Información del artículo
Resumen
Se analiza la potencia estadística de todas las publicaciones originales existentes hasta 1989 sobre anticonceptivos orales y cáncer de mama. Utilizando las técnicas del metaanálisis se ha recopilado un total de 77 publicaciones (procedentes de 44 estudios originales), que fueron evaluadas con respecto a la calidad de su metodología y otras variables referentes al patrón de publicación. El poder fue aceptable (≥0,8) sólo en el 10,8% de todas las asociaciones analizadas. La potencia mostró una relación significativa, como era de esperar, con la existencia de un riesgo relativo significativo entre los anticonceptivos orales y el cáncer de mama. No mostró una relación lineal con el tamaño muestra. No mostró, asi mismo, la potencia relación estadísticamente significativa con otras variables ligadas al diseño o con los sesgos encontrados en los estudios, aunque fue mayor en los estudios sin sesgo. La excepción a lo anterior fue la menor potencia de los estudios no apareados frente a los apareados. El análisis multivariable seleccionó como variables predictoras de un poder de 0,8 o más la existencia de significación en el riesgo relativo y la ausencia de sesgos en la investigación.
Palabras clave:
Anticonceptivos orales
Cáncer de mama
Metaanálisis
Métodos epidemiológicos
Estadística
Summary
The power of the association between oral contraceptives and breast cancer was analysed in all the papers published up to date. Seventy-seven publications (from 44 studies) were collected and graded as to quality using meta-analytical methods. Power achieved a figure of ≥0.8 in a 10.8% of the associations studied. It showed a significant relationship with the existence of a significant relative risk of the oral contraceptives for breast cancer. The relationship with the sample size of a study was not linear. Power did not show any significant relationship to other variables related to the design of a study (apart from matching, being the power higher in unmatched studies), or to the biases detected, although studies considered as unbiased yielded a higher power. Logistic regression analysis included as predictors of a power ≥0.80 the existence of a significant relative risk and the lack of biases in a research.
Key words:
Oral contraceptives
Breast neoplasms
Meta-analysis
Epidemiologic methods
Statistics
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Biblografía
[1.]
D.M. Parkin, E. Lāārā, C.S. Muir.
Estimates of the worldwide frequency of sixteen major cancers in 1980.
Int J Cancer, 41 (1988), pp. 184-197
[3.]
B.H. Hill.
The environment and disease: association or causation?.
Proc Royal Soc Med, 58 (1965), pp. 295-300
[4.]
M. Sillero Arenas.
Metaanálisis de la relación entre los contraceptivos orales y los cánceres de mama y de cuello uterino.
[5.]
M. Delgado Rodríguez, R. Rodríguez-Contreras, M. Sillero Arenas, P. Lardelli, A. Bueno, R. Gálvez, et al.
Contraceptivos orales y cánceres de mama y cuello uterino. Metaanálisis cualitativo.
Toko-Gin Práct, 49 (1990), pp. 336-344
[6.]
Delgado-Rodríguez M, Sillero Arenas M, Rodríguez-Contreras R, López Gigosos R, Gálvez vargas R. Oral Contraceptives and breast caneer. A meta-analysis. Rev Épidém Santé Publ (en prensa).
[7.]
T.C. Chalmers, H. Smith Jr., B. Blackburn, et al.
A method for assessing the quality of a randomized control trial.
Conrol Clin Trials, 2 (1981), pp. 31-49
[8.]
M.P. Longnecker, J.A. Berlin, M.J. Orza, T.C. Chalmers, et al.
A Meta-analysis of alcohol consumption in relation to risk of breast cancer.
JAMA, 260 (1988), pp. 652-656
[9.]
J.P. Realini, J.W. Goldzieher.
Oral contraceptive and cardiovascular disease: a critique of the epidemiologic studies.
Am J Obstet Gynecol, 152 (1985), pp. 729-798
[10.]
J.M. Elwood.
Causal relationships in Medicine. A practical system for critical appraisal.
[11.]
D.C.G. Skeeg.
Potential for bias in case-control studies of oral contraceptives and breast cancer.
Am J Epidemiol, 127 (1988), pp. 205-212
[12.]
J.M. Muhm, A.F. Olshan.
A program to calculate sample size, power, and least detectable relative risk using a programmable calculator.
Am J Epidemiol, 129 (1989), pp. 205-211
[13.]
J.P. Vandenbroucke.
Passive smoking and lung cancer: a publication bias?.
Br Med J, 296 (1988), pp. 391-392
[14.]
R. Rosenthal.
Metal-analytical procedures for social research.
[15.]
Boston Collaborative Drug Surveillance Programme.
Oral contraceptives and venous thromboembolic disease, surgically confirmed gallbladder disease, and breast tumours.
Lancet, 1 (1973), pp. 1.399-1.404
[16.]
B.E. Henderson, D. Powell, I. Rosario, et al.
An epidemiologic study of breast cancer.
JNCI, 53 (1974), pp. 609-614
[17.]
K. Stavraky, S. Emmons.
Breast cancer in premenopausal and postmenopausal women.
JNCI, 53 (1974), pp. 647-654
[18.]
P.E. Sartwell, F.G. Arthes, J.A. Tonascia.
Exogenous hormones, reproductive history, and breast cancer.
JNCI, 59 (1977), pp. 1.589-1.592
[19.]
F.G. Arthes, P.E. Sartwell, E.F. Lewison.
The pill, estrogens, and the breast.
Cancer, 28 (1971), pp. 1.391-1.394
[20.]
J.L. Kelsey, T.R. Holford, C. White, E.S. Mayer, S.E. Kilty, R.M. Acheson, et al.
Oral contraceptives and breast disease An epidemiological study.
Am J Epidemiol, 107 (1978), pp. 236-244
[21.]
A.W. Less, P.E. Burns, M. Grace.
Oral contraceptives and breast disease in premenopausal northern Albertan women.
Int J Cancer, 22 (1978), pp. 700-707
[22.]
B. Ravnlhar, D.G. Seigel, J. Lindtner.
An epidemiologic study of breast cancer and benign breast neoplasias in relation to the oral contraceptive and estrogen use.
Eur J Cancer, 15 (1979), pp. 395-405
[23.]
M.M. Balck, C.S. Kwon, H.P. Leis, T.H.C. Barclay, et al.
Family history and oral contraceptives. Unique relationships in breast cancer patients.
Cancer, 46 (1980), pp. 2.747-2.751
[24.]
H. Jick, A.M. Walker, R.N. Watkins, et al.
Oral contraceptives and breast cancer.
Am J Epidemiol, 112 (1980), pp. 577-585
[25.]
R.S. Paffenbarger, J.B. Kampert, H.-G. Chang.
Characteristics that predict risk of breast cancer before and alter the menopause.
Am J Epidemiol, 112 (1980), pp. 258-268
[26.]
R.S. Paffenbarger, J.B. Kampert, H.-G. Chang.
Oral contraceptives and breast cancer risk.
Edit INSERM, 83 (1979), pp. 93-114
[27.]
R.S. Paffenbarger, E. Fasal, M.E. Simmons, J.B. Kampert.
Cancer risk as related to use of oral contraceptives during fertile years.
Cancer, 39 (1977), pp. 1887-1891
[28.]
E. Fasal, R.S. Paffenbarger.
Oral contraceptives as related to cancer and benign lesions of the breast.
JNCI, 55 (1975), pp. 767-773
[29.]
F. Clavel, M. Lê, A. Laplanche.
Étude de la liaison entre le cancer du sein et la prise des médicaments hypotenseurs et contraceptifs oraux: résultats d'une étude cas-témoins.
Bull Cancer, 68 (1981), pp. 449-455
[30.]
M. Lê, R. Flamant, F. Clavel, C. Hill, et al.
Contraceptifs oraux et cancer du sein: résultats preliminaires d'une enquête française.
Edit INSERM, 83 (1979), pp. 169-180
[31.]
J.L. Kelsey, D.B. Fischer, T.R. Holford, et al.
Exogenous estrogens and other factors in the epidemiology of Breast cancer.
JNCI, 67 (1981), pp. 327-333
[32.]
L.A. Brinton, R.R. Williams, R.N. Hoover, N.L. Stegens, M. Feinleib, J.F. Fraumeni Jr., et al.
Breast cancer risk factors among screening program participants.
JNCI, 62 (1979), pp. 37-43
[33.]
L.A. Brinton, R. Hoover, M. Szklo, J.F. Fraumeni Jr., et al.
Oral contraceptives and breast cancer.
Int J Epidemiol, 11 (1982), pp. 316-322
[34.]
N.V. Harris, N.S. Weiss, A.M. Francis, L. Polissar, et al.
Breast cancer in relation to patterns of oral contraceptive use.
Am J Epidemiol, 116 (1982), pp. 643-651
[35.]
D.T. Janerich, A.P. Polednak, D.M. Glebatis, C.E. Lawrence, et al.
Breast cancer and oral contraceptive use, a case-control study.
J Chron Dis, 36 (1983), pp. 639-646
[36.]
M.C. Pike, B.E. Henderson, M.D. Krailo, A. Duke, S. Roy, et al.
Breast cancer in young women and use of oral contraceptives: Possible modifying effect of formulation and age at use.
Lancet, 2 (1983), pp. 926-930
[37.]
M.C. Pike, B.E. Henderson, J.T. Casagrande, I. Rosario, G.E. Gray, et al.
Oral contraceptive use and early abortion as risk factors for breast cancer in young women.
Br J Cancer, 43 (1981), pp. 72-76
[38.]
M.P. Vessey, R. Doll, P.M. Sutton.
Investigation of the possible relationship between oral contraceptives and bening and malignant breast disease.
Cancer, 26 (1971), pp. 1.395-1.399
[39.]
M.P. Vessey, R. Doll, P.M. Sutton.
Oral contraceptives and breast neoplasia: a retrospective study.
Br Med J, 3 (1972), pp. 719-724
[41.]
M.P. Vessey, R. Doll, K. Jones, K. McPherson, D. Yeates, et al.
An epidemiological study of oral contraceptives and breast cancer.
Br Med J, 1 (1979), pp. 1.755-1.758
[42.]
M.P. Vessey, K. McPherson, D. Yeates, R. Doll, et al.
Oral contraceptive use and abortion before first term pregnancy in relation to breast cancer risk.
Br J Cancer, 45 (1982), pp. 327-331
[43.]
M.P. Vessey, J. Baron, R. Doll, K. McPherson, D. Yeats, et al.
Oral contraceptives and breast cancer: final report of an epidemiologic study.
Br J Cancer, 47 (1983), pp. 455-462
[44.]
C.H. Hennekens, F.E. Speizer, R.J. Lipnick, et al.
A case-control study of oral contraceptive use and breast cancer.
JNCI, 72 (1984), pp. 39-42
[45.]
H. Olsson, M.L. Olsson, T.R. Moller, J. Ranstam, P. Holm, et al.
Oral contraceptive use and breast cancer in young women in Sweden.
Lancet, 1 (1985), pp. 748-749
[46.]
H. Olsson, T.R. Möller, J. Ranstam.
Early oral contraceptive use and breast cancer among premenopausal women: Final report from a study in Southern Sweden.
JNCI, 81 (1989), pp. 1.000-1.004
[47.]
R. Talamini, C. La Vecchia, S. Franceschi, et al.
Reproductive and hormonal factors and breast cancer in a northern Italian population.
Int J Epidemiol, 14 (1985), pp. 70-74
[48.]
C. La Vecchia, A. Decarli, M. Fasoli, et al.
Oral contraceptives and cancers of the breast and the genital tract. Interim results from a case-control study.
Br J Cancer, 54 (1986), pp. 311-317
[49.]
D.R. Miller, L. Rosenberg, D.W. Kaufman, D. Schottenfeld, P.D. Stolley, S. Shapiro, et al.
Breast cancer risk in relation to early oral contraceptive use.
Obstet Gynecol, 68 (1986), pp. 863-868
[50.]
L. Rosenberg, D.R. Miller, D.W. Kaufman, et al.
Breast cancer and oral contraceptive use.
Am J Epidemiol, 119 (1984), pp. 167-176
[51.]
C. Paul, D.C.G. Skegg, G.F.S. Spears, J.M. Kaldor, et al.
Oral contraceptives and breast cancer: a national study.
Br Med J, 293 (1986), pp. 723-726
[52.]
F.E. Alexander, M.M. Roberts, A. Huggins.
Risk factors for breast cancer with applications to selection for the prevalence screen.
J Epidemiol Commun Healt, 41 (1987), pp. 101-106
[53.]
N.C. Lee, L. Rosero-Bixby, M.W. Oberle, C. Grimaldo, A.S. Whatley, E.Z. Rovira, et al.
A case-control study of breast cancer and hormonal contraception in Costa Rica.
JNCI, 79 (1987), pp. 1.247-1.254
[54.]
K. McPherson, M.P. Vessey, A. Neil, R. Doll, L. Jones, M. Roberts, et al.
Early oral contraceptive use and breast cancer: results of another case-control study.
Br J Cancer, 56 (1987), pp. 653-660
[55.]
K. McPherson, A. Neil, M.P. Vessey, R. Doll, et al.
Oral contraceptives and breast cancer.
Lancet, 2 (1983), pp. 1.414-1.415
[56.]
R.C. Brownson, C.W. Backwell, D.K. Pearson, R.D. Reynolds, J.W. Richens, B.W. Papermaster, et al.
Risk of breast cancer in relation to cigarette smoking.
Arch Intern Med, 148 (1988), pp. 140-144
[57.]
B. Ravnihar, M.P. Zakelj, K. Kosmelj, J. Stare, et al.
A case-control study of breast cancer in relation to oral contraceptive use in Slovenia.
Neoplasma, 35 (1988), pp. 109-121
[58.]
The Centers for Disease Control and The National Institute of Child Health and Human Development.
Long-term oral contraceptive use and the risk of breast cancer.
JAMA, 249 (1983), pp. 1.591-1.595
[59.]
The Centers for Disease Control and The National Institute of Child Health and Human Development.
Oral contraceptive use and the risk of breast cancer. The Cancer and Steroid Hormone Study.
N Engl J Med, 315 (1986), pp. 405-411
[60.]
J.J. Schlesselman, B.V. Stadel, P. Murray, S. Lai, et al.
Breast cancer risk in relation to type of estrogen contained in oral contraceptives.
Contraception, 36 (1987), pp. 595-613
[61.]
J.J. Schlesselman, B.V. Stadel, P. Murray, S. Lai, et al.
Breast cancer in relation to early use of oral contraceptives. No evidence of a latent effect.
JAMA, 259 (1988), pp. 1.828-1.833
[62.]
B.V. Stadel, G.L. Rubin, L.A. Webster, J.J. Shlesselman, P.A. Wingo, et al.
Oral contraceptives and breast cancer in young women.
Lancet, 2 (1985), pp. 970-973
[63.]
B.V. Stadel, S. Lai, J.J. Schlesselman, P. Murray, et al.
Oral contraceptives and premenopausal breast cancer in nulliparous women.
Contraception, 38 (1988), pp. 287-299
[64.]
B.V. Stadel, J.J. Schlesselman, P.A. Murray.
Oral contraceptives and breast cancer.
Lancet, 1 (1989), pp. 1.257-1.258
[65.]
P.P. Murray, B.V. Stadel, J.J. Schlesselman.
Oral contraceptive use in women with a family history of breast cancer.
Obstet Gynecol, 73 (1989), pp. 977-983
[66.]
J. Peto.
Oral contraceptives and breast cancer: is the CASH study really negative?.
Lancet, 1 (1989), pp. 552
[67.]
W.D. Dupont, D.L. Page, L.W. Rogers, F.F. Parl, et al.
Influence of exogenous estrogens, proliferative breast disease, and other variables on breast cancer risk.
Cancer, 63 (1989), pp. 948-957
[68.]
O. Meirik, T.M.M. Farley, E. Lund, H.-O. Adami, T. Christoffersen, P. Bergsjö, et al.
Breast cancer and oral contraceptives: patters of risk among parous and nulliparous women —Further analysis of the Swedish-Norwegian material.
Contraception, 39 (1989), pp. 471-475
[69.]
O. Meirik, E. Lund, H.O. Adami, R. Bergström, T. Christoffersen, P. Bergsjö, et al.
Oral contraceptive use and breast cancer in young women. A Joint National Case-Control Study in Sweden and Norway.
Lancet, 2 (1986), pp. 650-654
[70.]
D.R. Miller, L. Rosenberg, D.W. Kaufman, P. Stolley, M.E. Warshauer, S. Shapiro, et al.
Breast cancer before age 45 and oral contraceptive use: new findings.
Am J Epidemiol, 129 (1989), pp. 269-280
[71.]
UK National Case-control Study Group.
Oral contraceptive use and breast cancer risk in young women.
Lancet, 1 (1989), pp. 973-982
[72.]
C. Ellery, R. MacLennan, G. Berry, R. Shearman, et al.
A case-control study of breast cancer in relation to the use of steroids contraceptive agents.
Med J Aust, 144 (1986), pp. 173-176
[73.]
S.S. Jick, A.M. Walker, A. Stergachis, H. Jick, et al.
Oral contraceptives and breast cancer.
Br J Cancer, 59 (1989), pp. 618-621
[74.]
T.E. Rohan, A.J. McMichael.
Oral contraceptive agents and breast cancer: a population-based case-control study.
Med J Aust, 149 (1988), pp. 520-526
[75.]
E. Redondo Margüello, A.L. Aguilar Oliván, F. Bernaldo de Quirós Abad, V. Furió Bacete, et al.
Estudio epidemiológico del cáncer de mama en nuestro medio.
Toko-Gin Pract, 48 (1989), pp. 334-340
[76.]
R.D. Gambrell Jr..
Oral contraceptives and breast cancer.
Lancet, 2 (1983), pp. 1.201-1.202
[77.]
R.D. Gambrell Jr..
Commentary: Oral contraception and breast cancer risk.
J Reprod Med, 31 (1986), pp. 543-545
[78.]
S. Ramcharan, F.A. Pellegrin, R.M. Ray, J.-P. Hsu, et al.
The Walnut Creek Contraceptive drug study. A prospective study of the side effects of oral contraceptives. Volume III, an interim report: A comparison of disease ocurrence leading to hospitalization or death in users and nonusers of oral contraceptives.
J Reprod Med, 25 (1980), pp. 346-372
[79.]
S. Ramcharan, F.A. Pellegrin, R. Roy, J.P. Hsu, et al.
The Walnut Creek contraceptive drug study —a prospective study of the side effects of oral contraceptives.
pp. 81-564
[80.]
Royal College of General Practitioners.
Oral contraceptives and Health. An interim report from the Oral Contraception Study of the Royal College of General Practitioners.
[81.]
Royal College of General Practitioners.
Breast cancer and oral contraceptives: findings in Royal College of General Practitioners' study.
Br Med J, 282 (1981), pp. 2.089-2.093
[82.]
C.R. Kay, P.C. Hannaford.
Breast cancer and the pill —A further report from the Royal College of General Practitioners' oral contraception study.
Br J Cancer, 58 (1988), pp. 675-680
[83.]
E.J. Trapido.
A prospective cohort study of oral contraceptives and breast cancer.
JNCI, 67 (1981), pp. 1.011-1.015
[84.]
H. Ory, P. Cole, B. MacMahon, R. Hoover, et al.
Oral contraceptives and reduced risk of benign breast diseases.
N Engl J Med, 294 (1976), pp. 419-422
[85.]
M.P. Vessey, K. McPherson, L. Villard-Mackintosh, D. Yeates, et al.
Oral contraceptives and breast cancer: latest findings in a large cohort study.
Br J Cancer, 59 (1989), pp. 613-617
[86.]
M.P. Vessey, K. McPherson, R. Doll.
Breast cancer and oral contraceptives: findigns in Oxford-Family Planning Association contraceptive study.
Br Med J, 282 (1981), pp. 2.093-2.094
[87.]
M.P. Vessey, R. Doll, R. Peto, B. Johnson, P. Wiggins, et al.
A long-term follow-up study of women using different methods of contraception —an interim report.
J Biosoc Sci, 8 (1976), pp. 373-427
[88.]
R.J. Lipnick, J.E. Buring, C.H. Hennekens, et al.
Oral contraceptives and breast cancer. A prospective cohort study.
JAMA, 255 (1986), pp. 58-61
[89.]
I. Romieu, W.C. Willett, G.A. Colditz, et al.
Prospective study of oral contraceptive use and risk of breast cancer in women.
JNCI, 81 (1989), pp. 1.313-1.321
[90.]
P.K. Mills, W.L. Beeson, R.L. Philips, G.E. Fraser, et al.
Prospective study of exogenous hormone use and breast cancer in seveth-day adventists.
Cancer, 64 (1989), pp. 591-597
[91.]
W.L. Beeson, P.K. Mills, R.L. Phillips, M. Andress, G.E. Fraser, et al.
Chronic disease among seventh-day adventists, a low risk group. Rationale, methodology, and description of the population.
Cancer, 64 (1989), pp. 570-581
[92.]
W.J. Dixon, F.J. Massey Jr..
Introduction to Statistical analysis.
4 ed, pp. 87-91
[93.]
K. O'Rourke, A.S. Detsky.
Meta-analysis in medical research: Strong encouragement for higher quality in individual research efforts.
J Clin Epidemiol, 42 (1989), pp. 1.021-1.024
[94.]
R.J. Light, D.B. Pillemer.
Summing up: The science of reviewing research.
[95.]
C.B. Begg, J.A. Berlin.
Publication bias and dissemination of clinical research.
JNCI, 81 (1989), pp. 107-115
[96.]
J. Hetherington, K. Dickersin, I. Chalmers, C.L. Meinert, et al.
Retrospective and prospective identification of unpublished controlled trials: Lessons from a survey of obstetricians and pediatricians.
Pediatrics, 84 (1989), pp. 374-380
[97.]
R.L. Prentice, D.B. Thomas.
On the epidemiology of oral contraceptives and disease.
Adv Cancer Res, 49 (1987), pp. 285-401
[98.]
J.M. Domènech i Massons.
Bioestadistica. Métodos estadísticos para investigadores.
3 ed,
[99.]
K. McPherson, P.A. Coope, M.P. Vessey.
Early oral contraceptive use and breast cancer.
J Epidemiol Commun Health, 40 (1986), pp. 289-294
[100.]
K. McPherson.
Latent effect of oral contraceptives on breast cancer (letter).
JAMA, 260 (1988), pp. 1.240-1.241
[101.]
M.G. Lé, C. Hill, A. Kramar, L.H. Moulton, et al.
Possible cohort effects in studies on oral contraceptive use and breast cancer.
Br J Cancer, 52 (1985), pp. 805-806
[102.]
H. Olsson, J. Ranstam, T.R. Möller.
On cohort effects in studies on oral contraceptive use and breast cancer.
Br J Cancer, 53 (1986), pp. 579
[103.]
H.W. Simpson, W. Candlish, A.W. Pauson, C.S. McArdle, K. Griffiths, R.G. Small, et al.
Genesis of breast cancer is in the premenopause.
Lancet, 2 (1988), pp. 74-76
[104.]
Rodriguez-Gontreras R. Delgado Rodliguez M, Sillero Arenas M, Lardelli Ciaret P, Gálvez Vargas R. Contraceptivos orales y cáncer de culello uterino: análisis del poder de asociación. Rev San Hig Públ (en prensa).
Copyright © 1991. Sociedad Española de Salud Pública y Administración Sanitaria
