Risk factors for epithelial ovarian cancer in women under age 45

doi:10.1016/0959-8049(93)90077-S

European Journal of Cancer

Volume 29, Issue 9, 1993, Pages 1297-1301

https://doi.org/10.1016/0959-8049(93)90077-S Get rights and content

Abstract

Risk factors for ovarian cancer in young women were investigated using data from a case-control study conducted between 1983 and 1992 in Milan, northern Italy, on 194 women below age 45 with histologically confirmed incident cancers of the ovary and 710 controls admitted to the same network of hospitals for acute non-gynecological, non-hormonal and non-neoplastic diseases. An elevated relative risk (RR) of ovarian cancer was found among women reporting 12 or more years of education [RR 1.6, 95% confidence intervals (CI) 1.0–2.03] and belonging to the highest social class (RR 1.8, 95% CI 1.1–3.0). Women whose mothers had had ovarian cancer had a multivariate RR of 2.7 (95% CI 0.7–10.5) compared to those with no family history. Menarche above age 13 and irregular menstrual cycles were significantly protective against ovarian cancer (RR 0.6 for both risk factors). There was a significant inverse relationship with abortions, the RR being 0.6 both for spontaneous and for induced abortions, while protection of parity was not significant. Higher risks of ovarian cancer were observed in women having first or last birth when older than 30 years (RR 2.0 and 2.4, respectively, compared to those delivering under age 25). A significant trend toward an increased risk of ovarian cancer was also observed with decreasing time since last birth. Compared with women whose last birth occurred 10 or more years before diagnosis, the RR was 2.1 (95% CI 1.1–3.9) for those reporting a birth during the last 5 years. The RR for oral contraceptive users was 0.7 (95% CI 0.5–1.0) and the protection increased with duration, with RR of 0.3 (95% CI 0.1–0.7) for 5 or more years of use. This study indicates that, although the incidence of ovarian cancer is higher in older women, recognised risk and protective factors are similar below age 45. An excess risk in the few years after a term delivery is also suggested.

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Has Age at Menarche Changed? Results from the National Health and Nutrition Examination Survey (NHANES) 1999-2004
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Citation Excerpt :
Other prospective studies have reported that sexual maturation is associated with body size [22,25,26], ethnicity [10,26,27], and exposure to environmental toxicants including polychlorinated aromatic hydrocarbons (PCAHs) [30], polychlorinated biphenyls (PCBs) and polybrominated biphenyls (PBBs) [31], and dioxins [32]. Additionally, menarcheal age may be an etiologic factor for chronic diseases such as osteoporosis [33], cancer [34,35], and cardiovascular disease [36]. This analysis used a unique approach to examine menarcheal trends in U.S. adults and provides national data on three race/ethnic groups, including Mexican American women 60 years of age and over.
To examine self-reported age at menarche in U.S. adults and the associations between age at menarche and race/ethnicity.
Data from 1999–2004 National Health and Nutrition Examination Survey (NHANES) for 6788 females 20 years and over were analyzed. Self-reported age at first menses (in years) by birth year groups is reported overall and for Mexican Americans, non-Hispanic whites, and non-Hispanic blacks.
Mean age at menarche in the United States declined over time from 13.3 years (95% CI: 13.2–13.5) in the oldest age group, those born prior to 1920, to 12.4 years (95% C.I. 12.2–12.5 years) in the youngest group, born between 1980 and 1984. Declines in age at menarche were observed for all race/ethnicity groups. Non-Hispanic black females had the largest decline in mean age at menarche from 13.6 years (95% CI: 13.1–14.1) in women born prior to 1920, to 12.2 years (95% CI: 11.8–12.6) in the 1980–84 birth cohort. Mean age at menarche among non-Hispanic white females declined from 13.3 years (13.1–13.6) in the pre-1920 birth cohort to 12.5 years (12.3–12.8) in the 1980–84 birth cohort.
Significant declines in the mean age of menarche for U.S. females occurred overall and for all race/ethnic groups examined. Mean age of menarche declined by .9 year overall in women born before 1920 compared to women born in 1980–84; the declines in the mean age at menarche ranged from .7 to 1.4 years depending on the race/ethnicity group.
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Ovarian cancer is the leading cause of death from gynaecological malignancy. The incidence is high in the Western world. The incidence of ovarian cancer is reduced by pregnancy, lactation, the oral contraceptive pill and tubal ligation. Lifestyle factors are important in the aetiology of ovarian cancer and current evidence suggests the risk can be reduced by eating a diet rich in fruit and vegetables, taking regular exercise, avoiding smoking, avoiding being overweight and avoiding long-term use of hormonal replacement therapy (HRT). Familial ovarian cancer is responsible for about 10% of ovarian cancer cases. Strategies available to high-risk women include screening (covered elsewhere) and prophylactic salpingo-oophorectomy. The precise role of chemoprevention for high-risk women in the form of the oral contraceptive pill is unclear.
Hereditary breast and ovarian cancer
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Time since last birth and the risk of ovarian cancer
2001, Gynecologic Oncology
Objectives. While parity is a protective factor in ovarian cancer, the role of time factors of pregnancy and birth is still controversial. We considered therefore the role of birth timing in the risk in ovarian cancer from a large case–control study.
Methods. Cases were 971 women (age range 22–74 years, median age 54) with histologically confirmed, incident epithelial ovarian cancer, interviewed between 1983 and 1991 in a network of hospitals in Milan, Italy. Controls were 2758 women (age range 23–74 years, median age 52) admitted to the same hospitals where cases were identified for acute, nonneoplastic conditions.
Results. In comparison with nulliparous women, the multivariate odds ratios (OR) were 0.8 for women reporting one or two and 0.6 for those with three or more births. No clear association emerged between time since last birth and ovarian cancer. Compared to women who had last given birth since ≥20 years, a moderately increased risk of ovarian cancer was observed in the first 10 years after last birth, with an OR of 1.7 (95% confidence interval, CI 1.0–2.9). When we considered only multiparous women and included in the multivariate analysis allowance for age at first birth, the OR decreased to 1.2 (95% CI 0.6–2.4). No consistent pattern of trends was observed ≥10 years since last pregnancy.
Conclusions. This study confirms the protective effect of parity on ovarian carcinogenesis, but shows no consistent pattern of risk across time since last birth.
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1997, Critical Reviews in Oncology/Hematology
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PaperRisk factors for epithelial ovarian cancer in women under age 45

Abstract

Gynecol Oncol

Adv Cancer Res

Eur J Cancer

Lancet

Gynecol Oncol

Lancet

Cancer incidence and mortality in Europe

Soz Praventivmed

Pooled analysis of 3 European case-control studies: I. Reproductive factors and risk of epithelial ovarian cancer

Int J Cancer

Pooled analysis of 3 European case-control studies of epithelial ovarian cancer: III. Oral contraceptive use

Int J Cancer

Familial ovarian cancer: a population-based case-control study

Am J Epidemiol

Paper
Risk factors for epithelial ovarian cancer in women under age 45