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PubMed2003

Ovulation and risk of epithelial ovarian cancer.

Incessant ovulation is thought to be one of the primary causes of epithelial ovarian cancer. However, the effects of ovulation at different ages and of the various exposures or events that suppress ovulation have not been established. We used data from an Australian case-control study of 791 ovarian cancer cases and 853 controls to examine the effect of ovulation on ovarian cancer risk. The total number of lifetime ovulations was calculated using information provided in a monthly contraceptive/reproductive calendar, as well as incorporating other information such as average menstrual cycle length. An increase of 1 year's worth of ovulation was associated with a 6% increase in risk of ovarian cancer (95% confidence interval [CI] = 4-8%). Ovulations in the 20-29-year age group were associated with the greatest risk, with a 20% increase in risk associated with each year of ovulation during this age period (95% CI = 13-26%). When the effects of different exposures that suppress ovulation were compared, there was an indication that some factors may have a greater effect than others. These findings support the theory that incessant ovulation is a major contributor to the occurrence of ovarian cancer and suggest that ovulations during the 20s may be those most associated with disease risk.

Adult↗
PubMed2003

Socioeconomic factors in cancer in Sweden.

It is well known that certain cancers have shown clustering in socioeconomic groups, but limited data are available on recent results and time trends in such clustering. We determined standardized incidence ratios (SIR) for cancer, adjusted for age, period, region, parity and age at first childbirth among men and women in 6 socioeconomic groups based on the Swedish Family-Cancer Database. Persons had to be identified with the same socioeconomic status in the census of years 1960 and 1970, or of years 1960, 1970 and 1980; the comparison group was all people according to the same censuses. Cancers were followed from years 1970 to 1998 or from 1980 to 1998. Both increased and decreased SIRs were found, and a consistent pattern emerged, although the overall SIRs for cancer did not differ much, the lowest being for farmers (0.85) and the highest for professional men (1.07) and women (1.11). At individual sites, manual workers were at risk of tobacco-, alcohol- and occupation- and human papilloma virus-related cancers and at a decreased risk at most other cancers. Manual workers and farmers showed an excess of stomach cancer; professionals had an excess of melanoma and squamous cell skin cancer. Male and female SIRs correlated highly for manual and blue-collar workers and for professionals. The overall population-attributable fraction for selected sites was 16.7% for men and 10.9% for women and it was highest, over 50%, for lung cancer in both genders.

Agricultural Workers' Diseases↗
PubMed2003

Reproductive and anthropometric factors in relation to the risk of lobular and ductal breast carcinoma among women 65-79 years of age.

Use of combined estrogen-progestin hormone replacement therapy appears to be associated with an increased risk of invasive lobular breast carcinomas (ILC) and, to a lesser degree, with risk of invasive ductal carcinoma (IDC). Conceivably, ILCs are more hormonally responsive and so may be more strongly associated than IDCs with reproductive and anthropometric characteristics that can influence hormone levels. However, few epidemiologic studies of breast cancer have evaluated these factors by histologic type. We conducted a population-based case-control study of women aged 65-79 years in western Washington State. Responses from 975 women diagnosed with breast cancer during 1997-1999 were compared to those of 1,007 controls. Associations between various reproductive and anthropometric factors and risks of IDC (n = 656) and ILC (n = 196) were evaluated using polytomous logistic regression. Earlier age at menarche, later age at menopause and obesity were more strongly associated with elevated risks of IDC than ILC. Alternatively, oral contraceptive use was associated with an increased risk of ILC but not IDC. Thus, the pattern of results that we observed suggest that factors influencing endogenous hormones and duration of ovarian function may be more strongly associated with IDC risk, while exogenous hormones may be more strongly associated with ILC risk.

Aged↗
PubMed2002

Burning wood in the kitchen increases the risk of cervical neoplasia in HPV-infected women in Honduras.

There is suggestive evidence that the use of wood for cooking increases the risk of invasive cervical cancer. We investigated this association in women with cervical neoplasia in Honduras. Women aged 20-64 years with cervical intraepithelial neoplasia (CIN) grade I (n = 44), CIN II (n = 36) or CIN III (n = 45) were recruited from screening programs in Tegucigalpa City and each was matched by age and clinic to 2 controls (241 total) without cervical abnormalities. The clinics selected women of low socioeconomic status. Cervical scrapes were tested for the presence of human papillomavirus (HPV) DNA using a general primer set directed against the L1 open reading frame, and HPV genotyping was performed. Odds ratios (ORs) were computed through conditional logistic regression; p-values were from tests for linear trend of risk with increasing exposure. HPV DNA was detected in 48% of women with CIN I, 67% with CIN II and 89% with CIN III. The ORs were 1.5, 2.5 and 38.3 respectively. At univariate analysis, age at first intercourse was consistently lower among cases than controls. Risk was reduced by 50% or more in all 3 CIN classes when initiation of sexual activity at age 20 years or older was compared with initiation before age 16 years (p = 0.013 for CIN I). No effect was observed for smoking, oral contraceptives or previous cytologic screening. Effects for number of sexual partners, parity, age at first pregnancy and education were in the expected directions but never persisted after adjustment for HPV. Chronic exposure to wood smoke significantly increased the risk of CIN III (p = 0.022). However, women who said "No" when asked if they ever used wood in the kitchen had a higher risk than those with low or intermediate exposure. This was taken as evidence that the initial screening question had either been misunderstood or that answers were biased. Restricting the analysis to women who reported exposure yielded positive associations in all CIN classes with for CIN III ORs of 2.3 for 25-34 and 9.5 for 35+ years compared with women who had 1-14 years of exposure (p = 0.017). A multivariate analysis of the complete dataset (n = 366) allowed for separate ORs for HPV in each CIN class. Inclusion of age at first intercourse significantly improved this model (p = 0.021). Adding exposure to wood smoke further improved the model only if an interaction between woodsmoke and HPV was allowed for. If, as the data suggest, it was assumed that wood smoke had its effect among HPV-positives only, there was a significant linear dose-response relationship between exposure to woodsmoke and risk of CIN (p = 0.026). This association was independent of other risk factors including education, parity and number of sexual partners. ORs in the final model were 0.37 for age at first intercourse 20 years or higher and 5.69 for more than 35 years of exposure to wood burning in the kitchen. The present study suggests that the use of wood for cooking is a risk factor for cervical neoplasia that deserves further study, given its high prevalence in developing countries.

Adolescent↗
PubMed2006

Reproductive factors, exogenous hormone use and bladder cancer risk in a prospective study.

Sex is a consistent predictor of bladder cancer: men experience 2-4-fold higher age-adjusted rates than women in the U.S. and Europe. The objective of this study was to examine whether hormone-related factors are associated with bladder cancer in women. We examined parity, age at menarche, age at first birth, age at menopause, oral contraceptive use and menopausal hormone therapy (HT) use and bladder cancer risk in the Breast Cancer Detection Demonstration Project Follow-Up Study. Endpoint and exposure information was collected on 54,308 women, using annual telephone interviews (1980-86) and 3 mailed, self-administered questionnaires (1987-98). During an average follow-up time of 15.3 years, 167 cases of bladder cancer were identified. Univariate and adjusted rate ratios (RRs) were estimated using Poisson regression. Parity, age at menarche, age at first birth, age at menopause, and oral contraceptive use were not associated with bladder cancer risk. The majority of menopausal women who took HT used estrogen therapy (ET). Postmenopausal women with less than 4 years, 4-9 years, 10-19 years and 20 or more years of ET use had RRs of 1.55 (95% CI = 0.96-2.51), 1.00 (95% CI = 0.49-2.04), 1.23 (95% CI = 0.62-2.43) and 0.57 (95% CI = 0.14-2.34), respectively, compared with nonusers (p = 0.50). Findings from this study are not consistent with the hypothesis that hormone-related factors in women are associated with bladder cancer.

Age Factors↗
PubMed1994

A case-control study of reproductive risk factors associated with cervical cancer.

Using the logistic-regression technique, a hospital-based case-control study of 177 married women with invasive squamous-cell cervical cancer and 149 hospital-visiting controls enabled evaluation of selected reproductive factors as risks. Early age at marriage was found to be the single best predictor of the disease status. However, those who married late but gave birth to a large number of children were generally found to be suffering from cervical cancer. The results support the hypothesis that it is not so much parity per se that enhances the risk, but the rapidity of multiple pregnancies that matters. Logistic analysis also revealed the independent influence of birth interval on the risk of cervical cancer. These findings warrant serious consideration in future studies, given the obvious implications for prevention. Other implications for the prevention of cervical cancer are briefly discussed.

Adult↗
PubMed1993

Attitudes of women of childbearing age towards prenatal diagnosis in southeastern France.

The objective of this study was to explore women's attitudes towards prenatal diagnosis of trisomy 21 and to examine some of the factors possibly responsible for these attitudes before implementing in real practice serological screening of pregnant women at risk for trisomy 21. We carried out a telephone survey on a representative sample of women who had recently had a normal livebirth delivery in the Marseille district in 1990. The participation rate was 80 per cent and the average age of the mothers was 28.9 years. Among the 514 women interviewed, 78 per cent stated that they would ask for an amniocentesis for a 1 per cent risk of trisomy 21 at their next pregnancy. When adjusting for confounding factors, the decision to have or not to have an amniocentesis was found to depend not only on the women's attitude towards induced abortion, but also on their understanding of the risk involved and on the social context (knowing a handicapped child, discussion with the father). It also depended on the women's age and on what they knew about amniocentesis from the medical point of view. The risk of miscarriage can influence a woman's choice but this objection was not found to affect the women's decisions significantly in our survey. The data showed the existence of a high potential demand for fetal karyotyping.

Abortion, Therapeutic↗
PubMed1995

Estrogen replacement therapy may protect against intellectual decline in postmenopausal women.

Postmenopausal women over the age of 50, who were either on estrogen replacement therapy (N = 21) or not (N = 33), were assessed on several sexually dimorphic cognitive functions. The two groups were strictly equivalent in age, education, and vocabulary score (an abbreviated measure of past intelligence). Overall, women on therapy had better scores than those not on therapy, regardless of whether the specific function favored men or women. Previous history of reproductive surgery had no effect on scores. Estrogen may guard against some of the intellectual decline which is to be expected postmenopausally.

Affect↗
PubMedDate not supplied

Energy intake and monounsaturated fat in relation to bone mineral density among women and men in Greece.

BACKGROUND: Several variables have been established as risk factors for osteoporosis: it is more common among women and the gender difference increases with age and with years since menopause. Estrogens, androgens, physical activity, and body mass index have been previously shown to be positively associated with bone mineral density and inversely with risk for fractures. METHODS: To assess the effect on bone mineral content of energy-generating nutrients, healthy men (n = 36) and women (n = 118) ages 25-69 years were interviewed among visitors and staff of the University of Athens Department of Medical Physics. Bone mineral density (BMD) was measured by single photon absorptiometry. RESULTS: Demographic and lifestyle variables were not significantly related to BMD in this study, although the patterns were consistent with those previously reported by other investigators. Total energy intake, which also reflects energy expenditure through physical activity, was positively associated with BMD among both men (P = 0.003) and women (P = 0.04). After adjustment for nonnutritional variables and energy intake, monounsaturated fat, which in the Greek population is mostly derived from olive oil, was associated with BMD. The association was positive among both men (P = 0.01) and women (P = 0.03). There was evidence for an inverse association between carbohydrate intake and BMD, but the association was significant only with respect to mono- and disaccharides. CONCLUSIONS: In this population, consumption of monounsaturated fat and physical activity were predictive of bone mineral density, but larger studies are needed.

Adult↗
PubMed1993

A case-control study of thyroid cancer in women under age 55 in Shanghai (People's Republic of China).

A population-based interview study of 207 case-control pairs investigated reproductive, dietary, and other factors thought likely to increase thyroid cancer risk among women of reproductive age in Shanghai. Of particular interest were factors that might help explain the striking female over male excess in this age group. Risk was strongly associated with prior goiter or benign nodules (odds ratio [OR] = 7.0, 95 percent confidence interval [CI] = 2.5-27.5) and miscarriage as outcome of first pregnancy (OR = 9.9, CI = 2.0-48.4). Weaker associations were seen for women who were ever-pregnant (OR = 2.1, CI = 1.1-4.2), ever had an induced abortion (OR = 1.6, CI = 0.9-2.9), and ever used oral contraceptives (OR = 1.7, CI = 1.0-3.1). Compared with controls, cases gained significantly more weight from menarche to highest nonpregnant weight (P trend < 0.01). Overall, cases ate more fish and shellfish, but there was no trend with level of consumption. More cases had a parent, sibling, or child with thyroid disease (OR = 5.2, CI = 2.5-12.1). Our findings relating to goiter and benign nodules and various reproductive factors support earlier studies. Consumption of seafood was difficult to evaluate; more detailed dietary data are needed to assess iodine intake.

Abortion, Spontaneous↗
PubMed1996

Lifestyle changes during adolescence and risk of breast cancer: an ecologic study of the effect of World War II in Norway.

There are biologic reasons to believe that the period between the larche and the first full-term pregnancy is a particularly sensitive period in a woman's life regarding the development of breast cancer. In this ecologic study, data provided by the Norwegian Cancer Registry were analyzed to compare risk of breast cancer among women who experienced this sensitive period before, during, or after World War II. An ordinary age-cohort model and a model where the cohort was described by exposure by calendar period and sensitivity to this exposure at different ages, were fitted to the data. The incidence of breast cancer was lower than expected among women who experienced puberty during the war. The estimated configuration of the exposure variable showed an increase in exposure up to the start of WWII to twice the level in 1916, dropped by 13 percent during the war, and increased again after the war. The level in 1975 was approximately 2.7 times higher than the level in 1916. The results indicate that one or more lifestyle factors that changed among adolescent women during the war, influenced their risk of breast cancer. Dietary intake of energy, fat, meat, milk, fish, fresh vegetables, and potatoes, in addition to physical activity level and height, are important factors to consider in relation to breast cancer risk.

Adolescent↗
PubMed1996

Progestogen-only oral contraceptives and risk of breast cancer in New Zealand.

Little is known about the influence of progestogen-only oral contraceptives on a woman's risk of breast cancer. This issue was examined in a national population-based case-control study in New Zealand. A total of 891 women aged 25 to 54 years with a first diagnosis of breast cancer and 1,864 control subjects, randomly selected from the electoral rolls, were interviewed. Use of progestogen-only pills was reported by 8.7 percent of all control subjects (and by 17.3 percent of those aged 25 to 34 years). The relative risk (RR) of breast cancer in women who had ever used progestogen-only pills was estimated to be 1.1 (95 percent confidence interval [CI] = 0.73-1.5). In women aged 25 to 34 years, the RR was 2.3 (CI = 1.2-4.3). Women who had started using progestogen-only pills within the last 10 years were at increased risk of breast cancer (RR = 1.6, CI = 1.0-2.4), whereas those who had first used them earlier were at significantly reduced risk (RR = 0.44, CI = 0.22-0.90). These findings are similar to results for depot medroxyprogesterone acetate, and a possible analogy with the influence of pregnancy is also suggested.

Adult↗
PubMed1996

Reproductive factors and incidence of epithelial ovarian cancer: a Norwegian prospective study.

To examine relations between the risk of epithelial ovarian cancer and time-related effects of pregnancies, we analyzed data from a prospective study of 1,145,076 women in Norway aged 20 to 56 years. The mean follow-up time per woman was 16.4 years and a total of 1,694 women were diagnosed with epithelial ovarian cancer. Incidence rate ratios (IRR) were estimated by Poisson regression analysis of person-years at risk. The risk of epithelial ovarian cancer decreased with an increasing number of full-term pregnancies (IRR = 0.56, 95 percent confidence interval = 0.48-0.67 for three pregnancies cf one). However, no further reduction in risk was seen after the third pregnancy. The association with parity became weaker with increasing age at last birth. Further, the reduction in risk among parous women compared with nulliparous women was more pronounced shortly after birth. Both higher age at last birth and shorter time since last birth were associated with a reduction in risk, although these relations were seen mainly for the first and second births. Increasing age at first birth was associated with a decrease in risk among uniparous women but not among multiparous women. Our results indicate that the relations between the incidence of epithelial ovarian cancer and reproductive factors are more complex than previously believed.

Adult↗
PubMed1996

Reproductive variables and risk of uterine cervical cancer in Norwegian registry data.

The influence of reproductive variables on cervical cancer incidence, controlling for other sociodemographic factors, was estimated in Norwegian register and census data, using Poisson regression models. Among the 1.3 million women under observation, a total of 2,870 cases of cervical cancer were diagnosed. According to models restricted to parous women, parity level had no independent impact on cervical cancer incidence, but a clear effect of age at first birth was noted. It was most pronounced in the squamous cell carcinomas, where the incidence was reduced by 48 percent from age at first birth < 21 years to age at first birth 27+ years. Women without children had the same cervical cancer incidence as parous women with a first birth after age 24. The sociodemographic variables controlled for exerted a strong net effect on the cervical cancer incidence. Educational level was related inversely to the cancer risk. Moreover, an increased risk was seen for women who had given birth when they were still single (never married) and for those who were divorced/separated at the time of the last previous census. A fairly small excess risk was found to be associated with living in non-rural compared with rural areas.

Adult↗
PubMed1996

Sexual, reproductive, and other risk factors for adenocarcinoma of the cervix: results from a population-based case-control study (California, United States)

The incidence of adenocarcinoma of the cervix increased steadily in young women in the United States between the early 1970s and the mid-1980s. Despite this increase, little is known about the etiology of this cancer, although a role for risk factors for both squamous cell carcinoma of the cervix and endometrial adenocarcinoma has been suggested. Incident cases of adenocarcinoma of the cervix diagnosed in women born after 1935 (ages 42 to 56 at diagnosis) were identified from the Los Angeles (California) County Cancer Surveillance Program (LACCSP). Data from personal interviews with 195 cases and 386 controls (matched on age, race, and neighborhood) were analyzed. Compared with women in the highest categories of education and income, women in the lowest categories had a 2.5 and 3.1-fold elevated risk of adenocarcinoma of the cervix. Number of sexual partners, especially before age 20, was strongly predictive of risk (odds ratio = 5.6, 95 percent confidence interval = 1.4-22.0 for 10 or more compared with no partners before age 20). Smoking was not associated significantly with risk. Weight gain and long-term use of oral contraceptives increased risk, while long-term diaphragm use was protective. This study suggests that both sexual and hormonal factors are important etiologic factors for adenocarcinoma of the cervix.

Adenocarcinoma↗