History of uterine leiomyoma and risk of endometrial cancer in black women

Abstract

Background

Previous studies have found an association between uterine leiomyomata (UL) and uterine malignancies. This relation has not been studied in black women, who are disproportionately affected by UL.

Methods

We investigated prospectively the association between self-reported physician-diagnosed UL and endometrial cancer in the Black Women’s Health Study. During 1995–2013, 47,267 participants with intact uteri completed biennial health questionnaires. Reports of endometrial cancer were confirmed by pathology data from medical records and cancer registries. Cox regression was used to derive incidence rate ratios (IRR) and 95 % confidence intervals (CI).

Results

There were 300 incident endometrial cancer cases during 689,546 person-years of follow-up. In multivariable models, UL history was associated with a 42 % greater incidence of endometrial cancer compared with no such history (95 % CI 1.12–1.80). IRRs for cancer diagnosed 0–2, 3–9, and ≥10 years after UL diagnosis were 3.20 (95 % CI 2.06–4.98), 0.95 (95 % CI 0.60–1.52), and 1.35 (95 % CI 1.03–1.77), respectively. Stronger overall associations between UL history and endometrial cancer were observed for later stages at cancer diagnosis (IRR = 2.25, 95 % CI 1.09–4.63) and type II/III cancers (IRR = 3.13, 95 % CI 1.64–5.99).

Conclusions

In this large cohort of black women, a history of UL was positively associated with endometrial cancer, particularly type II/III tumors. The strongest association was observed for cancer diagnosed within 2 years of UL diagnosis, a finding that might be explained by greater surveillance of women with UL or misdiagnosis of cancer as UL. However, an association was also observed for cancer reported ≥10 years after UL diagnosis.

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Abbreviations

BWHS:

Black Women’s Health Study

CI:

Confidence interval

IRR:

Incidence rate ratio

UL:

Uterine leiomyomata

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Acknowledgments

The authors gratefully acknowledge the contributions of BWHS participants & staff. This research was supported by grants R03-CA169888 (PI: Wise), R01-CA058420 (PI: Rosenberg), and UMI-CA164974 (PI: Rosenberg) from the National Cancer Institute, National Institutes of Health. Data on endometrial cancer pathology were obtained from several state cancer registries (AZ, CA, CO, CT, DE, DC, FL, GA, IL, IN, KY, LA, MD, MA, MI, NJ, NY, NC, OK, PA, SC, TN, TX, VA) and results reported do not necessarily represent their views.

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Correspondence to Lauren A. Wise.

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Wise, L.A., Sponholtz, T.R., Rosenberg, L. et al. History of uterine leiomyoma and risk of endometrial cancer in black women. Cancer Causes Control 27, 545–552 (2016). https://doi.org/10.1007/s10552-016-0728-3

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Keywords

  • African-Americans
  • Uterine leiomyoma
  • Endometrial cancer
  • Prospective studies