口服避孕药与中国妇女出血型脑卒中的1:1病例对照研究

目的:探讨目前我国广泛应用的国产低剂量复方口服避孕药对女性出血型脑卒中发病危险性的影响,以期结合避孕药具知情选择和计划生育优质服务对服避孕药女性进行心脑血管疾病预防,减少口服避孕药严重不良反应的发生。方法:采用1:1病例对照研究。结果:单因素条件Logistic回归分析显示,口服避孕药能增加出血型脑卒中发生的危险性,相对危险度OR为3,57(95％CI 1.55-8.26),用文化程度、高血压病史调整后仍具有统计学意义;多因素条件Logistic回归分析结果提示,高血压病史、服用口服避孕药、猪肉摄入量增多等因素均能增加出血型脑卒中危险性,其中服用口服避孕药的相对危险度OR为5.81(95％CI 1.51-22.35),高血压病史的相对危险度OR为27.29(95％CI 4.29-173.59)。结论:本研究提示口服避孕药能增加中国妇女出血型脑卒中发病危险性,建议加强避孕药不良反应监测与防治工作,并进一步开展深入研究。     

成都地区女性乳腺癌危险因素的病例对照研究

目的　调查成都地区女性乳腺癌危险因素,为确定高危人群、提出预防措施提供依据。方法　对过去3年中成都地区经病理证实的乳腺癌265例进行1∶1配对病例对照研究。结果在单因素分析中,达到显著性水平的危险因素为行经期≥35年、服用避孕药、良性乳腺疾病史、被动吸烟及常食用蜂王浆等,达到显著性水平的保护因素为哺乳及常食豆类食品。条件logistic多元回归分析显示,重要的有统计学显著意义的乳腺癌危险因素是良性乳腺疾病史、被动吸烟,重要保护性因素是常食豆制品及哺乳。结论　成都地区女性乳腺癌重要危险因素为良性乳腺疾病史及被动吸烟。     

联合决策树及logistic回归建立乳腺癌相对风险预测模型

目的运用决策树和logistic回归建立乳腺癌相对风险预测模型,实现分级管理。方法本研究为病例对照设计,病例来源于2014-2015年就诊于四川大学华西医院、四川省肿瘤医院和四川省人民医院的原发性乳腺癌783例;对照来源于2009-2012年四川省妇幼中心和成都市双流区妇幼保健院的筛查队列3 879例。运用问卷收集相关信息,构建决策树,采用logistic回归模型计算OR值,并评价回归拟合效果。结果决策树选择乳腺良性疾病史、绝经状态、初产年龄(22/24岁)、活产次数(1个)、年龄(50岁)及行经时间(34年)作为危险因素,组合危险因素logistic回归模型中OR取值范围1-65.71(95%CI:32.19,134.13),其中有乳腺良性疾病史的未绝经妇女患病风险最高(OR=65.71,95%CI:32.19,134.13),回归模型灵敏度0.68,特异度0.79,AUC 0.8038。结论联合决策树和组合危险因素logistic回归能区分不同患病风险的危险因素组合,可用于构建相对风险预测模型。     

孕产妇不良妊娠结局危险因素的病例对照研究

目的：探讨孕产妇不良妊娠结局的危险因素。方法采用以医院为基础的非匹配病例对照研究,收集产妇一般情况、既往生育史、孕期异常状况及患病等资料,使用单因素χ2检验和多因素Logistic回归进行分析。结果单因素分析显示,病例组产妇高龄、职业为农民、不良妊娠史、早孕期异常、胎位异常、妊娠合并症的比例高于对照组,差异均有统计学意义（χ2值分别为9．529、13．512、10．134、4．465、11．586、31．562,均P＜0．05）。多因素非条件Logistic回归分析表明,职业为农民（ OR＝2．298,95％CI：1．202～4．396）、不良妊娠史（OR＝1．612,95％CI：1．150～2．260）、早孕期异常（OR＝1．897,95％CI：1．142～3．152）、胎位不正（OR＝3．067,95％CI：1．536～6．126）、妊娠合并症（OR＝2．539,95％CI：1．764～3．656）为不良妊娠结局的危险因素。结论鼓励育龄期妇女优生优育,加强围孕期健康教育,孕妇应定期产检,发现异常及时就诊,以减少不良妊娠结局的发生。     

深圳市宝安区女性乳腺癌发病情况及危险因素的调查分析

目的了解及掌握深圳市宝安区女性人群乳腺癌的发病情况及其危险因素，以便确定高危人群，为制定预防措施提供科学依据。方法对2004—2007年累积观察的7518名女性乳腺病人中乳腺癌患者的数量、年龄进行了统计分析。将232例经病理证实的乳腺癌患者同非乳腺癌患者进行1：1配对病例对照研究。研究其妇科史、肿瘤家族史、乳腺良性疾病史、服用避孕药物史、吸烟史及饮酒史等。结果本地区该病的多发年龄为40-60岁，20-29岁妇女中也发现乳腺癌病患者。提示该病的流行出现年轻化倾向良性。乳腺疾病史、肿瘤家族史、流产次数多、服避孕药及被动吸烟是乳腺癌的危险因素，而哺乳是保护因素。月经初潮年龄、第一胎生育年龄及饮酒嗜好与乳腺癌发生无相关性。结论深圳宝安区女性乳腺癌流行出现年轻化倾向，重要危险因素为良性乳腺疾病史、肿瘤家族史及流产次数多。     

代谢综合征危险因素研究

目的　探讨代谢综合征 (MS)的危险因素。方法　对 95名MS病例及 13 0名健康对照进行病例对照研究 ,运用单因素和多因素非条件Logistic回归分析 ,探讨影响MS发生的危险因素。 结果　进入多因素非条件Logistic回归模型的因素有年龄、糖尿病阳性家族史和饮酒 (P <0 0 5)。其中年龄OR值为 1 15,糖尿病阳性家族史OR值为2 79,饮酒OR值为 4 0 5。结论　年龄、糖尿病阳性家族史、饮酒均为MS的危险因素     

868例中老年妇女乳腺检查结果分析

目的:探讨中老年妇女使用激素替代类药物或服用美容、保健品对乳腺方面的影响。方法:按是否使用激素替代类药物或服用美容、保健品将中老年妇女分为三组进行对照分析。结果:使用激素替代类药物或服用美容、保健品的中老年妇女发生乳腺小叶增生或使原有增生加重者明显高于未服用组,差异有显著性(P<0.01),且有1例发生乳腺癌。结论:中老年妇女使用激素替代类药物或服用美容、保健品应在医生的指导下使用,并且必须定期检查乳腺。强调乳房自检的重要性以及须慎用美容、保健品。     

146对女性乳腺癌病例对照研究

应用１∶１配比病例对照研究方法对１４６对女性乳腺癌患者及其对照的危险因素进行了研究。配对Ｌｏｇｉｓｔｉｃ回归分析结果表明：既往有乳腺良性肿瘤史及常吃香肠是乳腺癌发生的主要危险因素；而蔬菜摄入量多及经常服用维生素类药物可明显降低发生乳腺癌的危险。另外，单因素分析结果还提示：腊肉摄入量多和长期被动吸烟等因素亦可明显增加乳腺癌发病的危险；而累积哺乳时间长则对乳腺癌发病有保护作用，Ｌｏｇｉｓｔｉｃ回归分析亦有类似结果。     

武汉市大肠癌危险因素的1:2配比病例对照研究

目的：探讨大肠癌发病的危险因素。方法：采用以医院和社区为基础的1：2配比病例对照研究，对100例经组织学确诊的大肠癌患及200例对照的相关资料进行条件Logistic回归分析。结果：10年前猪肉食用频率、10年前动物油食用频率、腌渍食品食用频率、情绪自我调节能力差、患胃十二指肠溃疡、慢性阑尾炎、旁系亲属患肿瘤是大肠癌的危险因素，其OR值依次为1．114，1．091，1．117，1．490，2．483，5．751，11．531；喜食稀软食物是保护因素，OR值为0．789；患呼吸系统疾病、患冠心病与大肠癌呈负相关，OR值为0．230，0．441。结论：大肠癌发病与饮食因素、情绪自我调节能力差、消化系统疾病史及旁系亲属患肿瘤有关。     

妇女乳腺癌预防知识知晓情况及影响因素分析

目的：在上海市开展妇女乳腺癌预防知晓情况调查,为有效开展乳腺癌预防的健康教育、确定乳腺癌宣传的重点人群提供依据。方法选取2013年3至4月参加上海市妇女保健所和上海市第一妇婴保健院义诊活动的妇女进行问卷调查,共有205份有效问卷纳入研究。应用Logistic回归模型进行乳腺癌知晓情况的影响因素分析。结果乳腺癌预防知识的知晓率为4．9％～91．2％,平均得分6．14±2．56）。多因素Logistic回归模型分析结果显示,在调整其他变量的情况下,高分组域低分组相比,仅家庭年人均可支配收入（OR＝0．4,95％CI：0．2～0．8）和婚姻状况（已婚OR＝0．0,95％CI：0．0～0．2;未婚OR＝0．1,95％CI：0．0～0．9）对知晓水平存在影响,具有统计学意义（均P＜0．05）。结论上海地区妇女乳腺癌预防知识水平仍有待提高,可将收入较低或离异丧偶的妇女作为乳腺癌健康教育的重点人群。     

Oral contraceptives and breast cancer

The association between the use of oral contraceptives and the development of breast cancer was re-examined at a 3-day conference in which research from the US, the UK, Scandinavia and New Zealand was presented. It was agreed that earlier use of oral contraceptives did not appear to increase the risk of breast cancer in women over 45. However, no consensus was reached on whether an increased risk was present in women under age 35. Evidence from the UK suggest the overall chance of a women developing breast cancer at any time in her life was 1 in 14, while in women under 35 it was 1 in 500 in the absence of oral contraceptives, and 1 in 350 for women under 35 using the pill. Another study from the UK revealed that the risks were lower in those women taking the newer low-dose pills with less estrogen. Furthermore, it was suggested that progestagen-only pills might have a protective effect against breast cancer. Also discussed at the conference were the benefits of the pill, such as its great efficacy, good acceptability, and its role in a 50% decrease in both ovarian and endometrial cancers. No definitive view on the matter of oral contraceptives and breast cancer was reached. It was concluded that more research is needed in the developed countries, as well as in the developing world. In the meantime, the International Medical Advisory Panel and the British Committee on Safety of Medicines agree that no change in oral contraceptive prescribing practice is currently necessary. The association between oral contraceptives and breast cancer, however, should remain under regular review.     

Breast cancer risk and oral contraceptive use: results from a large case-control study.

The association between oral contraceptive use and breast cancer risk was examined using data from a case-control study of breast cancer in Long Island, New York. Cases were defined as female residents of Nassau and Suffolk Counties between the ages of 20 and 79, diagnosed with breast cancer between January 1, 1984 and December 31, 1986. Age- and county-matched controls were selected from driver's license files. Among all women under age 70 at diagnosis, there was no association between oral contraceptive use and breast cancer; there was, however, a positive association in the subgroup ages 20-49 (adjusted odds ratio = 1.68, 95% CI: 1.16-2.42). Risk increased with increasing duration of use, but did not differ between women who first used oral contraceptives before the first pregnancy and those who first used them later, or between women who first used oral contraceptives before age 25 and those who first used them at a later age. Risk also appeared to increase with number of years of use before the first pregnancy or before age 25, although numbers were small. History of benign breast disease did not influence risk. The association of breast cancer risk with oral contraceptive use appeared stronger in women from Suffolk County than Nassau County.     

Hormonal Contraceptive Use and Breast Cancer in Thai Women

Background

Breast cancer is the most common cancer in women worldwide. We investigated the association of hormonal contraceptive use and breast cancer in Thai women.

Methods

A cohort study was conducted in Khon Kaen, Thailand. There were 70 cases of histologically confirmed breast cancer among 11 414 women aged 30 to 69 years who were recruited as participants in the cohort study during the period from 1990 through 2001. The study population was followed-up until December 31, 2011. To identify factors associated with incidence of breast cancer, hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated using a Cox proportional hazards model.

Results

The 11 414 women provided a total observation time of 157 200 person-years. Breast cancer risk among women with a history of hormonal contraceptive use was 1.31 times that of women without such a history, but the difference was not statistically significant (95% CI, 0.65–2.65). No type of hormonal contraceptive was associated with a significant increase in breast cancer risk as compared with women who had never used hormonal contraceptives (oral contraception: HR = 1.35, 95% CI, 0.65–2.78; injection contraception: HR = 1.25, 95% CI, 0.56–2.80), and there was no relationship between duration of hormonal contraceptive use and breast cancer.

Conclusions

There was no association between hormonal contraceptive use and breast cancer; however, this finding should be viewed with caution due to the small number of cases.Key words: hormonal contraceptive, breast cancer, Thai women     

Do oral contraceptives cause breast cancer?

This critique of the research study on oral contraceptives and breast cancer by Weinstein, et al., published in the journal Epidemiology, September 1991, points out several design faults, then notes some of the findings that nevertheless agree with other large, well conceived studies. Some of the difficulties of the study were the lack of disaggregation by race, fewer low socioeconomic group controls, more high socioeconomic group users, and lack of data on pill formulation used. The results agree with those of the large CASH study, which found that there was no overall dose response of pill use with risk of breast cancer, even taking into account use before or after the 1st birth. The results also agree with the finding in the CASH study that relative risk was higher, here 1.8, for women using the pill 4 or more years in the 20-49 age group, while lower, 0.7, for those aged 50-70. This suggests that the pill may have accelerated onset of breast cancer in some young women, but not affected cumulative lifetime risk. Since the question of oral contraceptive use and breast cancer still remains unsettled, women over 30 who have taken the pill for 4 or more years should have mammagraphy and self and clinical breast exams regularly.     

Oral contraceptives and breast cancer risk: a case-control study

The association between breast cancer risk and oral contraceptive use was examined in 401 breast cancer patients and 519 hospital controls interviewed in New York City during 1979-1981. Control subjects were ascertained utilizing variable ratio matching to the cases (2:1 or 1:1) by sex, age, hospital, and time of diagnosis. No evidence of a positive association was found between cancer risk and the duration of use in either parous or nulliparous women. The odds ratios obtained by comparing users to non-users in women under 50 years of age after adjusting for other risk factors were 0.8 (95% CI = 0.4-1.4) for less than five years duration and 0.4 (95% CI = 0.2-0.8) for five or more years duration (P less than 0.05 when tested for decreasing trend). There was also no evidence of effect modification between oral contraceptive use and other breast cancer risk factors (viz. family history, nulliparity, late age at first pregnancy, or abstention from breastfeeding). Our results do not indicate that the use of oral contraceptives increases the risk of breast cancer.     

New Product Review (September 2003). Norelgestromin/ethinyl oestradiol transdermal contraceptive system (Evra)

This new transdermal contraceptive system (contraceptive patch), Evra (Janssen-Cilag), received a UK product licence in 2003. In clinical trials: Consistent doses of norelgestromin and ethinyl oestradiol are released into the systemic circulation daily. Pharmacokinetic data suggest that levels are sufficient to inhibit ovulation for at least 7 days. The overall Pearl index for the contraceptive patch (1.24; 95% CI 0.19-2.33) was similar to that of a triphasic combined oral contraceptive (COC) pill (2.18; 95% CI 0.57-3.8). Self-reported "perfect" compliance was significantly better with the contraceptive patch (88.2%) than with a combined contraceptive pill (77.7%). Patch detachment, requiring replacement with a new patch, with normal daily activity is uncommon (4.6%). Breakthrough bleeding and spotting were significantly more common with the contraceptive patch than with combined oral contraception in the first two cycles but differences were not significant by cycle three. In general, reported side effects were not significantly different with contraceptive patch or combined pill use. However, breast tenderness in the first two treatment cycles was more common with patch use. Symptoms were mild to moderate in 85% of women and were rarely treatment limiting. Currently, there are limited data regarding risk of venous thromboembolism, and cervical or breast cancer with the contraceptive patch. No clinically significant alterations in metabolic or haemostatic parameters were identified with contraceptive patch use. A month's supply of the contraceptive patch costs 7.74 UK pounds. Combined oral contraception prices range from approximately 0.80 to 5.00 UK pounds and hormone replacement therapy patches range from 10.00 to 13.00 UK pounds. The contraceptive patch offers additional choice for women who wish to use a combined hormonal method of contraception.     

Weighing the evidence on the pill and breast cancer

Three new studies have found some connection between oral contraceptive use and breast cancer among women younger than 45. None of the studies find an increased risk of breast cancer among the same subgroups of women, and their results are contradictory. Consequently, a committee advising the U.S. Food and Drug Administration concluded that "the existing data do not support a change in prescribing practices by physicians or in the use of oral contraceptives by women." One of the three studies, a U.S. hospital-based analysis of breast cancer patients, showed ever-users of the pill to have a statistically significant risk of breast cancer of 2.0 compared with never-users. The relative risk was elevated in virtually all duration-of-use categories. A significantly increased relative risk was also found among ever-users aged 30-34 and 35-39, among those who did not experience menarche until age 14 or older and among those who were parous. A new analysis of data from the U.S. population-based Cancer and Steroid Hormone Study found no increased risk among parous women or those who had used the pill for less than eight years. However, nulliparous women who had experienced menarche prior to age 13 and had used the pill for eight or more years did have a significantly increased relative risk. Most of the increased risk was confined to women who had begun pill use as teenagers; they had a relative risk of 5.6 compared with never-users.(ABSTRACT TRUNCATED AT 250 WORDS)     

Breast cancer before age 45 and oral contraceptive use: new findings

The relation between the risk of breast cancer before 45 years of age and oral contraceptive use was examined in a case-control study conducted in New York, Philadelphia, Baltimore, and Boston from 1983 to 1986 of 407 patients with breast cancer and 424 controls. With allowance for confounding, for ever use, the multivariate relative risk estimate was 2.0 (95% confidence interval (CI), 1.4-2.9). For less than 10 years of use, the estimate approximated 2.0 in all categories of duration, including less than three months; for 10 or more years of use it was 4.1 (95% CI, 1.8-9.3). The association was apparent in virtually all subgroups examined, including younger and older women, and women at low and high underlying risk of breast cancer. Contrary to some previous reports, the association was not stronger for use before a first term pregnancy or at an early age. The results suggest that oral contraceptive users, particularly those with very long durations of use, may be at increased risk of breast cancer. However, information bias, particularly for short-term use, could not be ruled out. There may also have been selection bias if oral contraceptive users were under more intensive medical surveillance. It has not been possible to reconcile the findings of the various studies to date, including the authors' earlier results showing no association. The latter results were derived from data collected using methods almost identical to those used in the present study.     

Oral contraceptive and breast cancer: a case-control study

OBJECTIVE: To investigate the association between breast cancer and the duration of use of oral contraceptives (OC), and age it started to be used in a population of Pelotas, Southern Brazil. METHODS: There were identified 250 incident cases of breast cancer in patients aged 20 to 60 years from records of pathology laboratories and there were enrolled 1,020 controls drawn from hospital and neighbourhood population. For 90 cases identified in Pelotas, 270 hospital controls and 270 neighbourhood controls were selected, for another 78 cases in Pelotas, 234 controls were selected, and for 82 cases from other municipalities, 246 hospital controls were selected. Controls were matched by age. Adjusted analysis was performed using conditional logistic regression. RESULTS: No association between oral contraceptive use and breast cancer was found (OR=1.1;CI95% 0.7 - 1.6 for hospital controls, and OR=0.9;CI95% 0.6 - 1.6 for neighbourhood controls) neither for different duration of use or starting age. To increase the test power, 250 cases and all 1020 controls were analyzed together, and an odds ratio of 1.6 (CI95% 1.0 - 2.4) was found for women older than 45 years of age who had been using oral contraceptives for five years or more. CONCLUSIONS: No evidence was found of a general association between oral contraceptive use and breast cancer. When analyzing the whole date set, with all neighbourhood and hospital controls together, for women older than 45 years of age who had been using oral contraceptives for more than 5 years, it was found an increased risk almost statistically significant (p=0.05).     

Effect of Honey and Royal Jelly against Cisplatin-Induced Nephrotoxicity in Patients with Cancer

Objectives: Cisplatin constitutes one of the most potent antineoplastic drugs; however, nephrotoxicity limited its eligibility for optimal clinical use. This study was designed to evaluate the role of honey and royal jelly with antioxidant properties in the protection of cisplatin-induced acute kidney injury in patients with cancer.

Methods: Patients with cancer assigned for cisplatin chemotherapy were randomly divided into bee honey and royal jelly groups pretreated before the initiation and during cisplatin chemotherapeutic regimen and control group on cisplatin only. Serum creatinine and urea levels were measured before and after the chemotherapeutic cycle and over 2 cycles.

Results: Patients on crude bee honey and royal jelly capsules showed lower serum levels of renal injury products (creatinine and urea) compared to those in the control group. The changes in kidney parameters were significantly (p < 0.05) lower when compared within the bee honey group before and after cisplatin treatment. Royal jelly was found to be effective; however, the difference in creatinine and urea levels before and after chemotherapy was not statistically significant.

Conclusions: The use of bee honey and royal jelly as natural compounds is effective in reducing cisplatin nephrotoxicity and may offer a promising chance for clinically meaningful prevention. This study has potentially important implications for the treatment of cisplatin kidney side effects and is considered to be the first to investigate this effect of honey and royal jelly in human subjects. However, due to its small sample size, we recommend further investigation using a larger sample size.