La Vecchia C
Istituto Di Richerche Farmacologiche Mario Negri, Universitá di Milano, Italy.
Contraception. 1994 Mar;49(3):223-30. doi: 10.1016/0010-7824(94)90040-x.
The relationship between depot-medroxyprogesterone acetate (DMPA), and other injectable contraceptives and cervical neoplasia was reviewed mainly on the basis of three studies: the WHO Collaborative Study of Neoplasia and Steroid Hormone Contraceptives (2,009 cases and 9,583 controls collected in several, mainly developing, countries); a study of 369 cases of carcinoma in situ, 133 of invasive cancer and 646 controls collected by the National Tumor Registry of Costa Rica; and a cooperative study of 759 cases of invasive cervical cancer and 1,430 controls from four countries in Latin America (Costa Rica, Peru, Mexico and Colombia). There was no evidence of an appreciably elevated risk since most relative risks for ever users ranged from between 0.8 and 1.4, nor of consistent duration-risk relationship which was observed only in one study. The relative risk estimates for longest duration of use ranged from between 0.9 and 2.4. The data are still compatible with the absence of a causal association and with a moderately increased risk (up to a factor 1.5), which finds some biological plausibility as it is in agreement with the overall evidence of the relation between oral contraceptives and cervical neoplasia.
主要基于三项研究，对醋酸甲羟孕酮长效注射剂（DMPA）以及其他注射用避孕药与宫颈肿瘤形成之间的关系进行了综述：世界卫生组织肿瘤与甾体激素避孕药协作研究（在几个主要为发展中国家收集了2009例病例和9583例对照）；哥斯达黎加国家肿瘤登记处收集的一项针对369例原位癌、133例浸润癌病例及646例对照的研究；以及一项来自拉丁美洲四个国家（哥斯达黎加、秘鲁、墨西哥和哥伦比亚）的759例浸润性宫颈癌病例与1430例对照的合作研究。没有证据表明风险显著升高，因为大多数曾经使用者的相对风险在0.8至1.4之间，也没有观察到仅在一项研究中出现的持续时间与风险的一致关系。使用时间最长者的相对风险估计值在0.9至2.4之间。这些数据仍与不存在因果关联以及风险适度增加（高达1.5倍）相符，这在生物学上具有一定合理性，因为它与口服避孕药和宫颈肿瘤形成之间关系的总体证据一致。
