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PubMed2003

Medical, reproductive and psychosocial experiences of women diagnosed with von Willebrand's disease receiving care in haemophilia treatment centres: a case-control study.

OBJECTIVE: To assess the medical, gynaecological and reproductive experiences of women with von Willebrand's disease (VWD) and to evaluate the impact of VWD on mental health and life activities. METHODS: A total of 102 women with VWD who were registered in haemophilia treatment Centres (HTCs) in the United States and 88 controls were interviewed regarding medical, gynaecological and reproductive history, life activities and symptoms of depression. Symptoms of depression were measured using the Center for Epidemiological Studies Depression Scale (CES-D). RESULTS: Excessive bleeding symptoms were reported in 74% of VWD cases compared with 6% of controls. Women with VWD had a higher prevalence of menorrhagia, excessive postpartum bleeding, other gynaecological conditions, arthritis and migraine headaches than did controls. More VWD cases than controls reported that menstruation had a negative impact on overall life activities. No difference in the prevalence of depression was found between cases and controls. DISCUSSION: Women with VWD experience menorrhagia and other gynaecological conditions at a higher frequency than women without bleeding disorders. Menstruation in women with VWD has a negative impact on life activities. The prevalence of depression was not elevated in this group of women whose VWD is being managed in an HTC.

Activities of Daily Living↗
PubMed2003

Lifestyle, parity, menstrual and reproductive factors and risk of gallbladder cancer.

Together with thyroid cancer, cancer of the gallbladder is the only non-sex hormone-related cancer displaying a female preponderance, with incidence being 3-4 times more common among women. We carried out this study to evaluate the role of menstrual, reproductive and lifestyle factors in gallbladder carcinogenesis. A case-control study involving 64 newly diagnosed cases of gallbladder cancer and 101 cases of cholelithiasis was carried out. A detailed menstrual and reproductive history was illustrated beside detailed lifestyle history, in particular consumption of betel nut, tobacco and alcohol and smoking, odds ratio was calculated. Mean age of the patients with cancer was 51+/-1.2 years while it was 40.9+/-1.2 years for gallstones; 69% of cancer patients and 90% of gallstones patients were females. More than half of the cancer patients (53%) and 43% of the gallstone patients were illiterate. A past history of typhoid was present in 22% of cancer patients and 13% of gallstone patients, while 35% of cancer and 25% of gallstone patients were chewers, 18.1 and 9.9% were smokers, and 10% of cancer and 2% of gallstone patients consumed alcohol. Mean age of menarche was 13.4+/-1.2 years among female patients with cancer while it was 14.0+/-1.4 years for gallstone patients. Higher age at menarche (>13 years, OR 2.48, 95% confidence interval (CI) 1.16-5.3), higher number of childbirths(>3 births, OR 3.92; 95% CI 1.4-10.3), higher number of pregnancies (>3 pregnancies, OR 6.66, 95% CI 1.8-23.4), and higher age at last childbirth (>25 years, OR 2.97, 95% CI 1.04-8.5) were found to have significantly higher risk of developing gallbladder cancer. In conclusion, tobacco chewing and smoking are associated with increased odds of gallbladder cancer. Similarly early menarche, late menopause, multiple pregnancies and childbirth increased the risk of gallbladder cancer.

Adult↗
PubMed2004

Ectopic pregnancy in Africa: a population-based study.

OBJECTIVE: To estimate the incidence of ectopic pregnancy in Yaounde, the capital of Cameroon (Central Africa). METHODS: In 2000, all women admitted for an ectopic pregnancy to health facilities in the city of Yaounde were systematically enrolled. Sociodemographic information on the women and their reproductive history was collected by questionnaire during a face-to-face interview. Medical and obstetrical data (clinical findings at hospital entry, medical history, type of surgery, and final vital status) were collected from gynecologic and surgical files and admission registers. RESULTS: We recorded 320 cases of ectopic pregnancy in health facilities in the city of Yaounde and we estimated that 40100 live births occurred during the same study period (January to December 2000). The population-based incidence rate of ectopic pregnancy in the city of Yaounde was 0.79% (95% confidence interval 0.72%, 0.88%) in 2000. Three maternal deaths were recorded giving a mortality rate of 0.94% (95% confidence interval 0.32%, 2.72%). CONCLUSION: The 0.79% ectopic pregnancy incidence rate observed in this African country must be considered a minimum due to probable underestimation. Nevertheless, this rate is lower than that currently observed in industrialized countries. Late diagnosis, low percentage of conservative treatment, and subsequent maternal deaths are important findings that should encourage African gynecologists to promote ectopic pregnancy prevention programs and to improve the care given to women with ectopic pregnancy. LEVEL OF EVIDENCE: III

Adolescent↗
PubMed2006

Experience of miscarriage in the UK: qualitative findings from the National Women's Health Study.

Miscarriage is the most common adverse outcome in pregnancy. For many women it is a traumatic experience. Previous research has identified shortcomings in the emotional and social support provided for miscarriage sufferers but personal accounts of pregnancy loss remain relatively under-explored. The UK National Women's Health Study (NWHS) is a nationally representative survey of women's reproductive histories. It provided an opportunity to study accounts of miscarriage written in response to an invitation for further comments on the survey questionnaire. In conjunction with quantitative findings from the NWHS, we thematically analysed 172 detailed narratives that facilitated qualitative exploration of a characteristically private event. Analysis of the narratives suggested that few women who had planned their pregnancy were satisfied with fatalistic explanations of miscarriage. Those who were not given medical explanations for their loss engaged in complex searches for meaning, often linked to accounts of their moral deservedness as mothers. The narratives highlighted tensions between biomedical and lay understandings of pregnancy loss. There were reports of inappropriate medicalisation and a perceived lack of emotional support, but also a desire for medical validation of the reality of miscarriage and investigations to identify medical causes. Professionals' reported behaviour played a key role in women's accounts. These findings remind providers that: women do not experience miscarriage as a routine complication; medicalisation is both resisted and desired; and, for some women, more support and information is needed to assist their search for meaning.

Abortion, Spontaneous↗
PubMed1997

Dichlorodiphenyltrichloroethane serum levels and breast cancer risk: a case-control study from Mexico.

Some, but not all, epidemiological studies have suggested that dichlorodiphenyltrichloroethane (DDT) may play a role in the development of breast cancer. These investigations have been conducted in countries where this substance has been banned for at least 20 years. We conducted a study in Mexico, a country in which DDT is still being used to control malaria. In a hospital-based case-control study, we compared 141 histologically confirmed cases of breast cancer with 141 age-matched controls (+/-3 years). All subjects were identified at three referral hospitals of Mexico City between March 1994 and April 1996. Reproductive histories and other variables were obtained by structured interviews, DDT/DDE levels were determined in serum by gas-liquid chromatography. The arithmetic mean of serum DDE in lipid basis was 562.48 +/- 676.18 ppb (range, 10.24-4661.44) for the cases and 505.46 +/- 567.22 ppb (range, 0.004 to 4361.75) for the controls, but this difference was not statistically significant. The age-adjusted odds ratios for breast cancer regarding the serum level of DDE were 0.69 (95% confidence interval, 0.38-1.24) and 0.97 (confidence interval, 0.55-1.70) for the contrasts between tertile 1 (lowest level) and tertiles 2 and 3, respectively. These estimates were unaffected by adjustment for body mass, accumulated time of breast-feeding and menopause, and other breast cancer risk factors. These results do not lend support to the hypothesis that DDT is causally related to breast cancer at the body-burden levels found in our study population but do not exclude the possibility that higher levels of exposure could still play a role in the etiology of this tumor.

Adult↗
PubMed2006

[Prevalence and associated factors of osteoporosis among postmenopausal women in Chuncheon: Hallym Aging Study (HAS)].

OBJECTIVES: A community-based, cross-sectional survey was conducted to determine theprevalence of osteoporosis and to evaluate the effects of body composition, health behaviors and reproductive history on bone density in postmenopausal women. METHODS: The study subjects were 362 postmenopausal women, aged 45 years old or over, who were invited to the hospital. Information on their socio-demographic characteristics and the potential risk factors such as their past medical history, smoking, alcohol intake, exercise, diet and menstrual/reproductive histories were collected by trained interviewers. Weight, height, the body mass index (kg/m2), and body composition variables were measured. Bone mineral density of the lumbar spine was measured by dual energy X-ray absorptiometry (DXA). RESULTS: The prevalence of osteoporosis was 30.6% in the 45-64 years old women, 52.5% in the elderly women aged 65-74, and 68.7% in the women aged 75 years or over. After adjustment for the effect of potential covariates, those women in the highest 25% (4th quartile) of the lean body mass are less likely to have osteoporosis (aOR=0.31, 95% CI=0.12-0.76), compared with the lowest quartile group. More parity also had significantly detrimental effects on osteoporosis. CONCLUSIONS: These findings suggest that the prevalence of osteoporosis in postmenopausal women increased with age from 46.3% of those aged 45-64 to 68.7% for those aged 75 and over. Lean body mass and parity appeared significant contributor to bone mineral density in postmenopausal women in this population.

Aged↗
PubMed2003

The association between hormonal and reproductive factors and hand osteoarthritis.

OBJECTIVE: To describe the association of reproductive and hormonal factors with the presence and severity of hand osteoarthritis (OA) in Tasmanian women. METHODS: Cross-sectional study of 348 women from 76 families. A structured questionnaire collected information regarding reproductive history and the use of estrogen containing medications. Hand OA was assessed by two observers using the Altman atlas for joint space narrowing and osteophytes at distal interphalangeal (DIP) and carpometacarpal (CMC) joints, as well as Heberden's nodes (HN) based on hand photography. RESULTS: The prevalence of hand OA was high in this sample at 65-70%. Parity, increasing age at menopause and years of menstruation were associated with both symptomatic hand OA and a more severe DIP score (but not presence of radiographic disease) while both current and ever use of hormone replacement therapy (HRT) were significantly associated with increased prevalence of HN and severity of HN and DIP OA (all P<0.05). HRT usage less than 5 years was associated with increased severity of both DIP disease and HN. No factors were associated with CMC disease apart from ever breast-feeding which was protective (OR 0.37, 95% CI 0.18-0.79). CONCLUSIONS: These results require confirmation in clinical trials or carefully controlled longitudinal studies but suggest that estrogen exposure around the time of disease onset (either endogenous or exogenous) may have a "priming" effect on the severity of DIP OA while breast-feeding in earlier life may be protective for CMC OA.

Aged↗
PubMed1998

Childbearing and the risk of Hodgkin's disease.

The causes of Hodgkin's disease remain incompletely known, but a higher incidence in men than in women has prompted an interest in the role of female sex hormones and reproductive history. Available epidemiological data are, however, contradictory. We analyzed possible associations between parity, age at first birth, and the risk of developing Hodgkin's disease by a linkage between the Swedish Cancer Register and a nationwide Fertility Register. Among women born between 1925 and 1972, 917 cases with Hodgkin's disease and concomitant fertility information were identified. For each case patient, five age-matched controls were randomly selected among women in the Fertility Register. Conditional logistic regression was used to estimate odds ratios of Hodgkin's disease associated with a birth. We found a slightly and nonsignificantly reduced risk of Hodgkin's disease in ever-parous compared with nulliparous women. Among parous women, the number of children was unrelated to risk, whereas there was some evidence of an increased risk with late age at first birth in women under age 45 at diagnosis. No clear temporal relations between childbearing and subsequent risk were discernible in any parity or age group. Although uncontrolled confounding might have affected our results, they do not indicate that hormonal or immunological changes associated with childbearing play a role in the development of Hodgkin's disease.

Adult↗
PubMed1996

A case-control study of parity, age at first full-term pregnancy, breast feeding and breast cancer in Taiwanese women.

A hospital-based case-control study was designed herein to investigate the relationship between parity, breast feeding and breast cancer in Taiwan. Reproductive histories of patients with breast cancer confirmed by either pathology or cytology were assessed by questionnaire and compared with age-matched healthy controls. One hundred and fourteen cases and 228 age-matched controls were recruited for this study. According to those results, women having had more than three full-term pregnancies, age at first full-term pregnancy younger than 30, and breast feeding for more than 3 years displayed significantly protective effects against breast cancer. Following adjustment for ethnicity and menopausal status, women with more than three full-term pregnancies and younger than 30 years old at first full-term pregnancy had a decreased risk of breast cancer. However, duration of breast feeding was not related to breast cancer, after adjustment for ethnicity and menopausal status. The effect of number of full-term pregnancies on the risk of breast cancer was found to be independent of the effect of age at first full-term pregnancy. Moreover, the effect of age at first full-term pregnancy and number of full-term pregnancies was also independent of the effect of breast feeding.

Abortion, Spontaneous↗
PubMed2004

Age at natural menopause and exposure to organochlorine pesticides in Hispanic women.

A cross-sectional study was conducted to evaluate the relationship between exposure to selected organochlorine pesticides (OCP) (p,p'-DDT, p',p'-DDE, dieldrin, hexachlorobenzene, beta-hexachlorocyclohexane [beta-HCH], oxychlordane, trans' nonachlor) and age at natural menopause in a sample of 219 menopausal women participating in the Hispanic Health and Nutrition Examination Survey in 1982-1984. Information on age at menopause, reproductive history, demographic variables, and potential confounding variables was collected via interview. Analysis of variance was employed to compare adjusted mean age at natural menopause among women by category of serum OCP level. Serum levels of p,p'-DDT, p,p'-DDE, beta-HCH, and trans-nonachlor were associated with a younger age at menopause. In particular, women with exposure levels in the highest exposure categories (serum p,p'-DDT > or = 6ppb, beta-HCH > or = 4ppb, or trans-nonachlor > or = 2ppb) had an adjusted mean age at menopause on average 5.7, 3.4, and 5.2 yr earlier, respectively, than women with serum levels of these pesticides below the detection limit. Women with serum p,p'-DDE levels greater than 23.6 ppb (highest quintile) had an adjusted mean age at menopause 1.7 yr earlier than women with serump,p'-DDE levels less than 5.5 ppb (lowest quintile). However, no consistent dose-response effect was apparent across low, medium, and high exposure categories. Interactions were detected for p,p'-DDT in combination with beta-HCH, trans-nonachlor, or oxychlordane, as well as beta-HCH in combination with oxychlordane.

Adolescent↗
PubMed1996

Child spacing and two child policy in practice in rural Vietnam: cross sectional survey.

OBJECTIVE: To explore the reproductive pattern of women in rural Vietnam in relation to the existing family planning policies and laws. DESIGN: Cross sectional survey with question-naires on reproductive history. SETTING: Tien Hai, a district in Red River Delta area, where the population density is one of the highest in Vietnam. SUBJECTS: 1132 women who had at least one child under 5 years of age in April 1992. MAIN OUTCOME MEASURES: Birth spacing and probability of having a third child. RESULTS: The mean age at first birth was 22.2 years. The average spacing between the first and the second child was 2.6 years. Mothers with a lower educational level, farmers, and women belonging to the Catholic religion had shorter spacing between the first and second child and also a higher probability of having a third child. In addition, women who had no sons or who had lost a previous child were more likely to have a third child. CONCLUSION: Most families do not adhere to the official family planning policy, which was introduced in 1988, stipulating that each couple should have a maximum of two children with 3-5 years' spacing in between. More consideration should be given to family planning needs and perceptions of the population, supporting the woman to be in control of her fertility. This may imply improved contraceptive services and better consideration of sex issues and cultural differences as well as improved social support for elderly people.

Age Factors↗
PubMed1994

Bacterial vaginosis and vaginal microorganisms in idiopathic premature labor and association with pregnancy outcome.

The vaginal microflora of 49 women in idiopathic preterm labor was compared with that of 38 term controls to determine whether the presence of bacterial vaginosis (BV) and/or specific microorganisms would influence the rate of preterm delivery. Demographic factors, pregnancy outcome, and reproductive history were also studied. BV, as defined by the presence of clue cells in a vaginal wet mount and characteristic microbial findings in a stained vaginal smear and vaginal culture, was more common in women with preterm labor and delivery than in controls (P < 0.01). The condition, diagnosed in 41% of women who had both preterm labor and delivery (n = 22) and in 11% each of women who had preterm labor but term delivery (n = 27) and controls, was associated with a 2.1-fold risk (95% confidence intervals, 1.2 to 3.7) for preterm birth prior to 37 weeks of gestation. BV was associated with low birth weight. Of 49 women with preterm labor, 67% (8 of 12) of women with BV were delivered of low-birth-weight neonates (< 2,500 g) compared with 22% (8 of 37) of women without the condition (P < 0.0005). The presence of hydrogen peroxide-producing facultative Lactobacillus spp. was strongly negatively associated with both preterm delivery and BV. BV-associated microorganisms, i.e., Mobiluncus, Prevotella, and Peptostreptococcus species, Porphyromonas asaccharolytica, Fusobacterium nucleatum, Mycoplasma hominis, and high numbers of Gardnerella vaginalis were significantly associated with preterm delivery; all species also strongly associated with BV (P = 0.0001 for each comparison). Mobiluncus curtisii and Fusobacterium nucleatum were recovered exclusively from women with preterm delivery. Our study clearly indicates that BV and its associated organisms are correlated with idiopathic premature delivery.

Adult↗
PubMed2004

Miscarriage but not fecundity is associated with progression of joint destruction in rheumatoid arthritis.

OBJECTIVE: To determine whether reproductive history before disease onset is associated with severity of joint destruction in rheumatoid arthritis. METHODS: A special early arthritis clinic (EAC) was established at the department of rheumatology of Leiden University Medical Centre. General practitioners were encouraged to refer patients with joint complaints to this clinic, where the diagnosis of rheumatoid arthritis was made by a rheumatologist. In all, 113 female patients with definite rheumatoid arthritis were included in this study. A structured questionnaire was administered and joint damage was assessed by sequential x rays of the hands and feet, using the modified Sharp score. RESULTS: The length of time of unprotected intercourse until first pregnancy (fecundity) was comparable with data from earlier studies, with 16% of the patients reporting a time to first pregnancy of more than 12 months. Fecundity did not reflect the extent of joint damage over time. The miscarriage rate was 15% per pregnancy, comparable to population figures (12-15%). A significant increase in joint damage over a two year follow up was found in patients with rheumatoid arthritis who had experienced at least one miscarriage compared with those who had never had a miscarriage (mean modified Sharp scores at 2 years, 24 (95% confidence interval, 15 to 32) and 16 (10 to 23), respectively; p<0.05). At baseline, the Sharp scores were similar in the two subgroups. CONCLUSIONS: Miscarriage before disease onset but not fecundity is associated with the progression of joint damage in rheumatoid arthritis.

Abortion, Spontaneous↗
PubMed2001

Mechanisms of hormonal prevention of breast cancer.

Reproductive history is a consistent risk factor for human breast cancer. Epidemiological studies have repeatedly demonstrated that early age of first pregnancy is a strong protective factor against breast cancer and provides a physiologically operative model to achieve a practical mode of prevention. In rodents, the effects of full-term pregnancy can be mimicked by a three-week exposure to low doses of estrogen and progesterone. Neither hormone alone is sufficient to induce protection. The cellular and molecular mechanisms that underlie hormone-induced refractoriness are largely unresolved. Our recent studies have demonstrated that an early cellular response that is altered in hormone-treated mammary cells is the initial proliferative burst induced by the chemical carcinogen methylnitrosourea. The decrease in proliferation is also accompanied by a decrease in the ability of estrogen receptor-positive cells to proliferate. RNA expression of several mammary cell-cycle-related genes is not altered in hormone-treated mice; however, immunohistochemical assays demonstrate that the protein level and nuclear compartmentalization of the p53 tumor suppressor gene are markedly upregulated as a consequence of hormone treatment. These results support the hypothesis that hormone stimulation, at a critical period in mammary development, results in cells with persistent changes in the intracellular regulatory loops governing proliferation and response to DNA damage. A corollary to this hypothesis is that the genes affected by estrogen and progesterone are independent of alveolar differentiation-specific genes. Suppressive subtractive hybridization-PCR methods have identified several genes that are differentially expressed as a consequence of prior estrogen and progesterone treatment. Future experiments are aimed at determining the mechanisms of hormone-induced upregulation of p53 protein expression as part of the overall goal of identifying and functionally characterizing the genes responsible for the refractory phenotype.

9,10-Dimethyl-1,2-benzanthracene↗
PubMed1992

Risk factors for breast cancer by age and menopausal status: a case-control study in Singapore.

A case-control study was conducted among Singapore Chinese women, comprised of 200 histologically confirmed cases of breast cancer and 420 hospital controls. Subjects were interviewed on family history of breast cancer, social and demographic characteristics, reproductive history, and diet one year prior to interview. Differences in risk factors were observed according to menopausal status. In the premenopausal group, the most consistently significant nondietary effect was an increased risk with late age at first birth. In postmenopausal women, the most consistent nondietary effects were increased risks with nulliparity, tall stature, high educational status, and a family history of breast cancer. In premenopausal women, the strongest dietary effects were low risks with high intakes of polyunsaturated fatty acids (PUFA), beta-carotene, soya protein as a proportion of all protein, and a high risk with high red-meat intake. No dietary effects were observed in postmenopausal women. Examination of effects by 10-year age groups suggested that the differences in the effects of age at first birth, nulliparity, height, education, beta-carotene intake, and PUFA intake between premenopausal and postmenopausal women were at least partly attributable to age-related differences in the baseline distributions of these variables. The variation in the effects of red meat and soya protein appeared to be attributable mainly to menopausal status itself, which is consistent with the hypothesis that these factors operate on risk by way of hormonal mechanisms.

Adult↗
PubMed2004

Conception and pregnancy during the Persian Gulf War: the risk to women veterans.

PURPOSE: To enumerate Gulf-War (GW) exposed conceptions and to compare reproductive outcomes of GW-exposed pregnancies with postwar conceptions of women Gulf War veterans (GWV) and women nondeployed veterans (NDV). METHODS: Deployment data and inpatient records from 153 military hospitals identified servicewomen who were pregnant between August 1990 and May 1992 and belonged to military units that were deployed to the Gulf War. Postal surveys were used in 1997 and 1998 to elicit reproductive history; responses were validated against military hospitalization records. Reproductive outcomes of GW-exposed pregnancies were compared with postwar conceptions of women GWVs and NDVs. RESULTS: 3285 women had a pregnancy-related admission; of these, 1558 completed the questionnaire. Self-reported reproductive outcomes and dates, gestational data, and individual deployment dates identified 415 Gulf War-exposed pregnancies, 298 GWV postwar conceptions, and 427 NDV conceptions. Compared with NDV conceptions, adverse reproductive outcomes were similar among GW-exposed pregnancies. However, spontaneous abortions [NDV: 9.1%, GWV postwar: 22.8%, adjusted odds ratio (OR)=2.92, 95% confidence interval (CI): 1.9, 4.6] and ectopic pregnancies (NDV: 1.4%, GWV postwar: 10.7%, adjusted OR=7.70, 95% CI, 3.0, 20) were elevated for GWV postwar conceptions. CONCLUSION: GW-exposed conceptions and nondeployed conceptions had similar outcomes. However, GWV postwar conceptions were at increased risk for ectopic pregnancies and spontaneous abortions.

Abortion, Spontaneous↗
PubMed1997

Risk factors of early menopause in two generations of gainfully employed French women.

OBJECTIVES: Numerous studies have been focused on the detection of factors which can act on the age of menopause. Little is known about the factors related to the occurrence of an early menopause. Some factors such as occupational work factors and generational effects have not been taken into account as yet. METHODS: We examined the risk factors of early natural menopause (before age 45) in a large random sample of gainfully employed French women born in the years 1938 (n = 1743) and 1943 (n = 1959). The subjects were selected from files of an occupational physician. A woman was considered to be post-menopausal when at least 12 consecutive months had passed without menstruation at the time of the survey. Subjects were questioned and examined during their annual visit by the occupational physician. Occupational history, working conditions, living conditions, smoking habits and reproductive history were explored. RESULTS: The prevalence of early natural menopause, before age 45, was higher in the generation of 1938 (5.3%) than in that of 1943 (3.3%) with P < 0.01. After multivariate regressions, significant relationships existed statistically between the occurrence of early natural menopause and marital status, educational level, age at first childbirth and breast-feeding of children. CONCLUSIONS: Our results show important generation effects. There was no evidence of a significant relationship between early natural menopause at 45 years of age and factors relative to heavy physical work conditions.

Adult↗
PubMed1996

Risk of breast cancer among white women following induced abortion.

Some studies (but not all) have suggested that there may be an increase in the risk of breast cancer associated with a prior induced abortion. The risk, if present, may vary according to the duration of the pregnancy in which the abortion occurred, or to a woman's age or parity at that time. The authors conducted a case-control study of breast cancer in white women under age 45 years to address the question of breast cancer risk in relation to induced abortion, with the intention of identifying subgroups of women who might be at particularly increased risk. White women who were diagnosed with breast cancer (n = 1,302) from May 1, 1990, through December 31, 1992, in three geographic regions of the United States (Atlanta, Georgia; Seattle/Puget Sound, Washington; and five counties in central New Jersey) were interviewed about their reproductive histories, including the occurrence of induced abortion. Similar information was obtained from control women identified through random digit dialing. Logistic regression analysis was used to estimate the relative risk of breast cancer associated with a history of induced abortion, controlling for the potentially confounding influence of other breast cancer risk factors. Among women who had been pregnant at least once, the risk of breast cancer in those with a prior induced abortion was 20% higher than that in women with no history of abortion (95% confidence interval 1.0-1.5). This small increase in risk varied little according to number of abortions or a woman's current age. The association was present primarily among nulliparous women whose abortions occurred prior to 9 weeks' gestation (estimated relative risk = 2.0, 95% confidence interval 1.2-3.3). There was no excess risk of breast cancer associated with induced abortion among parous women. These data support the hypothesis that there may be a small increase in the risk of breast cancer related to a history of induced abortion among young women of reproductive age. However, the data from this study and others do not permit a causal interpretation at this time; neither do the collective results of the studies suggest that there is a subgroup of women in whom the relative risk associated with induced abortion is unusually high.

Abortion, Induced↗