背景:2006年,国际癌症研究机构(IARC)得出结论,无石棉滑石的致癌性证据不足(第3组),而会阴使用滑石粉被归类为可能致癌(2B组)。
目的:评估后续研究是否提供了有关无石棉滑石粉和滑石粉致癌风险的更可靠信息以及更好的暴露特征。
方法:系统评价。
方法:对接触无石棉滑石粉的滑石粉矿工和磨坊进行队列研究,以及从2006年起发表的报告滑石粉消费者癌症风险的队列和病例对照研究通过PubMed和参考列表进行了鉴定.包括汇总分析,但不是评论和荟萃分析。在反复报告研究的情况下,选取随访时间最长或观察病例数量最多的文章进行数据抽象.注意到分别报告并包括在汇总分析中的研究。
结果:符合纳入标准的出版物是:2项关于滑石粉矿工和磨坊的队列研究,10项关于滑石粉使用者的队列研究(其中4项评估卵巢癌风险),和14个病例对照研究(13个卵巢和1个子宫内膜癌)的滑石粉使用的风险。在无石棉滑石粉矿工和磨坊主中,没有报告过重的癌症死亡率。病例对照研究始终导致与使用会阴滑石粉相关的卵巢癌过度估计(比值比高达1.5)。大多数量化暴露的研究也提供了剂量-反应关系的证据。个体队列研究估计风险比(HR)略高于1。在对总共3,112例病例的汇总队列的分析中,生殖道未闭女性的HR为1.13(95CI1.01-1.26),HR与使用频率之间存在相关性(p为趋势0.03).在所有队列研究中,在随访的早期阶段,会阴使用滑石粉仅测量一次,从而产生不准确的累积暴露量。关于其他器官癌症风险的流行病学研究结果有限且不一致。
结论:在IARC2006年评估后更新或发表的流行病学研究表明:无石棉滑石粉矿工和磨坊主的癌症风险没有增加;在会阴使用商业滑石粉后,卵巢癌的风险增加。许多研究表明,使用量指标与癌症风险之间存在相关性。在这些研究中考虑的滑石粉的组成是未知的。
in 2006, the International Agency for Research on Cancer (IARC) concluded that the evidence of carcinogenicity for
asbestos-free talc was inadequate (group 3), whereas perineal use of talcum powder was classified as possibly carcinogenic (group 2B).
to assess whether later studies provide more solid information on the carcinogenic risk from
asbestos-free talc and talcum powder and a better characterization of exposure.
systematic review.
cohort studies of talc miners and millers exposed to
asbestos-free talc, as well as cohort and case-control studies reporting cancer risk in talc powder consumers published from 2006 onwards were identified through PubMed and reference lists. Pooled analyses were included, but not reviews and meta-analyses. In the case of repeatedly reported studies, the article with the longest follow-up or the largest number of observed cases was selected for data abstraction. Notice was taken of studies which were both reported individually and included in pooled analyses.
publications meeting inclusion criteria were: 2 cohort studies on talc miners and millers, 10 cohort studies on talcum powder users (4 of which estimated ovarian cancer risk), and 14 case-control studies (13 on ovarian and 1 on endometrial cancer) on the risk from talcum powder use. No excess cancer mortality has been reported among
asbestos-free talc miners and millers. Case-control studies consistently led to estimates of ovarian cancer excesses associated with the use of perineal talcum powder (odds ratios up to 1.5). Most studies quantifying exposure also provided evidence of a dose-response relationship. Individual cohort studies estimated hazard ratios (HR) just above 1. In an analysis of pooled cohorts for a total of 3,112 cases, the HR for women with patent reproductive tract was 1.13 (95%CI 1.01-1.26) with a correlation between HR and frequency of use (p for trend 0.03). In all cohort studies, the perineal use of talcum powder was measured only once in the early phases of follow-up, thus producing an inaccurate measure of cumulative exposure. Results of epidemiological studies regarding cancer risk in other organs are limited and inconsistent.
epidemiological studies updated or published after IARC 2006 evaluation indicate that: no increase in cancer risk is apparent among miners and millers of
asbestos-free talc; risk for ovarian cancer increases following the perineal use of commercial talcum powder. A correlation between indicators of quantity of use and cancer risk is suggested by a number of studies. The composition of talcum powders considered in such studies is not known.