Reproductive factors and incidence of endometrial cancer in U.S. black women
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Previous studies have shown that reproductive history is a strong determinant of endometrial cancer risk among white women. Less is known about how reproductive history affects endometrial cancer risk among black women, whose incidence and mortality differ from white women. We investigated the associations of age at menarche, parity, timing of births, and menopausal age with endometrial cancer in the Black Women’s Health Study, a prospective cohort study.
Every 2 years from 1995 to 2013, 47,555 participants with intact uteri at baseline in 1995 completed questionnaires on reproductive and medical history, and lifestyle factors. Self-reported cases of endometrial cancer were confirmed by medical record, cancer registry, or death certificate when available. Cox proportional hazards regression was used to estimate multivariable incidence rate ratios (IRR) and 95% confidence intervals (CI).
During 689,501 person-years of follow-up, we identified 300 incident cases of endometrial cancer. The strongest associations with endometrial cancer were found for early age at menarche (<11 vs. 12–13 years: IRR 1.82, 95% CI 1.31, 2.52), and later age at first birth (≥30 vs. <20 years: IRR 0.26, 95% CI 0.13, 0.50). Parous women were less likely than nulliparous women to develop endometrial cancer (IRR 0.77, 95% CI 0.57, 1.05), but there was little evidence of a dose–response relationship for number of births.
Associations between reproductive factors and endometrial cancer among black women were generally consistent with those in studies of white women.
KeywordsBlack women Endometrial cancer Reproduction Prospective studies
This work was supported by National Cancer Institute grants R01-CA58420 (principal investigator: L.R.), UM1-CA164974 (principle investigator: L.R.), and R03-CA169888 (principal investigator: L.A.W.), and National Institute of Health grant 1T32HL125232-01A1 (principal investigator: Vasan S. Ramachandran). We thank the participants and staff of the Black Women’s Health Study as well as Drs. Sara Olson and Rie Adser Virkus for their feedback. Data on endometrial cancer pathology were obtained from several state and district cancer registries (Arizona; California; Colorado; Connecticut; Delaware; Washington, DC; Florida; Georgia; Illinois; Indiana; Kentucky; Louisiana; Maryland; Massachusetts; Michigan; New Jersey; New York; North Carolina; Oklahoma; Pennsylvania; South Carolina; Tennessee; Texas; and Virginia). The study sponsors played no role in the study design, data collection, analyses, or interpretation of results, the preparation of the manuscript, or the decision to submit the manuscript for publication. The results reported here do not necessarily represent the views of the National Cancer Institute or the respective state cancer registries.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.
Informed consent was obtained from all individual participants in the study.
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