Reproductive risk factors and endometrial cancer: the European Prospective Investigation into Cancer and Nutrition.
Endometrial cancer risk has been associated with reproductive factors (age at menarche, age at menopause, parity, age at first and last birth, time since last birth and use of oral contraceptives (OCs)]. However, these factors are closely interrelated and whether they act independently still requires clarification. We conducted a study to examine the association of menstrual and reproductive variables with the risk of endometrial cancer among the European Prospective Investigation into Cancer and Nutrition (EPIC). Among the 302,618 women eligible for the study, 1,017 incident endometrial cancer cases were identified. A reduction in endometrial cancer risk was observed in women with late menarche, early menopause, past OC use, high parity and a shorter time since last full-term pregnancy (FTP). No association was observed for duration of breast feeding after adjustment for number of FTP or for abortion (spontaneous or induced). After mutual adjustment, late age at menarche, early age at menopause and duration of OC use showed similar risk reductions of 7-8% per year of menstrual life, whereas the decreased risk associated with cumulative duration of FTPs was stronger (22% per year). In conclusion, our findings confirmed a reduction in risk of endometrial cancer with factors associated with a lower cumulative exposure to estrogen and/or higher exposure to progesterone, such as increasing number of FTPs and shorter menstrual lifespan and, therefore, support an important role of hormonal mechanisms in endometrial carcinogenesis.
Dossus
Laure
L
German Cancer Research Center, Heidelberg, Germany. l.dossus@dkfz.de
Allen
Naomi
N
Kaaks
Rudolf
R
Bakken
Kjersti
K
Lund
Eiliv
E
Tjonneland
Anne
A
Olsen
Anja
A
Overvad
Kim
K
Clavel-Chapelon
Francoise
F
Fournier
Agnes
A
Chabbert-Buffet
Nathalie
N
Boeing
Heiner
H
Schütze
Madlen
M
Trichopoulou
Antonia
A
Trichopoulos
Dimitrios
D
Lagiou
Pagona
P
Palli
Domenico
D
Krogh
Vittorio
V
Tumino
Rosario
R
Vineis
Paolo
P
Mattiello
Amalia
A
Bueno-de-Mesquita
H Bas
HB
Onland-Moret
N Charlotte
NC
Peeters
Petra H M
PH
Dumeaux
Vanessa
V
Redondo
Maria-Luisa
ML
Duell
Eric
E
Sanchez-Cantalejo
Emilio
E
Arriola
Larraitz
L
Chirlaque
Maria-Dolores
MD
Ardanaz
Eva
E
Manjer
Jonas
J
Borgquist
Signe
S
Lukanova
Annie
A
Lundin
Eva
E
Khaw
Kay-Tee
KT
Wareham
Nicholas
N
Key
Tim
T
Chajes
Veronique
V
Rinaldi
Sabina
S
Slimani
Nadia
N
Mouw
Traci
T
Gallo
Valentina
V
Riboli
Elio
E
D000293:Adolescent; D000328:Adult; D002648:Child; D003276:Contraceptives, Oral; D016889:Endometrial Neoplasms / Q000453:epidemiology*; D005060:Europe / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008593:Menopause; D008875:Middle Aged; D009749:Nutrition Surveys; D010298:Parity; D011247:Pregnancy; D011379:Prognosis; D011446:Prospective Studies; D012098:Reproduction / Q000502:physiology*; D012307:Risk Factors; D011795:Surveys and Questionnaires; D055815:Young Adult
D003276:Contraceptives, Oral