正文
题目：使用滑石粉与卵巢癌风险增加有关
作者：Zosia Chustecka
出處：WebMD医学新闻
October 8, 2008 — 根据一項發表於9月號癌症流行病學生物標記與預防期刊上的研究結果，經常於生殖器官區域使用滑石粉，會顯著增加卵巢癌風險。研究團隊表示，應避免於生殖器官部位使用滑石粉。
這並不是一項新發現，生殖器官部位使用滑石粉與卵巢癌風險上升之間的關係，過去已經有相關報導，且於一項收納16項研究的綜合分析中獲得確認。
研究者表示，這項最新的研究提供了生殖器官部位使用滑石粉對於上皮卵巢癌主要作用更多的證據。他們指出，除此之外，這項使用頻率增加與風險上升之間高度顯著趨勢的研究結果，進一步強化了這之間關連的證據，因為過去大部分研究並未觀察到劑量與反應之間的關係。
此外，這項研究是第一項分析不同基因型的研究。研究團隊發現解毒路徑基因可能與滑石粉的生物反應有關。滑石粉與卵巢癌之間的關係可能隨著基因型而有不同，研究團隊指出，需要更多的研究來確認這些發現。
研究作者、麻州波士頓布萊根婦女醫院的研究員Margaret gates表示，根據我們的研究結果與過去的證據支持生殖器官部位使用滑石粉與卵巢癌風險之間的關係，我們認為，女性們應避免於在生殖器官部位使用滑石粉。臨床醫師們應該詢問病患使用滑石粉的病史，且如果病患尚未停止使用，應建議病患停止於生殖器官部位使用滑石粉。
她向Medscape腫瘤學表示，滑石粉的另一個選擇是玉米澱粉粉，並沒有研究顯示它會增加卵巢癌風險，或是放棄合併使用生殖器官用粉末。
【身體其他部位使用滑石粉並無風險】
最新的這項研究結果是來自兩個不同試驗族群，研究團隊取得1,231位上皮卵巢癌患者的紀錄，與1,244位來自新英格蘭病例控制（NECC）研究的控制組受試者，以及210位病例，還有600位來自前瞻性護士健康研究（NHS）的600位控制組病患。詢問有關使用滑石粉的問卷，經常使用定義為每週至少於生殖器官／會陰部位使用一次滑石粉。
研究者評論，於生殖器官部位使用滑石粉，在這兩個族群都與卵巢癌風險顯著增加有關，95%信賴區間在NHS研究中較寬，因為其研究樣本數目較少。在合併分析中，與經常使用滑石粉有關的整體卵巢癌相對風險為1.36，而嚴重侵入性亞型為1.6。
這與過去收納16項研究的綜合分析結果大致相似，那項綜合分析發現經常於生殖器官部位使用滑石粉會增加整體上皮卵巢癌風險30%（Anticancer Res. 2003;23:1955-1960）。
研究者指出，於身體其他部位使用滑石粉並不會增加卵巢癌風險。
研究者寫道，雖然有些研究證實其顆粒可以穿過女性生殖道到達輸卵管與卵巢，而其他研究在卵巢組織發現了滑石粉顆粒，但於會陰部位使用滑石粉是否會到達卵巢，目前並不清楚。他們也指出，部分研究已經證實，滑石粉顆粒會引發活體外發炎反應，不但如此，其他研究證實這是一種與免疫反應有關的機轉。下生殖道暴露在滑石粉下可能就足以造成變化，例如產生熱休克蛋白，滑石粉堆積在骨盆淋巴結中，以及抗MUCI抗體減少，這些可能導致卵巢癌風險上升。
【滑石粉被歸類為「潛在的人類致癌原」】
美國癌症醫學會流行病學與監視性研究副總裁Michael Thun醫師評論，生殖器官部位使用滑石粉與卵巢癌風險增加之間的關連並不是新的。事實上，他指出，國際癌症研究署，將滑石粉歸類為「潛在的人類致癌原」；該組織與世界衛生組織合作。
Thun醫師評論，然而，對於這之間的關連，仍有一些問題，包括缺乏劑量與反應之間的關連性、滑石粉顆粒是否真的會到達卵巢、以及是否滑石粉被污染（例如石棉與石英），這些成分是否才是元兇？而不是滑石粉。第一個問題已經由最新的研究結果回答，且越來越多證據可以回答第二個問題，但有關於污染物的問題仍然存在，且目前並不清楚較新的、沒有這些污染物的滑石粉是否仍有這樣的問題。
當被問到有關於使用滑石粉的建議，Thun醫師表示，這是個人選擇。擔心的婦女們可以避免於生殖器官部位使用滑石粉，但這是否可以降低卵巢癌風險，仍然是未知的。
Thun醫師向Medscape腫瘤學表示，卵巢癌可以變更的危險因子並不多。最主要的是使用口服避孕藥物，這已經很清楚地可以降低卵巢癌風險。其他例如輸卵管結紮、子宮切除術與生產。接著有些因素可能會增加卵巢癌風險，與滑石粉一樣，包括石綿、停經後使用荷爾蒙治療以及放射線。
研究者們表示無相關資金上的往來。
=======================================================================
（英文原文：）
Talc Use in Genital Area Linked to Increased Risk for Ovarian Cancer
By Zosia Chustecka
Medscape Medical News
October 8, 2008 — Regular use of talc in the genital area was significantly associated with an increased risk for ovarian cancer in a new analysis reported in the September issue of Cancer Epidemiology Biomarkers and Prevention. The researchers say that genital use of talc should be avoided.
This is not a new finding — the association between genital talc use and an increased risk for ovarian cancer has been reported previously, and was confirmed in a meta-analysis of 16 studies.
These latest results provide additional support for a main effect of genital talc exposure on epithelial ovarian cancer, say the researchers. Also, the finding of highly significant trends between increasing frequency of use and risk strengthens the evidence of an association, because most previous studies have not observed a dose response, they point out.
In addition, this study was the first to analyze different genotypes. Researchers found that genes in detoxification pathways might be involved in the biologic response to talc. The association between talc and ovarian cancer might vary by genotype, the researchers report, although they add that more research is needed to confirm these findings.
We believe that women should be advised not to use talcum powder in the genital area, based on our results and previous evidence supporting an association between genital talc use and ovarian cancer risk, commented author Margaret Gates, ScD, research fellow at Brigham and Women\'s Hospital, in Boston, Massachusetts. Physicians should ask the patient about talc use history and should advise the patient to discontinue using talc in the genital area if the patient has not already stopped.
An alternative to talc is cornstarch powder, which has not been shown to increase ovarian cancer risk, or to forgo genital powder use altogether, she told Medscape Oncology.
No Risk From Talc Use Elsewhere on the Body
The latest findings come from an analysis of data from 2 separate study populations. Researchers obtained records for 1231 epithelial ovarian cancer cases and 1244 controls from the New England Case Control (NECC) study, and on 210 cases and 600 controls from the prospective Nurses\' Health Study (NHS). In the questionnaire about talc use, regular use was defined as the application of powder to the genital/perineal region at least once a week.
Genital talc use was associated with an increased risk for ovarian cancer in both study populations, although the 95% confidence intervals were wide in the NHS because of the limited sample size, the researchers comment. In the pooled analysis, the relative risk for the association with regular talc use was 1.36 for total ovarian cancer and 1.60 for the serous invasive subtype.
This is broadly similar to the findings from the meta-analysis of 16 previous studies, which reported an approximately 30% increase in the risk for total epithelial ovarian cancer with regular genital exposure to talc (Anticancer Res. 2003;23:1955-1960).
Talc use elsewhere on the body was not associated with an increase in ovarian cancer risk, the researchers point out.
It is unclear whether talc applied to the perineum can reach the ovaries, although some studies have shown that inert particles can travel through the female genital tract to the fallopian tubes and ovaries, and others have found talc particles in ovarian tissue, the researchers write. They also note that some studies have shown that talc particles can induce an inflammatory response in vivo, whereas others have suggested an immune-mediated mechanism. It might be that exposure of the lower genital tract to talc is sufficient to cause changes, such as production of heat shock proteins, accumulation of talc in pelvic lymph nodes, or decreased levels of anti-MUCI antibodies, and these could lead to an increase in the risk for ovarian cancer.
Talc Classified as Possible Human Carcinogen
The association between genital talc use and increased risk for ovarian cancer is not new, commented Michael Thun, MD, vice president of epidemiology and surveillance research at the American Cancer Society. In fact, he pointed out, the International Agency for Research on Cancer, which works with the World Health Organization, has classified talc as a possible human carcinogen.
However, there have been some questions about this association, including the lack of a dose–response relationship, whether talc particles could actually reach the ovaries, and whether it is the contaminants in talc (asbestos and quartz) that are to blame, rather than the talc itself, Dr. Thun commented. The first question has been answered by this latest study, and evidence is growing for the second, but the question about contaminants remains, and it is unclear whether modern products free of these contaminants carry a similar risk.
Asked about what advice should be given on the use of talc, Dr. Thun said that it was an individual choice. Women who are concerned can avoid the use of talc in the genital area, but whether or not this will reduce the risk of ovarian cancer is unclear, he said.
There are very few modifiable risk factors for ovarian cancer, Dr. Thun told Medscape Oncology. The main 1 is the use of oral contraceptives, which has been clearly established to lower the risk for ovarian cancer, he said. Others include tubal ligation, hysterectomy, and parity. Then there are factors that probably increase the risk for ovarian cancer, and this is where talc fits in, alongside asbestos, postmenopausal hormone therapy, and radiation.
The researchers have disclosed no relevant financial relationships.
Cancer Epidemiol Biomarkers Prev. 2008;17:2436-2444. Abstract
作者：Zosia Chustecka
出處：WebMD医学新闻
October 8, 2008 — 根据一項發表於9月號癌症流行病學生物標記與預防期刊上的研究結果，經常於生殖器官區域使用滑石粉，會顯著增加卵巢癌風險。研究團隊表示，應避免於生殖器官部位使用滑石粉。
這並不是一項新發現，生殖器官部位使用滑石粉與卵巢癌風險上升之間的關係，過去已經有相關報導，且於一項收納16項研究的綜合分析中獲得確認。
研究者表示，這項最新的研究提供了生殖器官部位使用滑石粉對於上皮卵巢癌主要作用更多的證據。他們指出，除此之外，這項使用頻率增加與風險上升之間高度顯著趨勢的研究結果，進一步強化了這之間關連的證據，因為過去大部分研究並未觀察到劑量與反應之間的關係。
此外，這項研究是第一項分析不同基因型的研究。研究團隊發現解毒路徑基因可能與滑石粉的生物反應有關。滑石粉與卵巢癌之間的關係可能隨著基因型而有不同，研究團隊指出，需要更多的研究來確認這些發現。
研究作者、麻州波士頓布萊根婦女醫院的研究員Margaret gates表示，根據我們的研究結果與過去的證據支持生殖器官部位使用滑石粉與卵巢癌風險之間的關係，我們認為，女性們應避免於在生殖器官部位使用滑石粉。臨床醫師們應該詢問病患使用滑石粉的病史，且如果病患尚未停止使用，應建議病患停止於生殖器官部位使用滑石粉。
她向Medscape腫瘤學表示，滑石粉的另一個選擇是玉米澱粉粉，並沒有研究顯示它會增加卵巢癌風險，或是放棄合併使用生殖器官用粉末。
【身體其他部位使用滑石粉並無風險】
最新的這項研究結果是來自兩個不同試驗族群，研究團隊取得1,231位上皮卵巢癌患者的紀錄，與1,244位來自新英格蘭病例控制（NECC）研究的控制組受試者，以及210位病例，還有600位來自前瞻性護士健康研究（NHS）的600位控制組病患。詢問有關使用滑石粉的問卷，經常使用定義為每週至少於生殖器官／會陰部位使用一次滑石粉。
研究者評論，於生殖器官部位使用滑石粉，在這兩個族群都與卵巢癌風險顯著增加有關，95%信賴區間在NHS研究中較寬，因為其研究樣本數目較少。在合併分析中，與經常使用滑石粉有關的整體卵巢癌相對風險為1.36，而嚴重侵入性亞型為1.6。
這與過去收納16項研究的綜合分析結果大致相似，那項綜合分析發現經常於生殖器官部位使用滑石粉會增加整體上皮卵巢癌風險30%（Anticancer Res. 2003;23:1955-1960）。
研究者指出，於身體其他部位使用滑石粉並不會增加卵巢癌風險。
研究者寫道，雖然有些研究證實其顆粒可以穿過女性生殖道到達輸卵管與卵巢，而其他研究在卵巢組織發現了滑石粉顆粒，但於會陰部位使用滑石粉是否會到達卵巢，目前並不清楚。他們也指出，部分研究已經證實，滑石粉顆粒會引發活體外發炎反應，不但如此，其他研究證實這是一種與免疫反應有關的機轉。下生殖道暴露在滑石粉下可能就足以造成變化，例如產生熱休克蛋白，滑石粉堆積在骨盆淋巴結中，以及抗MUCI抗體減少，這些可能導致卵巢癌風險上升。
【滑石粉被歸類為「潛在的人類致癌原」】
美國癌症醫學會流行病學與監視性研究副總裁Michael Thun醫師評論，生殖器官部位使用滑石粉與卵巢癌風險增加之間的關連並不是新的。事實上，他指出，國際癌症研究署，將滑石粉歸類為「潛在的人類致癌原」；該組織與世界衛生組織合作。
Thun醫師評論，然而，對於這之間的關連，仍有一些問題，包括缺乏劑量與反應之間的關連性、滑石粉顆粒是否真的會到達卵巢、以及是否滑石粉被污染（例如石棉與石英），這些成分是否才是元兇？而不是滑石粉。第一個問題已經由最新的研究結果回答，且越來越多證據可以回答第二個問題，但有關於污染物的問題仍然存在，且目前並不清楚較新的、沒有這些污染物的滑石粉是否仍有這樣的問題。
當被問到有關於使用滑石粉的建議，Thun醫師表示，這是個人選擇。擔心的婦女們可以避免於生殖器官部位使用滑石粉，但這是否可以降低卵巢癌風險，仍然是未知的。
Thun醫師向Medscape腫瘤學表示，卵巢癌可以變更的危險因子並不多。最主要的是使用口服避孕藥物，這已經很清楚地可以降低卵巢癌風險。其他例如輸卵管結紮、子宮切除術與生產。接著有些因素可能會增加卵巢癌風險，與滑石粉一樣，包括石綿、停經後使用荷爾蒙治療以及放射線。
研究者們表示無相關資金上的往來。
=======================================================================
（英文原文：）
Talc Use in Genital Area Linked to Increased Risk for Ovarian Cancer
By Zosia Chustecka
Medscape Medical News
October 8, 2008 — Regular use of talc in the genital area was significantly associated with an increased risk for ovarian cancer in a new analysis reported in the September issue of Cancer Epidemiology Biomarkers and Prevention. The researchers say that genital use of talc should be avoided.
This is not a new finding — the association between genital talc use and an increased risk for ovarian cancer has been reported previously, and was confirmed in a meta-analysis of 16 studies.
These latest results provide additional support for a main effect of genital talc exposure on epithelial ovarian cancer, say the researchers. Also, the finding of highly significant trends between increasing frequency of use and risk strengthens the evidence of an association, because most previous studies have not observed a dose response, they point out.
In addition, this study was the first to analyze different genotypes. Researchers found that genes in detoxification pathways might be involved in the biologic response to talc. The association between talc and ovarian cancer might vary by genotype, the researchers report, although they add that more research is needed to confirm these findings.
We believe that women should be advised not to use talcum powder in the genital area, based on our results and previous evidence supporting an association between genital talc use and ovarian cancer risk, commented author Margaret Gates, ScD, research fellow at Brigham and Women\'s Hospital, in Boston, Massachusetts. Physicians should ask the patient about talc use history and should advise the patient to discontinue using talc in the genital area if the patient has not already stopped.
An alternative to talc is cornstarch powder, which has not been shown to increase ovarian cancer risk, or to forgo genital powder use altogether, she told Medscape Oncology.
No Risk From Talc Use Elsewhere on the Body
The latest findings come from an analysis of data from 2 separate study populations. Researchers obtained records for 1231 epithelial ovarian cancer cases and 1244 controls from the New England Case Control (NECC) study, and on 210 cases and 600 controls from the prospective Nurses\' Health Study (NHS). In the questionnaire about talc use, regular use was defined as the application of powder to the genital/perineal region at least once a week.
Genital talc use was associated with an increased risk for ovarian cancer in both study populations, although the 95% confidence intervals were wide in the NHS because of the limited sample size, the researchers comment. In the pooled analysis, the relative risk for the association with regular talc use was 1.36 for total ovarian cancer and 1.60 for the serous invasive subtype.
This is broadly similar to the findings from the meta-analysis of 16 previous studies, which reported an approximately 30% increase in the risk for total epithelial ovarian cancer with regular genital exposure to talc (Anticancer Res. 2003;23:1955-1960).
Talc use elsewhere on the body was not associated with an increase in ovarian cancer risk, the researchers point out.
It is unclear whether talc applied to the perineum can reach the ovaries, although some studies have shown that inert particles can travel through the female genital tract to the fallopian tubes and ovaries, and others have found talc particles in ovarian tissue, the researchers write. They also note that some studies have shown that talc particles can induce an inflammatory response in vivo, whereas others have suggested an immune-mediated mechanism. It might be that exposure of the lower genital tract to talc is sufficient to cause changes, such as production of heat shock proteins, accumulation of talc in pelvic lymph nodes, or decreased levels of anti-MUCI antibodies, and these could lead to an increase in the risk for ovarian cancer.
Talc Classified as Possible Human Carcinogen
The association between genital talc use and increased risk for ovarian cancer is not new, commented Michael Thun, MD, vice president of epidemiology and surveillance research at the American Cancer Society. In fact, he pointed out, the International Agency for Research on Cancer, which works with the World Health Organization, has classified talc as a possible human carcinogen.
However, there have been some questions about this association, including the lack of a dose–response relationship, whether talc particles could actually reach the ovaries, and whether it is the contaminants in talc (asbestos and quartz) that are to blame, rather than the talc itself, Dr. Thun commented. The first question has been answered by this latest study, and evidence is growing for the second, but the question about contaminants remains, and it is unclear whether modern products free of these contaminants carry a similar risk.
Asked about what advice should be given on the use of talc, Dr. Thun said that it was an individual choice. Women who are concerned can avoid the use of talc in the genital area, but whether or not this will reduce the risk of ovarian cancer is unclear, he said.
There are very few modifiable risk factors for ovarian cancer, Dr. Thun told Medscape Oncology. The main 1 is the use of oral contraceptives, which has been clearly established to lower the risk for ovarian cancer, he said. Others include tubal ligation, hysterectomy, and parity. Then there are factors that probably increase the risk for ovarian cancer, and this is where talc fits in, alongside asbestos, postmenopausal hormone therapy, and radiation.
The researchers have disclosed no relevant financial relationships.
Cancer Epidemiol Biomarkers Prev. 2008;17:2436-2444. Abstract
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