）略长于对照者（4.3年）。虽然某些亚组的比值比有所升高或降低，但在按使用时长、潜伏期、诊断年龄、首次使用年龄以及首次使用时间段对口服避孕药使用情况进行分析时，未观察到皮肤黑色素瘤风险与口服避孕药使用之间存在一致的关联。活产次数和头胎生育年龄均与皮肤黑色素瘤风险无关；流产、人工流产或子宫内膜异位病史也与之无关。未观察到月经周期规律与否、使用生育药物或激素调节月经周期与皮肤黑色素瘤风险之间存在关联。报告在既往妊娠期间面部皮肤出现色素沉着的女性患所有皮肤黑色素瘤的风险降低（比值比（OR）=0.64，95%置信区间（CI）0.44 - 0.93），患浅表扩散型黑色素瘤的风险也降低（OR = 0.54，95% CI 0.36 - 0.83）。这种效应在肤色浅的女性中更为明显（对于浅表扩散型黑色素瘤，OR = 0.37，95% CI 0.20 - 0.70），而在肤色深或中等肤色的女性中则不然（对于浅表扩散型黑色素瘤，OR = 0.84，95% CI 0.48 - 1.5）。报告使用过痤疮药物的女性患浅表扩散型黑色素瘤的风险也降低（OR = 0.55，95% CI 0.35 - 0.84）。这些结果表明，在这群女性中，口服避孕药对皮肤黑色素瘤风险总体上没有影响。既往妊娠期间色素沉着和使用痤疮药物（或与之相关的激素使用指征）与黑色素瘤风险降低之间的关联应进一步研究。
