{"id":437,"date":"2022-12-27T23:37:54","date_gmt":"2022-12-27T22:37:54","guid":{"rendered":"https:\/\/antikoncepcia.org\/?p=437"},"modified":"2022-12-29T10:14:12","modified_gmt":"2022-12-29T09:14:12","slug":"lng-iud-a-rakovina","status":"publish","type":"post","link":"https:\/\/antikoncepcia.org\/?p=437","title":{"rendered":"LNG-IUD a rakovina"},"content":{"rendered":"

RAKOVINA PRSN\u00cdKA<\/strong><\/p>\n

Aktu\u00e1lne prib\u00fadaj\u00fa d\u00f4kazy o zv\u00fd\u0161enom riziku rakoviny prsn\u00edka u \u017eien pou\u017e\u00edvaj\u00facich LNG-IUD (vn\u00fatromaternicov\u00e9 teliesko uvo\u013e\u0148uj\u00face levonorgestrel\u00a0 (LNG)). V ned\u00e1vnom systematickom presk\u00faman\u00ed (Conz a\u00a0kol., 2020<\/em>) pou\u017e\u00edvanie LNG-IUD s\u00faviselo s v\u00fdznamne zv\u00fd\u0161en\u00fdm rizikom rakoviny prsn\u00edka (OR 1.16; 95%CI: 1.06-1.28, P<\/em><0.01).[i]<\/a> Siegelmann-Danieli a\u00a0kol<\/em>. (2018) pozorovali v\u00fdznamne zv\u00fd\u0161en\u00e9 riziko invaz\u00edvnej rakoviny prsn\u00edka (P<\/em>=0.014) v\u00a0skupine mlad\u0161\u00edch pou\u017e\u00edvateliek LNG-IUD (40 \u2013 45 rokov).[ii]<\/a> Vo ve\u013ekej celon\u00e1rodnej \u0161t\u00fadi\u00ed v\u00a0D\u00e1nsku (M\u00f8rch a\u00a0kol. 2017<\/em>), ktor\u00e1 sledovala 1.8 mili\u00f3na \u017eien vo veku 15 \u2013 49 rokov, pou\u017e\u00edvate\u013eky LNG-IUD mali riziko rakoviny prsn\u00edka zv\u00fd\u0161en\u00e9 o\u00a021% (RR 1.21, 95%CI: 1.11\u22121.33).[iii]<\/a> V\u00a0n\u00f3rskej \u0161t\u00fadii vykonanej v\u00a0r\u00e1mci n\u00e1rodn\u00e9ho skr\u00edningov\u00e9ho programu (Ellingjord-Dale a\u00a0kol., 2017<\/em>), riziko rakoviny prsn\u00edka v\u00fdznamne r\u00e1stlo s trvan\u00edm u\u017e\u00edvania LNG-IUD; riziko bolo zv\u00fd\u0161en\u00e9 o\u00a017% pri pou\u017e\u00edvan\u00ed LNG-IUD 2 \u2013 5 rokov; o\u00a016% pri pou\u017e\u00edvan\u00ed 6 \u2013 10 rokov a\u00a0a\u017e o\u00a035% pri pou\u017e\u00edvan\u00ed LNG-IUD dlh\u0161ie ako 10 rokov (P<\/em><0.0001).[iv]<\/a> Vo ve\u013ekej celon\u00e1rodnej \u0161t\u00fadii vykonanej vo F\u00ednsku (Soini a\u00a0kol., 2016<\/em>), \u017eeny pou\u017e\u00edvaj\u00face LNG-IUD mali zv\u00fd\u0161en\u00e9 riziko jednak dukt\u00e1lnej (SIR 1.20, 95%Cl: 1.14\u20131.25, P<\/em><0.001) a jednak lobul\u00e1rnej rakoviny prsn\u00edka (SIR 1.33, 95%CI: 1.20\u20131.46, P<\/em><0.001). Najvy\u0161\u0161ie riziko rakoviny prsn\u00edka bolo pozorovan\u00e9 u\u00a0\u017eien, ktor\u00e9 pou\u017e\u00edvali LNG-IUD dlh\u0161ie ako 10 rokov (SIR 1.73, 95%Cl 1.37\u20132.15, P<\/em><0.001 pre lobul\u00e1rnu rakovinu).[v]<\/a> Trinh a\u00a0kol.<\/em> (2008) zistili, \u017ee \u017eeny pou\u017e\u00edvaj\u00face LNG-IUD v \u010dase diagn\u00f3zy rakoviny prsn\u00edka a ktor\u00e9 pokra\u010dovali v jeho pou\u017e\u00edvan\u00ed, mali viac ako 3-n\u00e1sobne zv\u00fd\u0161en\u00e9 riziko n\u00e1vratu ochorenia v porovnan\u00ed so \u017eenami, ktor\u00e9 nepou\u017e\u00edvali LNG-IUD (HR 3.39; P<\/em>=0.048). A\u017e 47.4% t\u00fdchto \u017eien malo postihnut\u00e9 uzliny a v\u0161etky pacientky s recid\u00edvou mali metast\u00e1zy.[vi]<\/a><\/p>\n

 <\/p>\n

RAKOVINA KR\u010cKA MATERNICE<\/strong><\/p>\n

V\u00a0\u0161t\u00fadii, ktor\u00fa vykonali Loopik a\u00a0kol.<\/em> (2020), pou\u017e\u00edvanie vn\u00fatromaternicov\u00fdch teliesok (v\u00e4\u010d\u0161ina \u017eien pou\u017e\u00edvala LNG-IUD) s\u00faviselo s\u00a0v\u00fdznamne zv\u00fd\u0161en\u00fdm rizikom v\u00fdvinu cervik\u00e1lnej intraepiteli\u00e1lnej neopl\u00e1zie 3+ (RR 1.51, 95%CI:1.32\u22121.74).[vii]<\/a> Cervik\u00e1lna intraepiteli\u00e1lna neopl\u00e1zia 3+ (CIN3+) zah\u0155\u0148a CIN3, adenokarcin\u00f3m in situ<\/em> alebo rakovinu kr\u010dka maternice.[viii]<\/a> Averbach a\u00a0kol.<\/em> (2018) hodnotili s\u00favislos\u0165 medzi pou\u017e\u00edvan\u00edm vn\u00fatromaternicov\u00e9ho telieska (IUD) pod\u013ea typu (LNG-IUD, meden\u00e9 IUD) a cervik\u00e1lnou intraepiteli\u00e1lnou neopl\u00e1ziou 2 a 3 (CIN2, CIN3), adenokarcin\u00f3mom in situ<\/em> alebo rakovinou (CIN2+ alebo CIN3+). Ned\u00e1vne pou\u017e\u00edvanie LNG-IUD s\u00faviselo so \u0161tatisticky v\u00fdznamne zv\u00fd\u0161en\u00fdm rizikom CIN2+ (RR 1.18, P<\/em><0.001) a\u00a0CIN 2 (RR 1.44; P<\/em><0.001).[ix]<\/a> V\u00a0\u0161t\u00fadii, ktor\u00fa vykonali Spotnitz a\u00a0kol<\/em>. (2020) diagn\u00f3za cervik\u00e1lnej neopl\u00e1zie vysok\u00e9ho stup\u0148a bola viac ako 2-n\u00e1sobne vy\u0161\u0161ia u pou\u017e\u00edvateliek LNG-IUD v\u00a0porovnan\u00ed s\u00a0pou\u017e\u00edvan\u00edm meden\u00e9ho IUD (P<\/em><0.02).[x]<\/a><\/p>\n

Shanmugasundaram a kol.<\/em> (2016) preuk\u00e1zali, \u017ee pou\u017e\u00edvanie LNG-IUD zvy\u0161uje koncentr\u00e1cie faktorov ovplyv\u0148uj\u00facich z\u00e1palov\u00e9 a imunosupres\u00edvne zmeny v imunitnom prostred\u00ed kr\u010dka a\u00a0sliznice maternice ako s\u00fa Monocyte Chemoattractant Protein-1, TNFalpha, IL-1beta, IFNgamma, IL-12 a IFNalpha2.[xi]<\/a> V\u00a0\u0161t\u00fadii, ktor\u00fa vykonali Smith-McCune a\u00a0kol.<\/em> (2020), pou\u017e\u00edvate\u013eky LNG-IUD v\u00a0porovnan\u00ed so \u017eenami, ktor\u00e9 ho nepou\u017e\u00edvali, mali v\u00a0sliznici maternice odli\u0161ne exprimovan\u00fdch a\u017e 2 509 g\u00e9nov reguluj\u00facich predov\u0161etk\u00fdm imunitn\u00e9 a z\u00e1palov\u00e9 dr\u00e1hy.[xii]<\/a> Faktory zni\u017euj\u00face lok\u00e1lnu imunitu v\u00a0oblasti kr\u010dka maternice, zvy\u0161uj\u00fa riziko z\u00edskania infekci\u00ed HIV (\u013eudsk\u00fd imunodeficientn\u00fd v\u00edrus) a\u00a0HPV (\u013eudsk\u00fd papil\u00f3ma v\u00edrus). Existuj\u00fa siln\u00e9 d\u00f4kazy, \u017ee infekcia HPV zohr\u00e1va v\u00fdznamn\u00fa \u00falohu v\u00a0etiol\u00f3gii nielen rakoviny kr\u010dka maternice, ale aj vulvy a vag\u00edny.[xiii]<\/a> [xiv]<\/a> [xv]<\/a><\/p>\n

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N\u00c1DORY MOZGU<\/strong><\/p>\n

V\u00a0\u0161t\u00fadii, ktor\u00fa realizovali Andersen a\u00a0kol.<\/em> (2015), riziko gli\u00f3mu (zhubn\u00fd n\u00e1dor mozgu) bolo najvy\u0161\u0161ie pri pou\u017e\u00edvan\u00ed antikoncepcie (tablety alebo LNG-IUD) obsahuj\u00facej len gestag\u00e9n (OR 2.8, 95%CI: 1.6\u22125.1). Pou\u017e\u00edvanie LNG-IUD s\u00faviselo s\u00a0takmer 2.5-n\u00e1sobne zv\u00fd\u0161en\u00fdm rizikom gli\u00f3mu (OR 2.4 95%Cl: 0.8\u22126.8).[xvi]<\/a> Supartoto a\u00a0kol.<\/em> (2019) zistili, \u017ee \u010d\u00edm dlh\u0161ie sa pou\u017e\u00edvali antikoncep\u010dn\u00e9 gestag\u00e9ny, t\u00fdm ni\u017e\u0161ia bola expresia progester\u00f3nov\u00e9ho receptora (PR) a NF2<\/em> (Neurofibromatosis-2) g\u00e9nu v s\u00e9re. N\u00edzka expresia PR a NF2 <\/em>s\u00favisela s vy\u0161\u0161\u00edm rizikom meningi\u00f3mu (meningi\u00f3m je najbe\u017enej\u0161\u00ed prim\u00e1rny n\u00e1dor mozgu), \u010do nazna\u010duje, \u017ee n\u00edzka expresia PR a inaktiv\u00e1cia NF2 m\u00f4\u017eu hra\u0165 k\u013e\u00fa\u010dov\u00fa \u00falohu vo v\u00fdvine meningi\u00f3mu s\u00favisiacim s\u00a0pou\u017e\u00edvan\u00edm gestag\u00e9nov na antikoncep\u010dn\u00e9 \u00fa\u010dely.[xvii]<\/a><\/p>\n

V\u00a0\u0161t\u00fadii, ktor\u00fa realizovali Wigertz<\/em><\/a> a\u00a0kol.<\/em> (2006) pou\u017e\u00edvanie dlhodobo p\u00f4sobiacej hormon\u00e1lnej antikoncepcie (LNG-IUD, antikoncep\u010dn\u00e9 injekcie a antikoncep\u010dn\u00e9 implant\u00e1ty) s\u00faviselo s\u00a01.5-n\u00e1sobne vy\u0161\u0161\u00edm rizikom meningi\u00f3mu (OR 1.5, 95%Cl: 0.9\u22122.6). Riziko meningi\u00f3mu r\u00e1stlo s\u00a0d\u013a\u017ekou jej pou\u017e\u00edvania a bolo takmer 3-n\u00e1sobne vy\u0161\u0161ie pri pou\u017e\u00edvan\u00ed 10 rokov a\u00a0dlh\u0161ie (OR 2.7, 95%Cl: 0.9\u22127.5).[xviii]<\/a> Harland a\u00a0kol.<\/em> (2018) zistili v\u00fdznamne zv\u00fd\u0161en\u00e9 riziko opakovania ochorenia na meningi\u00f3m (P<\/em>=0.038) a\u00a0krat\u0161ie pre\u017eitie bez progresie ochorenia u\u00a0\u017eien pou\u017e\u00edvaj\u00facich antikoncepciu obsahuj\u00facu len gestag\u00e9n.[xix]<\/a> Podobne aj najaktu\u00e1lnej\u0161ie \u0161t\u00fadie pozorovali s\u00favislos\u0165 medzi pou\u017e\u00edvan\u00edm syntetick\u00fdch gestag\u00e9nov a\u00a0rizikom v\u00fdvinu meningi\u00f3mu (Malaize a\u00a0kol., 2021<\/em>[xx]<\/a>, Apra a kol., 2020[xxi]<\/a>). V\u00fdsledky uveden\u00fdch \u0161t\u00fadi\u00ed nazna\u010duj\u00fa pozit\u00edvnu s\u00favislos\u0165 medzi pou\u017e\u00edvan\u00edm antikoncepcie obsahuj\u00facej len gestag\u00e9n a\u00a0n\u00e1dormi mozgu, av\u0161ak v\u00a0pr\u00edpade LNG-IUD s\u00fa potrebn\u00e9 \u010fal\u0161ie v\u00fdskumy.<\/p>\n

 <\/p>\n

 <\/p>\n

Odborn\u00e9 pramene<\/strong><\/em><\/p>\n

[i]<\/a> Conz L, Mota BS, Bahamondes L, et al. Levonorgestrel-releasing intrauterine system and breast cancer risk: A systematic review and meta-analysis. Acta Obstetricia et Gynecologica Scandinavica. 2020 Aug;99(8):970-982.<\/p>\n

[ii]<\/a> Siegelmann-Danieli N, Katzir I, Landes JV, et al. Does levonorgestrel-releasing intrauterine system increase breast cancer risk in peri-menopausal women? An HMO perspective. Breast Cancer Research and Treatment.\u00a0 2018 Jan;167(1):257-262.<\/p>\n

[iii]<\/a> M\u00f8rch LS, Skovlund CW, Hannaford PC, et al. Contemporary Hormonal Contraception and the Risk of Breast Cancer. The New England Journal of Medicine. 2017 Dec 7;377(23):2228-2239.<\/p>\n

[iv]<\/a> Ellingjord-Dale M, Vos L, Tretli S, Hofvind S, dos-Santos-Silva I, Ursin G. Parity, hormones and breast cancer subtypes – results from a large nested case-control study in a national screening program. Breast Cancer Research\u202f: BCR. 2017;19:10.<\/p>\n

[v]<\/a> Soini T, Hurskainen R, Gr\u00e9nman S. Levonorgestrel-releasing intrauterine system and the risk of breast cancer: A nationwide cohort study. Acta Oncologica. 2016;55(2):188-92.<\/p>\n

[vi]<\/a> Trinh XB, Tjalma WA, Makar AP. et al. Use of the levonorgestrel-releasing intrauterine system in breast cancer patients. Fertility and Sterility. 2008 Jul;90(1):17-22.<\/p>\n

[vii]<\/a> Loopik DL, IntHout J, Melchers WJG, Massuger LFAG, Bekkers RLM, Siebers AG. Oral contraceptive and intrauterine device use and the risk of cervical intraepithelial neoplasia grade III or worse: a population-based study. European Journal of Cancer<\/a>. 2020 Jan;124:102-109.<\/p>\n

[viii]<\/a> Averbach S<\/a>, Silverberg MJ<\/a>, Leyden W<\/a>, et al. Recent intrauterine device use and the risk of precancerous cervical lesions and cervical cancer. Contraception.<\/a> 2018 Apr 17; S0010-7824(18)30144-6. .<\/p>\n

[ix]<\/a> Averbach S<\/a>, Silverberg MJ<\/a>, Leyden W<\/a>, et al. Recent intrauterine device use and the risk of precancerous cervical lesions and cervical cancer. Contraception.<\/a> 2018 Apr 17; S0010-7824(18)30144-6.<\/p>\n

[x]<\/a> Spotnitz ME, Natarajan K, Ryan PB, Westhoff CL. Relative Risk of Cervical Neoplasms Among Copper and Levonorgestrel-Releasing Intrauterine System Users. Obstetrics and Gynecology. 2020 Feb;135(2):319-327.<\/p>\n

[xi]<\/a> Shanmugasundaram U, Hilton JF, Critchfield JW, et al. Effects of the levonorgestrel-releasing intrauterine device on the immune microenvironment of the human cervix and endometrium. American Journal of Reproductive Immunology. 2016 Aug ;76(2):137-148.<\/p>\n

[xii]<\/a> Smith-McCune K, Thomas R, Averbach S, et al. Differential Effects of the Hormonal and Copper Intrauterine Device on the Endometrial Transcriptome. Scientific Reports. 2020;10(1):6888.<\/p>\n

[xiii]<\/a> Bosch FX<\/a>, Broker TR<\/a>, Forman D<\/a>. et al. Comprehensive control of human papillomavirus infections and related diseases. See comment in PubMed Commons belowVaccine.<\/a> 2013 Dec 31;31 Suppl 7:H1-31.<\/p>\n

[xiv]<\/a> Tomai\u0107 V. Functional Roles of E6 and E7 Oncoproteins in HPV-Induced Malignancies at Diverse Anatomical Sites. Mok SC, ed. Cancers. 2016 Oct;8(10):95.<\/p>\n

[xv]<\/a> Walline HM, Komarck C, McHugh JB, et al. High-risk human papillomavirus detection in oropharyngeal, nasopharyngeal, and, oral cavity cancers: Comparison of multiple methods. JAMA Otolaryngology– Head & Neck Surgery. 2013 Dec;139(12):1320-1327.<\/p>\n

[xvi]<\/a> Andersen L, Friis S, Hallas J. et al. Hormonal contraceptive use and risk of glioma among younger women: a nationwide case-control study. <\/em>British Journal of Clinical Pharmacology. 2015;79(4):677-684.<\/p>\n

[xvii]<\/a> Supartoto A, Sasongko MB, Respatika D, et al. Relationships Between Neurofibromatosis-2, Progesterone Receptor Expression, the Use of Exogenous Progesterone, and Risk of Orbitocranial Meningioma in Females. Frontiers in Oncology. 2019 Jan 9;8:651.<\/p>\n

[xviii]<\/a> Wigertz A, L\u00f6nn S, Mathiesen T. et al. Risk of brain tumors associated with exposure to exogenous female sex hormones. American Journal of Epidemiology.<\/em> 2006 Oct 1;164(7):629-36.<\/p>\n

[xix]<\/a> Harland TA, Freeman JL, Davern M, et al. Progesterone-only contraception is associated with a shorter progression-free survival in premenopausal women with WHO Grade I meningioma. Journal of Neuro-oncology. 2018 Jan;136(2):327-333.<\/p>\n

[xx]<\/a> Malaize H, Samoyeau T, Zanello M, et al. Evolution of the neurosurgical management of progestin-associated meningiomas: a 23-year single-center experience. Journal of Neuro-Oncology. 2021 \u00a0Apr;152(2):279-288.<\/p>\n

[xxi]<\/a> Apra, C., Roblot, P., Alkhayri, A. et al.<\/em> Female gender and exogenous progesterone exposition as risk factors for spheno-orbital meningiomas. Journal of Neuro-Oncology. 149, <\/strong>95\u2013101 (2020).<\/p>\n

 <\/p>\n

(zdroj obr\u00e1zka: commons.wikimedia.org)<\/p>\n","protected":false},"excerpt":{"rendered":"

RAKOVINA PRSN\u00cdKA Aktu\u00e1lne prib\u00fadaj\u00fa d\u00f4kazy o zv\u00fd\u0161enom riziku rakoviny prsn\u00edka … <\/p>\n","protected":false},"author":4,"featured_media":474,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_monsterinsights_skip_tracking":false,"footnotes":""},"categories":[1,2,57,43],"tags":[325,198,332,331,324,329,328,280,188,189,326,330,180,4,3,187,327],"class_list":["post-437","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-psychika","category-rakovina","category-zdravie","category-zmeny-na-sliznici-maternice","tag-adenokarcinom-in-situ","tag-adolescentky","tag-antikoncepcne-implantaty","tag-antikoncepcne-injekcie","tag-cervikalna-intraepitelialna-neoplazia-3","tag-gestagen","tag-gliom","tag-hpv","tag-iud","tag-lng","tag-medene-vnutromaternicove-teliesko","tag-meningiom","tag-nadory-mozgu","tag-rakovina-krcka-maternice","tag-rakovina-prsnika","tag-vnutromaternicove-teliesko","tag-zvysne-riziko-infekcii-hiv"],"_links":{"self":[{"href":"https:\/\/antikoncepcia.org\/index.php?rest_route=\/wp\/v2\/posts\/437","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/antikoncepcia.org\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/antikoncepcia.org\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/antikoncepcia.org\/index.php?rest_route=\/wp\/v2\/users\/4"}],"replies":[{"embeddable":true,"href":"https:\/\/antikoncepcia.org\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=437"}],"version-history":[{"count":4,"href":"https:\/\/antikoncepcia.org\/index.php?rest_route=\/wp\/v2\/posts\/437\/revisions"}],"predecessor-version":[{"id":455,"href":"https:\/\/antikoncepcia.org\/index.php?rest_route=\/wp\/v2\/posts\/437\/revisions\/455"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/antikoncepcia.org\/index.php?rest_route=\/wp\/v2\/media\/474"}],"wp:attachment":[{"href":"https:\/\/antikoncepcia.org\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=437"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/antikoncepcia.org\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=437"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/antikoncepcia.org\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=437"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}