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Childbearing at older age and endometrial cancer risk (Sweden)

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Abstract

Objectives: Several studies have found an inverse association between older age at last birth and endometrial cancer risk. A nested case-control study was undertaken to examine the influence of this and other aspects of reproductive patterns on the risk of developing endometrial cancer.

Methods: Among women born in 1925 and later, 4,839 eligible patients were identified in the Swedish Cancer Register. For each case, five individually age-matched controls were randomly selected from a population-based Fertility Register. Relative risks were estimated from odds ratios obtained from conditional logistic regression analyses.

Results: Compared to uniparous women, childless women were at a higher risk of endometrial cancer (odds ratio [OR]=1.38, 95% confidence interval [CI]=1.25–1.52). This association was stronger in younger (<50 years) than in older (50+ years) women. At all ages of first birth, a delivery was associated with a reduced risk of endometrial cancer that slowly diminished with time. Among parous women, the risk decreased by almost 20% for each additional live birth (OR=0.81, CI=0.78–0.84). In an analysis limited to women with two or more births that compared the independent effects of age at first and at last birth, only older age at last birth was associated with a lowered risk of endometrial cancer. The risk decreased at a rate of about 15% per five-year delay of last birth.

Conclusions: Endometrial cancer is often referred to as the prototype hormonally-determined disease in women. However, our findings give further support to the hypothesis that a birth may not only affect risk through hormonal influences, but possibly also through mechanical shedding of cells that have undergone malignant transformation.

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References

  1. Parazzini F, La Vecchia C, Bocciolone L, Franceschi S (1991) The epidemiology of endometrial cancer [review]. Gynecol Oncol 41: 1-16.

    Google Scholar 

  2. Key TJA, Pike MC (1988) The dose-effect relationship between ‘unopposed’ estrogens and endometrial mitotic rate: its central role in explaining and predicting endometrial cancer risk. Br J Cancer 57: 205-212.

    Google Scholar 

  3. Grady D, Ernster VL (1996) Endometrial cancer. In: Schottenfield D, Fraumeni JF Jr., eds. Cancer Epidemiology and Prevention. 2nd Edition. New York, NY: Oxford University Press, pp. 1058-1089.

    Google Scholar 

  4. Preston-Martins, Pike MC, Ross R, Janes RK, Henderson B (1990) Increased cell division as a cause of human cancer. Cancer Res 50: 7415-7421.

    Google Scholar 

  5. Parazzini F, La Vecchia C, Negri E, Fedele L, Balotta F (1991) Reproductive factors and risk of endometrial cancer. Am J Obstet Gynecol 164: 522-527.

    Google Scholar 

  6. Petterson B, Adami H-O, Bergstroöm R, Johansson EDB (1986) Menstruation span — a time-limited risk factor for endometrial carcinoma. Acta Obstet Gynecol Scand 65: 247-255.

    Google Scholar 

  7. Kvåle G, Heuch I, Ursin G (1988) Reproductive factors and risk of cancer of the uterine corpus: a prospective study. Cancer Res 48: 6217-6221.

    Google Scholar 

  8. Lesko SM, Rosenberg L, Kaufman DW, et al. (1991) Endometrial cancer and age at last delivery: evidence for an association. Am J Epidemiol 133: 554-559.

    Google Scholar 

  9. Kvåle G, Heuch I, Nilssen S (1992) Endometrial cancer and age at last delivery: evidence for an association [letter]. Am J Epidemiol 135: 453-455.

    Google Scholar 

  10. Albrektsen G, Heuch I, Tretli S, Kvåle G (1995) Is the risk of cancer of the corpus uteri reduced by a recent pregnancy? A prospective study of 765,756 Norwegian women. Int J Cancer 62: 485-490.

    Google Scholar 

  11. Kvåle G (1989) Reproductive Factors and Risk of Cancers of the Breast And Genital Organs. A Prospective Study of Norwegian Women. Bergen: The Norwegian Cancer Society.

    Google Scholar 

  12. Castellsauge X, Thompson WD, Dubrow R (1993) Intra-uterine contraception and the risk of endometrial cancer. Int J Cancer 54: 911-916.

    Google Scholar 

  13. Parazzini F, La Vecchia C, Moroni S (1994) Intrauterine device and risk of endometrial cancer. Br J Cancer 70: 672-673.

    Google Scholar 

  14. Hill DA, Weiss NS, Voigt LF, Beresford SA (1997) Endometrial cancer in relation to intra-utrerine device use. Int J Cancer 70: 278-281.

    Google Scholar 

  15. Sturgeon SR, Brinton LA, Berman ML, et al. (1997) Intrauterine device and cancer risk. Int J Epidemiol 26: 496-500.

    Google Scholar 

  16. Lambe M, Hsieh C-c, Trichopoulos D, Ekbom A, Pavia M, Adami H-O (1994) Transient increase in the risk of breast cancer after giving birth. N Engl J Med 33: 5-9.

    Google Scholar 

  17. Lambe M, Hsieh C-c, Chan H-w, Ekbom A, Trichopoulos D, Adami H-O (1996) Parity, age at first and last birth. A population-based study in Sweden. Breast Cancer Res Treat 38: 305-311.

    Google Scholar 

  18. Adami H-O, Hsieh C-c, Lambe M, et al. (1994) Parity, age at first childbirth, and risk of ovarian cancer. Lancet 344: 1250-1254.

    Google Scholar 

  19. Johansson L, Finnas F (1983) Fertility of Swedish Women Born 1927–1960. Stockholm: Statistics Sweden, Urval nr 14.

    Google Scholar 

  20. The Cancer Register. Cancer Incidence in Sweden 1958–1992 (1995) Stockholm: Centre for Epidemiology. National Board of Health and Welfare.

    Google Scholar 

  21. World Health Organization (1957) International Classification of Diseases, Seventh Revision. Geneva: WHO.

    Google Scholar 

  22. Breslow NE, Day NE (1980) Statistical Methods in Cancer Research. The Analysis of Case-control Studies. Volume 1. IARC Sci. Pub. No. 32. Lyon: International Agency for Research on Cancer.

    Google Scholar 

  23. Hsieh Cc, Lan SJ (1996) Assessment of postpartum time-dependent disease risk in case-control studies: an application for examining age-specific estimates. Stat Med 15: 1545-1556.

    Google Scholar 

  24. National Board of Health and Welfare (1995) The Inpatient Register 1995. Stockholm: Centre for Epidemiology, National Board of Health and Welfare.

    Google Scholar 

  25. Koepsell TD, Weiss NS, Thompson DJ, Martin DP (1980) Prevalence of prior hysterectomy in the Seattle-Tacoma area. Am J Public Health 70: 40-47.

    Google Scholar 

  26. Shu X-O, Brinton LA, Zheng W, Gao YT, Fan J, Fraumeni JF Jr. (1991) A population-based case-control study of endometrial cancer in Shanghai, China. Int J Cancer 49: 38-43.

    Google Scholar 

  27. Brinton LA, Berman ML, Mortel R, et al. (1992) Reproductive, menstrual, and medical risk factors for endometrial cancer: results from a case-control study. Am J Obstet Gynecol 167: 1317-1325.

    Google Scholar 

  28. La Vecchia C, Francheschi S, Decarli A, Gallus G, Tognoni G (1984) Risk factors for endometrial cancer at different ages. J Natl Cancer Inst 73: 667-671.

    Google Scholar 

  29. Henderson BE, Casagrande JT, Pike MC, Mack T, Rosario I, Duke A (1983) The epidemiology of endometrial cancer in young women. Br J Cancer 47: 749-756.

    Google Scholar 

  30. Kelsey JL, LiVolsi VA, Holford TR, et al. (1982) A case-control study of cancer of the endometrium. Am J Epidemiol 116: 333-342.

    Google Scholar 

  31. Koumantaki Y, Tzonou A, Kouamantakis E, Kaklamani E, Aravantinos D, Trichopoulos D (1989) A case-control study of cancer of endometrium in Athens. Int J Cancer 43: 795-799.

    Google Scholar 

  32. McPherson CP, Sellers TA, Potter JD, Bostick RM, Folsom AR (1996) Reproductive factors and risk of endometrial cancer. The Iowa Women's Health Study. Am J Epidemiol 143: 1195-1201.

    Google Scholar 

  33. Elwood JM, Cole P, Rothman KJ, Kaplan SD (1977) Epidemiology of endometrial cancer. J Natl Cancer Inst 59: 1055-1060.

    Google Scholar 

  34. La Vecchia C, Negri E, Francheschi S, Parazzini F (1993) Longterm impact of reproductive factors on cancer risk. Int J Cancer 53: 215-219.

    Google Scholar 

  35. Miller AB, Barclay THC, Choi NW, et al. (1980) A study of cancer, parity and age at first pregnancy. J Chron Dis 33: 595-605.

    Google Scholar 

  36. Bernstein L, Pike MC, Ross RK, Judd HL, Brown JB, Henderson BE (1985) Estrogen and sex-hormone binding globulin levels in nulliparous and parous women. J Natl Cancer Inst 74: 741-745.

    Google Scholar 

  37. Musey VC, Collins DC, Brogan DR, et al. (1987) Long term effects of a first pregnancy on the hormonal environment: estrogens and androgens. J Clin Endocrinol Metab 64: 111-118.

    Google Scholar 

  38. Bernstein L, Dupue RH, Ross RK, Judd HL, Pick MC, Henderson BE (1986) Higher maternal levels of free estradiol in first compared to second pregnancy: early gestational differences. J Natl Cancer Inst 76: 1035-1039.

    Google Scholar 

  39. Pitot H (1986) Fundamentals of Oncology. New York, NY: Marcel Dekker Inc.

    Google Scholar 

  40. Blackburn ST, Loper DL (1992) Parturition and uterine physiology. In: Maternal, Fetal, and Neonatal Physiology. A Clinical Perspective, Ch 3, Philadelphia, PA: WB Saunders Co.

    Google Scholar 

  41. Resnik R (1984) The puerperium. In: Creasy RK, Resnik R, eds. Maternal Fetal Medicine. Principles and Practice. Philadelphia, PA: WB Saunders, pp. 155-156.

    Google Scholar 

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Authors and Affiliations

  1. Department of Medical Epidemiology, Karolinska Institutet, Box 281, S-171 77, Stockholm, Sweden

    Mats Lambe & Elisabete Weiderpass

  2. Cancer Center, University of Massachusetts, Worcester, MA, USA

    Joanne Wuu & Chung-Cheng Hsieh

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  1. Mats Lambe
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  2. Joanne Wuu
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  3. Elisabete Weiderpass
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  4. Chung-Cheng Hsieh
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Lambe, M., Wuu, J., Weiderpass, E. et al. Childbearing at older age and endometrial cancer risk (Sweden). Cancer Causes Control 10, 43–49 (1999). https://doi.org/10.1023/A:1008860615584

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