Journal
BRITISH JOURNAL OF CANCER
Volume 105, Issue 9, Pages 1436-1442Publisher
NATURE PUBLISHING GROUP
DOI: 10.1038/bjc.2011.371
Keywords
reproductive history; oral contraceptive use; ovarian cancer; cohort study
Categories
Funding
- European Commission (DG-SANCO)
- International Agency for Research on Cancer
- Danish Cancer Society (Denmark)
- Ligue contre le Cancer, Mutuelle Generale de l'Education Nationale, Institut National de la Sante et de la Recherche Medicale (France)
- Deutsche Krebshilfe, Deutsches Krebsforschungszentrum and Federal Ministry of Education and Research (Germany)
- Ministry of Health and Social Solidarity, Stavros Niarchos Foundation and Hellenic Health Foundation (Greece)
- Italian Association for Research on Cancer (AIRC) and National Research Council (Italy)
- Dutch Ministry of Public Health, Welfare and Sports (VWS), the Netherlands Cancer Registry (NKR)
- Statistics Netherlands (The Netherlands)
- Norwegian Cancer Society (Norway)
- Regional Governments of Andalucia [RD06/0020]
- Swedish Cancer Society, Swedish Scientific Council and Regional Government of Skane and Vasterbotten (Sweden)
- Cancer Research UK, Medical Research Council UK (UK)
- Medical Research Council [G1000143, MC_U106179471, G0401527] Funding Source: researchfish
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BACKGROUND: It is well established that parity and use of oral contraceptives reduce the risk of ovarian cancer, but the associations with other reproductive variables are less clear. METHODS: We examined the associations of oral contraceptive use and reproductive factors with ovarian cancer risk in the European Prospective Investigation into Cancer and Nutrition. Among 327 396 eligible women, 878 developed ovarian cancer over an average of 9 years. Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated using Cox proportional hazard models stratified by centre and age, and adjusted for smoking status, body mass index, unilateral ovariectomy, simple hysterectomy, menopausal hormone therapy, and mutually adjusted for age at menarche, age at menopause, number of full-term pregnancies and duration of oral contraceptive use. RESULTS: Women who used oral contraceptives for 10 or more years had a significant 45% (HR, 0.55; 95% CI, 0.41-0.75) lower risk compared with users of 1 year or less (P-trend, <0.01). Compared with nulliparous women, parous women had a 29% (HR, 0.71; 95% CI, 0.59-0.87) lower risk, with an 8% reduction in risk for each additional pregnancy. A high age at menopause was associated with a higher risk of ovarian cancer (>52 vs <= 45 years: HR, 1.46; 95% CI, 1.06-1.99; P-trend, 0.02). Age at menarche, age at first full-term pregnancy, incomplete pregnancies and breastfeeding were not associated with risk. CONCLUSION: This study shows a strong protective association of oral contraceptives and parity with ovarian cancer risk, a higher risk with a late age at menopause, and no association with other reproductive factors. British Journal of Cancer (2011) 105, 1436-1442. doi:10.1038/bjc.2011.371 www.bjcancer.com Published online 13 September 2011 (C) 2011 Cancer Research UK
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