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Reproductive factors and epithelial ovarian cancer survival in the EPIC cohort study

Bešević J 1 , Gunter MJ 1 , Fortner RT 2 , Tsilidis KK 1 , Weiderpass E 3 , Onland-Moret NC 4 Show all authors , Dossus L 5 , Tjønneland A 6 , Hansen L 6 , Overvad K 7 , Mesrine S 5 , Baglietto L 8 , Clavel-Chapelon F 5 , Kaaks R 2 , Aleksandrova K 9 , Boeing H 9 , Trichopoulou A 10 , Lagiou P 11 , Bamia C 12 , Masala G 13 , Agnoli C 14 , Tumino R 15 , Ricceri F 16 , Panico S 17 , Bueno-de-Mesquita HB 1 , Peeters PH 1 , Jareid M 3 , Quirós JR 18 , Duell EJ 19 , Sánchez MJ 20 , Larrañaga N 21 , Chirlaque MD 21 , Barricarte A 21 , Dias JA 22 , Sonestedt E 22 , Idahl A 23 , Lundin E 24 , Wareham NJ 25 , Khaw KT 26 , Travis RC 27 , Rinaldi S 28 , Romieu I 28 , Riboli E 1 , Merritt MA 1

Affiliations 

  • 1 Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, Norfolk Place, London W2 1PG, UK
  • 2 Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, Heidelberg 69120, Germany
  • 3 Department of Community Medicine, Faculty of Health Sciences, University of Tromsø-The Arctic University of Norway, Tromsø N-9037, Norway
  • 4 Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Huispost Str. 6.131, PO Box 85500, Utrecht 3508 GA, The Netherlands
  • 5 Inserm, Center for Research in Epidemiology and Population Health (CESP), U1018, Lifestyle, Genes and Health: Integrative Trans-generational Epidemiology, Villejuif F-94805, France
  • 6 Danish Cancer Society Research Center, Strandboulevarden 49, Copenhagen DK-2100, Denmark
  • 7 Section for Epidemiology, Department of Public Health, Aarhus University, Bartholins Alle 2, Aarhus C DK-8000, Denmark
  • 8 Cancer Epidemiology Center, Cancer Council of Victoria, 615 St Kilda Road, Melbourne 3004, Victoria, Australia
  • 9 Department of Epidemiology, German Institute of Human Nutrition Potsdam-Rehbrücke, Arthur-Scheunert-Allee 114-116, Nuthetal 14558, Germany
  • 10 Hellenic Health Foundation, 13 Kaisareias Street, Athens GR-115 27, Greece
  • 11 Department of Epidemiology, Harvard School of Public Health, 677 Huntington Avenue, Boston, MA 02115, USA
  • 12 Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Mikras Asias 75, Goudi, Athens GR-115 27, Greece
  • 13 Molecular and Nutritional Epidemiology Unit, Cancer Research and Prevention Institute-ISPO, Ponte Nuovo Palazzina 28A 'Mario Fiori', Via delle Oblate 4, Florence 50141, Italy
  • 14 Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Venezian, 1, Milano 20133, Italy
  • 15 Cancer Registry and Histopathology Unit, 'Civic-M.P. Arezzo' Hospital, ASP, Via Dante No. 109, Ragusa 97100, Italy
  • 16 Unit of Epidemiology, Regional Health Service ASL TO3, Via Sabaudia 164, Grugliasco (TO) 10095, Italy
  • 17 Dipartimento di Medicina Clinica e Chirurgia, Federico II University, via Pansini 5, 80131 Naples, Italy
  • 18 Public Health Directorate, Asturias, Ciriaco Miguel Vigil St 9, Oviedo 33006, Spain
  • 19 Unit of Nutrition and Cancer, Cancer Epidemiology Research Program, Catalan Institute of Oncology (ICO-IDIBELL), Avda Gran Via 199-203, 08908 L'Hospitalet de Llobregat, Barcelona, Spain
  • 20 Escuela Andaluza de Salud Pública, Instituto de Investigación Biosanitaria ibs, Hospitales Universitarios de Granada/Universidad de Granada, Cuesta del Observatorio, 4, Campus Universitario de Cartuja, Granada 18080, Spain
  • 21 CIBER de Epidemiología y Salud Pública (CIBERESP), Melchor Fernández Almagro, 3-5, Madrid 28029, Spain
  • 22 Department of Clinical Sciences Malmö, Lund University, Malmö 20502, Sweden
  • 23 Department of Clinical Sciences, Obstetrics and Gynecology, Umeå University, SE-901 87 Umeå, Sweden
  • 24 Department of Medical Biosciences and Pathology, Umeå University, Umeå SE-901 87, Sweden
  • 25 MRC Epidemiology Unit, University of Cambridge, Institute of Metabolic Science, Box 285, Addenbrooke's Hospital, Hills Road, Cambridge CB2 0QQ, UK
  • 26 School of Clinical Medicine, University of Cambridge, Addenbrooke's Hospital, Hills Rd, Cambridge CB2 0SP, UK
  • 27 Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Richard Doll Building, Oxford OX3 7LF, UK
  • 28 International Agency for Research on Cancer, 150 Cours Albert-Thomas, Lyon Cedex 08 69372, France
Br J Cancer, 2015 Dec 01;113(11):1622-31.
PMID: 26554655 DOI: 10.1038/bjc.2015.377

Abstract

BACKGROUND: Reproductive factors influence the risk of developing epithelial ovarian cancer (EOC), but little is known about their association with survival. We tested whether prediagnostic reproductive factors influenced EOC-specific survival among 1025 invasive EOC cases identified in the European Prospective Investigation into Cancer and Nutrition (EPIC) study, which included 521,330 total participants (approximately 370,000 women) aged 25-70 years at recruitment from 1992 to 2000.

METHODS: Information on reproductive characteristics was collected at recruitment. Cox proportional hazards regression models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs), and multivariable models were adjusted for age and year of diagnosis, body mass index, tumour stage, smoking status and stratified by study centre.

RESULTS: After a mean follow-up of 3.6 years (±3.2 s.d.) following EOC diagnosis, 511 (49.9%) of the 1025 women died from EOC. We observed a suggestive survival advantage in menopausal hormone therapy (MHT) users (ever vs never use, HR=0.80, 95% CI=0.62-1.03) and a significant survival benefit in long-term MHT users (⩾5 years use vs never use, HR=0.70, 95% CI=0.50-0.99, P(trend)=0.04). We observed similar results for MHT use when restricting to serous cases. Other reproductive factors, including parity, breastfeeding, oral contraceptive use and age at menarche or menopause, were not associated with EOC-specific mortality risk.

CONCLUSIONS: Further studies are warranted to investigate the possible improvement in EOC survival in MHT users.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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