中国女性生理生育因素与乳腺癌患病风险的Meta分析

Meta-analysis of the relationship between female physiology reproductive factors and female breast cancer risk in China

目的运用Meta分析方法,综合评价我国女性生理生育因素与乳腺癌发生的相关程度,探讨防治措施。方法收集我国2000-2013年间公开发表的37篇有关乳腺癌危险因素的病例对照研究文献,采用Meta分析的随机效应模型,计算有关危险因素的OR值及95%CI。结果各因素合并OR值(95%CI)分别为:月经异常3.61(2.66~4.89)、乳腺疾病3.04(2.52~3.66)、生殖系疾患3.01(2.61~3.48)、绝经年龄晚(≥50岁)2.41(1.65~3.53)、已绝经1.88(1.39~2.54)、流产1.71(1.38~2.13)、初育年龄高(≥30岁)1.33(1.07~1.76)、初婚年龄大(≥27岁)1.22(1.17~1.27)、行经年数长(≥35年)1.21(1.08~1.35);初潮晚(≥17岁)0.76(0.72~0.81)、哺乳时间长(≥3年)0.52(0.36~0.75)、哺乳0.51(0.31~0.86);除初育年龄高和哺乳两因素的P<0.05外,其他10个因素的P值均<0.01。生育多和服避孕药与乳腺癌无统计学联系。结论月经异常、乳腺疾病、生殖系疾病、流产、初婚年龄大等9个因素是乳腺癌的危险因素;初潮晚、哺乳则是乳腺癌的保护因素。因此,加强女性乳腺癌防治知识普及,遵守女性生理生育规律,开展高危人群筛查,积极治疗女性生理、生育的良性疾病,倡导正确母乳喂养等可有效控制乳腺癌的发生。

Objective To evaluate the association between breast cancer occurrence and the reproduction and fertility factor among Chinese female population by using Meta-analysis,and to discuss its ramification in preventions and treatments.Methods By searching the data from research papers published between 2000 and 2013 in China with case control studies of breast cancer,the OR and 95%CI associated with risk factors of breast cancer were calculated as an assessment of link between the reproduction and fertility factors and breast cancer in a random effect model of Meta-analysis.Results The total number of cases and controls were 11 012 and 11 546,respectively,in the total of 37 case-control studies.The pooled OR and 95%CI of each risk factor were as follows:menstrual disorders 3.61(2.66-4.89),breast disease 3.04(2.52-3.66),reproductive system disease 3.01(2.61-3.48),menopause late2.41(1.65-3.53),postmenopause 1.88(1.39-2.54),abortion 1.71(1.38-2.13),first birth late 1.33(1.01-1.76),being older at first marriage 1.22(1.17-1.27),menstruating years long 1.21(1.08-1.35),late menarche 0.76(0.72-0.81),long time of the breast-feeding 0.52(0.36-0.75),Breast-feeding 0.51(0.31-0.86).Conclusions The risk factors influencing breast cancer outcomes among Chinese women include menstrual disorders,breast disease,reproductive system disease,abortion,being older at first marriage.The protection factors are late menarche,breast-feeding and long time of the breast-feeding.