Rossing M A, Daling J R, Weiss N S, Moore D E, Self S G
Fred Hutchinson Cancer Research Center, Seattle, Washington, USA.
Gynecol Oncol. 1996 Jan;60(1):3-7. doi: 10.1006/gyno.1996.0002.
The purpose of this study was to assess: (1) the risk of breast cancer associated with use of ovulation-inducing agents (such as clomiphene citrate) as treatment for infertility; and (2) the risk associated with ovulatory abnormalities that result in infertility. We performed a case-cohort study among 3837 women evaluated for infertility at clinics in Seattle, Washington, at some time during 1974-1985. Computer linkage with a population-based tumor registry was used to identify women diagnosed with breast cancer before January 1, 1992. Data regarding infertility testing and treatment were abstracted from the infertility clinic medical records for women who developed breast cancer and a randomly selected subcohort. Twenty-seven women in the cohort developed in situ or invasive breast cancer, in comparison with an expected number of 28.8 cases (standardized incidence ratio, 0.9; 95% confidence interval (CI), ).6-1.4). Infertile women with evidence of an ovulatory abnormality were at a risk of breast cancer similar to that of women whose infertility was believed to be due to other causes. The risk among women who had taken clomiphene was reduced relative to infertile women who had not used this drug (adjusted relative risk, 0.5; 95% CI, 0.2-1.2), but the reduction in risk did not increase with duration of use. The possibility that use of clomiphene as treatment for infertility lowers the risk of breast cancer should be examined in other, larger studies.
（1）使用促排卵药物（如枸橼酸氯米芬）治疗不孕症与患乳腺癌风险之间的关联；以及（2）由排卵异常导致不孕症与患乳腺癌风险之间的关联。我们在1974年至1985年期间的某个时间，对华盛顿州西雅图市诊所中接受不孕症评估的3837名女性进行了一项病例队列研究。通过与基于人群的肿瘤登记处进行计算机链接，以识别在1992年1月1日前被诊断为乳腺癌的女性。从患乳腺癌女性和随机选择的一个亚队列的不孕症诊所病历中提取有关不孕症检查和治疗的数据。该队列中有27名女性患原位或浸润性乳腺癌，而预期病例数为28.8例（标准化发病率比，0.9；95%置信区间（CI），0.6 - 1.4）。有排卵异常证据的不孕女性患乳腺癌的风险与不孕症被认为由其他原因导致的女性相似。服用氯米芬的女性与未使用该药物的不孕女性相比，风险有所降低（调整后的相对风险，0.5；95%CI，0.2 - 1.2），但风险降低并未随用药时间延长而增加。使用氯米芬治疗不孕症是否会降低患乳腺癌风险这一可能性，应在其他更大规模的研究中进行检验。
