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首页> 外文期刊>Gynecologie, obstetrique & fertilit >Levonorgestrel-releasing intrauterine device (Mirena) and breast cancer: what do we learn from literature for clinical practice?
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Levonorgestrel-releasing intrauterine device (Mirena) and breast cancer: what do we learn from literature for clinical practice?

机译：释放左炔诺孕酮的宫内节育器（Mirena）和乳腺癌：从临床实践中我们可以从文献中学到什么？

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摘要

Annual occurrence of breast cancer is constantly increasing in France. In 2000, the number of breast cancer cases for women of 30-49 years was estimated at 9,918, which represents 23.7% of all breast cancer cases diagnosed that year. The levonorgestrel-releasing intrauterine device (IUD LNG) is one of the most frequently used coils in France. Because contraception is an important matter for women whose ovarian function survived cancer treatments, the question of whether to use such device on a woman with breast cancer has become a frequent and controversial gynaecological issue. With the review of available literature as a basis, we have tried to answer the following questions. First, whether the use of IUD LNG increases the risk of breast cancer: there is at the moment no "A" level answer available. According to the only study published, which may be considered "C" level, there is no such increase. Second, whether the use of IUD LNG counterbalances the endometrial effects of Tamoxifene: based on a limited level of evidence via a single randomised controlled trial on a small number of patients for one year only, this device appears to be able to prevent benign endometrial modifications. However, there is no conclusive study regarding its effectiveness on the prevention of endometrium adenocarcinoma caused by Tamoxifene. In addition, there are numerous uncertainties as to whether levonorgestrel presence in the plasma would have a systemic prejudicial impact. Third, whether a woman with a personal antecedent of breast cancer can safely use DIU LNG: it is necessary to remove it promptly upon suspicion or diagnosis, to dissuade its use in case of current cancer, and, in the event of cancer remission for more than 5 years, to generally avoid this contraceptive method except on a case by case basis and with a regular medical follow-up. In the latter situation, the use of IUD LNG can be considered only after a multidisciplinary collective formal decision and after the woman gave her informed consent.
机译：在法国，每年发生的乳腺癌在不断增加。 2000年，估计30-49岁女性的乳腺癌病例数为9,918，占当年确诊的所有乳腺癌病例的23.7％。左炔诺孕酮宫内节育器（IUD LNG）是法国最常用的线圈之一。由于避孕对于卵巢功能在癌症治疗后幸存的女性来说是重要的事情，因此是否对患有乳腺癌的女性使用这种装置已成为妇科常见且有争议的问题。在回顾现有文献的基础上，我们试图回答以下问题。首先，使用宫内节育器液化天然气是否会增加患乳腺癌的风险：目前尚无“ A”级答案。根据唯一发表的研究，可以将其视为“ C”级，没有这种增加。其次，使用宫内节育器LNG是否能抵消他莫昔芬对子宫内膜的影响：基于一项针对少数患者的单项随机对照试验仅一年的有限证据，该设备似乎能够防止良性子宫内膜改变。但是，关于其在预防由他莫昔芬引起的子宫内膜腺癌方面的有效性尚无定论。另外，血浆中左炔诺孕酮的存在是否会产生系统性的偏见影响，存在许多不确定性。第三，患有乳腺癌的妇女是否可以安全地使用DIU LNG：有怀疑或诊断时应立即将其移除，以防万一目前患有癌症，并在癌症缓解后进一步使用它。 5年以内，通常要避免使用这种避孕方法，除非要逐案并定期进行医学随访。在后一种情况下，只有在经过多学科的集体正式决定并在妇女知情同意后，才可以考虑使用宫内节育器液化天然气。

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