Cancer Causes & Control

, Volume 28, Issue 5, pp 437–445 | Cite as

Endometriosis and risk of ovarian and endometrial cancers in a large prospective cohort of U.S. nurses

  • Elizabeth M. PooleEmail author
  • Wayne T. Lin
  • Marina Kvaskoff
  • Immaculata De Vivo
  • Kathryn L. Terry
  • Stacey A. Missmer
Original paper



Endometriosis is associated with ovarian cancer, but the relation with endometrial cancer is unclear. Prior studies generally were retrospective and had potential limitations, including use of self-reported endometriosis, failure to account for delays between symptom onset and endometriosis diagnosis, and changes in risk factors post-endometriosis diagnosis. We evaluated whether these limitations obscured a weak association with endometrial cancer and the extent to which these limitations impacted associations with ovarian cancer.


Cox proportional hazards regression models were used to assess associations between endometriosis and cancer risk, evaluating the impacts of self-reported vs. laparoscopically confirmed endometriosis, delayed diagnosis, and post-endometriosis diagnosis changes in risk factor exposures on relative risk estimates.


Over 18 years of follow-up, we identified 228 ovarian and 166 endometrial cancers among 102,025 and 97,109 eligible women, respectively. Self-reported endometriosis was associated with ovarian cancer [relative risk (RR): 1.81; 95% confidence interval (CI): 1.26–2.58]; this association was stronger for laparoscopically confirmed endometriosis (HR: 2.14; 95% CI 1.45–3.15). No association was observed with endometrial cancer (self-report RR: 0.78; 95% CI 0.42–1.44; laparoscopic-confirmation RR: 0.76; 95% CI 0.35–1.64). Accounting for diagnosis delays or post-endometriosis diagnosis changes in risk factors had a little impact.


This study adds to the evidence that endometriosis is not strongly linked to endometrial cancer risk and that the association with ovarian cancer is robust to misclassification, diagnostic delay, and changes in exposures post-endometriosis diagnosis. Our analysis suggests that confounding and misclassification do not obscure a weak association for endometrial cancer risk, although our results should be replicated.


Endometriosis Ovarian cancer Endometrial cancer 



The authors wish to thank the participants and staff of the Nurses’ Health Study II for their valuable contributions as well as the following state cancer registries for their help: AL, AZ, AR, CA, CO, CT, DE, FL, GA, ID, IL, IN, IA, KY, LA, ME, MD, MA, MI, NE, NH, NJ, NY, NC, ND, OH, OK, OR, PA, RI, SC, TN, TX, VA, WA, and WY. This work was supported by the National Institutes of Health (R01 HD57210, UM1 CA176726) and Dana Farber Cancer Institute Mazzone Award.


This work was supported by the National Institutes of Health (R01 HD57210, UM1 CA176726) and Dana Farber Cancer Institute Mazzone Award.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no financial or personal relationships that might influence this work.


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Copyright information

© Springer International Publishing Switzerland 2017

Authors and Affiliations

  • Elizabeth M. Poole
    • 1
    Email author
  • Wayne T. Lin
    • 2
  • Marina Kvaskoff
    • 1
    • 3
  • Immaculata De Vivo
    • 1
    • 4
  • Kathryn L. Terry
    • 2
    • 4
  • Stacey A. Missmer
    • 1
    • 2
    • 4
    • 5
  1. 1.Channing Division of Network Medicine, Department of MedicineBrigham and Women’s Hospital and Harvard Medical SchoolBostonUSA
  2. 2.Department of Obstetrics and GynecologyBrigham and Women’s Hospital and Harvard Medical SchoolBostonUSA
  3. 3.Centre for Research in Epidemiology and Population HealthFrench National Institute for Health and Medical Research (Inserm)VillejuifFrance
  4. 4.Department of EpidemiologyHarvard School of Public HealthBostonUSA
  5. 5.Department of Obstetrics, Gynecology and Reproductive BiologyMichigan State UniversityEast LansingUSA

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