CEF美泰生殖中心科普卵巢癌和防护因素

Article: Ovarian Cancer Following Use of Clomiphene and Gonadotropin

文章：使用克罗米芬和促性腺激素后发生的卵巢癌

Author: Amin Philip Makar

Book: Complications and Outcomes of Assisted Reproduction

书籍：辅助生殖并发症和结果

Published by: Cambridge University Press

出版社：剑桥大学出版社

Editors: Botros Rizk

Jan Gerris

主编：Botros Rizk

Jan Gerris

Oral contraceptives

口服避孕药

Studies have consistently shown that prolonged use of oral contraceptives (OCs) reduces the risk of ovarian cancer. An analysis of 45 epidemiological studies found that, compared with women who had never used OCs, any use of OCs was associated with a statistically significant reduction in risk of developing ovarian cancer (relative risk 0.73, 95% CI 0.70-0.76) (1,2). Larger reductions in ovarian cancer risk occurred with increasing duration of OCs use (relative risk decreased by approximately 20% for each 5 years of use; by 15 years, the risk of ovarian cancer was reduced by 50%). Importantly, the protective effect persisted for 30 years after cessation of OCs, although the effect attenuated over time (1,2).

研究一致表明，长期使用口服避孕药可降低卵巢癌的风险。根据一项对45项流行病学研究的分析发现，与从未服用过避孕药的女性相比，任何使用过的女性患卵巢癌的风险都显著降低（相对风险 0.73，95%置信区间0.70-0.76）（1，2）。口服避孕药的使用时间越长，卵巢癌风险更低（每使用5 年，相对风险降低约20%；每使用15年，卵巢癌风险降低50%）。此外，在停止服用避孕药后，虽然其保护作用会随着时间推移而减弱，但仍能持续30年（1，2）。

The use of OCs offers also protective effect against border-line ovarian tumors, with the least protective effect in the case of mucinous tumors. OCs with the current standard dose or low dose (≤ 35μg ethinyl estradiol) were associated with a similar or lower likelihood of epithelial ovarian cancer compared with the higher-dose OCs previously used, based upon a case-control study (n=745 women with ovarian cancer) (1, 3).

口服避孕药也能降低卵巢交界性肿瘤的发生，但对粘液性肿瘤的防护性最差。一项病例对照研究发现，患者使用当前标准剂量或低剂量避孕药（≤ 35μg 乙炔雌二醇）发生卵巢上皮癌的概率低于之前使用高剂量避孕药的情况下（n=745名卵巢癌女性患者（1，3）。

The use of OCs is also associated with a decrease in mortality rate of ovarian cancer. In women who never used OCs, 1.2% are diagnosed with ovarian cancer and 0.7% die as a result of this disease before the age of 75 years. In women who used OCs for 10 years, the estimated cumulative incidence is only 0.8% and only 0.5% die as a result of this disease before the age of 75 years (2). The literature contains several meta-analyses evaluating the impact of OC use in BRCA mutation carriers. The published data also confirm significant risk reduction in this population. No difference in the risk reduction was notable between BRCA1 and BRCA2 mutation carriers (4).

口服避孕药也能降低卵巢癌死亡率。在从未服用过避孕药的女性中，1.2%被诊断患有卵巢癌，0.7%在75岁前因卵巢癌去世。在使用了口服避孕药的女性中，累计发病率预估仅为0.8%，75岁前因卵巢癌去世的女性仅占0.5%（2）。这个研究还进行了几项元分析，评估了口服避孕药对BRCA基因突变携带者的影响。公开的数据也证实了这类人群的风险显著降低。BRCA1和BRCA2基因突变携带者之间的风险降低率没有显著差异（4）。

Breastfeeding

母乳喂养

A meta-analysis found that breastfeeding for a cumulative duration of 12 months compared with never breastfeeding was associated with a statistically significant decrease in the risk of epithelial ovarian cancer (OR 0.72, 95% CI 0.54-0.97) (1).

一项元分析发现，与从不母乳喂养的人群相比，母乳喂养累计持续时间大于12个月的人群患卵巢上皮癌的风险显著降低（比值比0.72，95% 置信区间 0.54-0.97）（1）。

Nonhormonal protective factors

非激素防护因素

These include surgical resection of the ovaries and tubal ligation (1).

包括卵巢手术切除术和输卵管结扎（1）。

References

参考文献

1．Chen L M, Berek J S. Epithelial carcinoma of the ovary, fallopian tube, and peritoneum: epidemiology and risk factors. Up to date 2015;1-24. Available at www.uptoedate.com

2. Beral V, Doll R, Hermon C, Peto R, Reeves G. Ovarian cancer and oral contraceptives: collaborative reanalysis of data from 45 epidemiological studies including 23,257 women with ovarian cancer and 87,303 controls. Lancet 2008;371(9609):303-4.

3. Lurie G, Thompson P, McDuffie K E, et al. Association of estrogen and progestin potency of oral contraceptives with ovarian carcinoma risk. Obstet Gynecol 2007;109:597-607.

4. Moorman P G, Havrilesky L J, Gierisch J M, et al. Oral contraceptives and risk of ovarian cancer and breast cnacer among high-risk women: a systematic review and meta-analysis. J Clin Oncol 2013;31(33):4188-98.