Kelsey J L, Whittemore A S
Department of Health Research and Policy, Stanford University School of Medicine, CA 94305-5092.
Ann Epidemiol. 1994 Mar;4(2):89-95. doi: 10.1016/1047-2797(94)90052-3.
Cancers of the breast, endometrium, and ovary account for 41% of incident cancers among women. Many risk factors for breast cancer have been identified, but most are associated with only modest elevations in risk. Also, of all the risk factors identified, few are likely to be affected by intervention programs. The pathogenesis of breast cancer is not well understood, but estrogen and possibly estrogen plus progesterone are likely to be etiologically involved. For endometrial cancer, a major etiologic pathway is exposure to estrogen without cyclic exposure to progesterone. Most of the established risk factors for endometrial cancer appear to affect risk at least in part through this pathway. Only a few risk factors for ovarian cancer have been identified. The two most commonly suggested etiologic mechanisms for ovarian cancer are (a) that suppression of ovulation reduces risk and (b) that suppression of pituitary gonadotropins reduces risk. Each hypothesis is consistent with some, but not all, of the data. Prospects for the primary prevention of these cancers are discouraging at present because few of the risk factors identified to date are readily subject to modification, especially for breast cancer, and the underlying etiologies of these cancers are not well understood, particularly for breast and ovarian cancers.
乳腺癌、子宫内膜癌和卵巢癌占女性新发癌症的41%。已确定了许多乳腺癌的风险因素，但大多数仅与风险适度升高相关。此外，在所有已确定的风险因素中，很少有因素可能会受到干预项目的影响。乳腺癌的发病机制尚未完全明确，但雌激素以及可能的雌激素加孕激素可能在病因上与之相关。对于子宫内膜癌，一个主要的病因途径是暴露于雌激素而没有周期性地暴露于孕激素。大多数已确定的子宫内膜癌风险因素似乎至少部分通过这一途径影响风险。仅确定了少数卵巢癌的风险因素。卵巢癌最常被提及的两种病因机制是：（a）抑制排卵可降低风险；（b）抑制垂体促性腺激素可降低风险。每种假说都与部分而非全部数据相符。目前，这些癌症一级预防的前景不容乐观，因为迄今为止确定的风险因素中很少有能轻易改变的，尤其是乳腺癌，而且这些癌症的潜在病因尚未完全明确，特别是乳腺癌和卵巢癌。
