Expanding Our Understanding of Ovarian Cancer Risk: The Role of Incomplete Pregnancies-Reference-Cited by-同舟云学术

Expanding Our Understanding of Ovarian Cancer Risk: The Role of Incomplete Pregnancies

Published:2020-08-07 Issue:3 Volume:113 Page:301-308
ISSN:0027-8874
Container-title:JNCI: Journal of the National Cancer Institute
language:en
Short-container-title:

Author:

Lee Alice W¹^ORCID,Rosenzweig Stacey²,Wiensch Ashley²,Ramus Susan J³⁴^ORCID,Menon Usha⁵,Gentry-Maharaj Aleksandra⁵,Ziogas Argyrios⁶^ORCID,Anton-Culver Hoda⁶^ORCID,Whittemore Alice S⁷⁸,Sieh Weiva⁹,Rothstein Joseph H⁹,McGuire Valerie⁷,Wentzensen Nicolas¹⁰,Bandera Elisa V¹¹,Qin Bo¹¹^ORCID,Terry Kathryn L¹²¹³,Cramer Daniel W¹²¹³,Titus Linda¹⁴,Schildkraut Joellen M¹⁵,Berchuck Andrew¹⁶,Goode Ellen L¹⁷,Kjaer Susanne K¹⁸¹⁹,Jensen Allan¹⁸,Jordan Susan J²⁰^ORCID,Ness Roberta B²¹,Modugno Francesmary²²²³,Moysich Kirsten²⁴,Thompson Pamela J²⁵,Goodman Marc T²⁵,Carney Michael E²⁶,Chang-Claude Jenny²⁷²⁸^ORCID,Rossing Mary Anne²⁹³⁰,Harris Holly R²⁹³⁰,Doherty Jennifer Anne³¹,Risch Harvey A³²,Khoja Lilah²^ORCID,Alimujiang Aliya²,Phung Minh Tung²,Brieger Katharine²,Mukherjee Bhramar³³,Pharoah Paul D P³⁴³⁵^ORCID,Wu Anna H³⁶,Pike Malcolm C³⁶³⁷,Webb Penelope M³⁸^ORCID,Pearce Celeste Leigh²,

Affiliation:

1. Department of Public Health, California State University, Fullerton, Fullerton, CA, USA

2. Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI, USA

3. School of Women’s and Children’s Health, Faculty of Medicine, University of NSW Sydney, Sydney, New South Wales, Australia

4. Adult Cancer Program, Lowy Cancer Research Centre, University of NSW Sydney, Sydney, New South Wales, Australia

5. MRC Clinical Trials Unit, Institute of Clinical Trials & Methodology, University College London, London, UK

6. Department of Epidemiology, Genetic Epidemiology Research Institute, University of California Irvine, Irvine, CA, USA

7. Department of Epidemiology and Public Health, Stanford University School of Medicine, Stanford, CA, USA

8. Department of Biomedical Data Science, Stanford University School of Medicine, Stanford, CA, USA

9. Departments of Genetics and Genomic Sciences and of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA

10. Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA

11. Cancer Prevention and Control Program, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA

12. Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, MA, USA

13. Obstetrics and Gynecology Epidemiology Center, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA

14. Public Health, Muskie School of Public Service, University of Southern Maine, Portland, ME, USA

15. Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA

16. Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, NC, USA

17. Division of Epidemiology, Department of Health Science Research, Mayo Clinic, Rochester, MN, USA

18. Department of Virus, Lifestyle and Genes, Danish Cancer Society Research Center, Copenhagen, Denmark

19. Department of Gynaecology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark

20. School of Public Health, The University of Queensland, Brisbane, Australia

21. School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, USA

22. Womens Cancer Research Center, Magee-Womens Research Institute and Hillman Cancer Center, Pittsburgh, PA, USA

23. Division of Gynecologic Oncology, Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA

24. Division of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA

25. Samuel Oschin Comprehensive Cancer Institute, Cancer Prevention and Genetics Program, Cedars-Sinai Medical Center, Los Angeles, CA, USA

26. Department of Obstetrics and Gynecology, John A. Burns School of Medicine, University of Hawaii, Honolulu, HI, USA

27. Division of Cancer Epidemiology, German Cancer Research Center, Heidelberg, Germany

28. Cancer Epidemiology Group, University Cancer Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany

29. Program in Epidemiology, Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA

30. Department of Epidemiology, University of Washington, Seattle, WA, USA

31. Department of Population Health Sciences, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA

32. Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, USA

33. Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, MI, USA

34. Department of Oncology, University of Cambridge, Cambridge, UK

35. Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK

36. Department of Preventive Medicine, Keck School of Medicine, University of Southern California Norris Comprehensive Cancer Center, Los Angeles, CA, USA

37. Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA

38. Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia

Abstract

Abstract Background Parity is associated with decreased risk of invasive ovarian cancer; however, the relationship between incomplete pregnancies and invasive ovarian cancer risk is unclear. This relationship was examined using 15 case-control studies from the Ovarian Cancer Association Consortium (OCAC). Histotype-specific associations, which have not been examined previously with large sample sizes, were also evaluated. Methods A pooled analysis of 10 470 invasive epithelial ovarian cancer cases and 16 942 controls was conducted. Odds ratios (ORs) and 95% confidence intervals (CIs) for the association between incomplete pregnancies and invasive epithelial ovarian cancer were estimated using logistic regression. All models were conditioned on OCAC study, race and ethnicity, age, and education level and adjusted for number of complete pregnancies, oral contraceptive use, and history of breastfeeding. The same approach was used for histotype-specific analyses. Results Ever having an incomplete pregnancy was associated with a 16% reduction in ovarian cancer risk (OR = 0.84, 95% CI = 0.79 to 0.89). There was a trend of decreasing risk with increasing number of incomplete pregnancies (2-sided Ptrend < .001). An inverse association was observed for all major histotypes; it was strongest for clear cell ovarian cancer. Conclusions Incomplete pregnancies are associated with a reduced risk of invasive epithelial ovarian cancer. Pregnancy, including incomplete pregnancy, was associated with a greater reduction in risk of clear cell ovarian cancer, but the result was broadly consistent across histotypes. Future work should focus on understanding the mechanisms underlying this reduced risk.

Funder

Ovarian Cancer Research Fund

Kathryn Sladek Smith

US National Cancer Institute at the National Institutes of Health

US Army Medical Research and Materiel Command

The Cancer Council Tasmania and The Cancer Foundation of Western Australia

National Health and Medical Research Council of Australia

National Institutes of Health

German Federal Ministry of Education and Research

Programme of Clinical Biomedical Research

German Cancer Research Center

US National Institutes of Health