title: Estrogen exposure and bladder cancer risk in Egyptian women.
abstract: OBJECTIVE
  To examine associations between reproductive history and urinary bladder cancer in Egyptian women.
  
  
  METHODS
  We used questionnaire data from an ongoing, multicenter case-control study in Egypt. Controls were matched on age and residence area. This analysis focused on female cases with confirmed urothelial (UC) and squamous cell (SCC) carcinoma of the bladder.
  
  
  RESULTS
  We recruited 779 women (540 controls, 239 cases; >98.0% nonsmokers). Younger age at menopause (<45 y) and older age at first pregnancy (>18 y) were factors significantly associated with increased risk of bladder cancer, even after adjusting for schistosomiasis history and other covariates in the multivariable logistic model; adjusted odds ratio and 95% confidence intervals were 1.98 (1.41, 2.77) and 6.26 (3.46, 11.34), respectively. On the other hand, multiple pregnancies or use of oral contraceptives were associated with decreased odds of having bladder cancer. Similar associations were observed with UC and SCC when analyzed separately; however, the magnitude of association with SCC was lower than with UC.
  
  
  CONCLUSIONS
  Our data suggest that early estrogen exposure, or the relative lack of it, plays a role in urinary bladder carcinoma development among Egyptian women.
authors.affiliation: Department of Epidemiology and Preventive Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, USA. bwolpert@epi.umaryland.edu
authors.forename: Beverly J
authors.initials: BJ
authors.lastname: Wolpert
authors.forename: Sania
authors.initials: S
authors.lastname: Amr
authors.forename: Sameera
authors.initials: S
authors.lastname: Ezzat
authors.forename: Doa'a
authors.initials: D
authors.lastname: Saleh
authors.forename: Iman
authors.initials: I
authors.lastname: Gouda
authors.forename: Iman
authors.initials: I
authors.lastname: Loay
authors.forename: Tamer
authors.initials: T
authors.lastname: Hifnawy
authors.forename: Nabiel N
authors.initials: NN
authors.lastname: Mikhail
authors.forename: Mohamed
authors.initials: M
authors.lastname: Abdel-Hamid
authors.forename: Min
authors.initials: M
authors.lastname: Zhan
authors.forename: Yun-Ling
authors.initials: YL
authors.lastname: Zheng
authors.forename: Katherine
authors.initials: K
authors.lastname: Squibb
authors.forename: Mohamed A
authors.initials: MA
authors.lastname: Abdel-Aziz
authors.forename: Mohamed
authors.initials: M
authors.lastname: Zaghloul
authors.forename: Hussein
authors.initials: H
authors.lastname: Khaled
authors.forename: Christopher A
authors.initials: CA
authors.lastname: Loffredo
mesh_terms: D000367:Age Factors; D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000209:etiology*; D016022:Case-Control Studies; D003276:Contraceptives, Oral / Q000009:adverse effects; D004534:Egypt; D004967:Estrogens / Q000009:adverse effects / Q000378:metabolism*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008572:Menarche; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011247:Pregnancy; D011272:Pregnancy, Multiple; D017584:Reproductive History; D012307:Risk Factors; D011795:Surveys and Questionnaires; D001749:Urinary Bladder Neoplasms / Q000209:etiology*
chemical_list: D003276:Contraceptives, Oral; D004967:Estrogens
references.citation: Urol Oncol. 2004 Mar-Apr;22(2):86-92
references.pmid: 15082003
references.citation: Am J Epidemiol. 2007 Mar 15;165(6):660-6
references.pmid: 17204516
references.citation: Prev Med. 2002 Aug;35(2):114-20
references.pmid: 12200095
references.citation: J Natl Cancer Inst. 1990 Oct 17;82(20):1636-40
references.pmid: 2213906
references.citation: Br J Cancer. 1998 Apr;77(7):1186-9
references.pmid: 9569060
references.citation: Clin Microbiol Rev. 1999 Jan;12(1):97-111
references.pmid: 9880476
references.citation: Cancer Causes Control. 2008 May;19(4):421-9
references.pmid: 18188671
references.citation: Tumori. 2007 Jan-Feb;93(1):4-12
references.pmid: 17455864
references.citation: Int J Cancer. 2009 Jan 15;124(2):412-9
references.pmid: 18792102
references.citation: World J Urol. 2007 Jun;25(3):285-95
references.pmid: 17530260
references.citation: Br J Cancer. 2000 Apr;82(7):1364-9
references.pmid: 10755416
references.citation: Int J Cancer. 2003 Jun 20;105(3):408-12
references.pmid: 12704678
references.citation: Acta Oncol. 1997;36(6):631-6
references.pmid: 9408155
references.citation: Ann Epidemiol. 1993 Jul;3(4):429-33
references.pmid: 8275221
references.citation: J Egypt Soc Parasitol. 2003 Dec;33(3 Suppl):1031-50
references.pmid: 15119469
references.citation: Cancer Causes Control. 2002 Feb;13(1):83-90
references.pmid: 11899922
references.citation: Int J Cancer. 2006 Nov 15;119(10):2398-401
references.pmid: 16894568
references.citation: Cancer Causes Control. 1992 Jan;3(1):57-62
references.pmid: 1536914
references.citation: Nat Clin Pract Urol. 2007 Apr;4(4):205-17
references.pmid: 17415353
references.citation: Nicotine Tob Res. 2007 May;9(5):591-6
references.pmid: 17454715
references.citation: Int J Cancer. 2007 Mar 1;120(5):1093-8
references.pmid: 17131327
references.citation: CA Cancer J Clin. 2005 Mar-Apr;55(2):74-108
references.pmid: 15761078
references.citation: Am J Epidemiol. 2006 Feb 1;163(3):236-44
references.pmid: 16319290
references.citation: Cancer Res. 2007 Aug 1;67(15):7540-5
references.pmid: 17671226
references.citation: Am J Trop Med Hyg. 2000 Sep-Oct;63(3-4):133-8
references.pmid: 11388504
references.citation: Obstet Gynecol. 2003 Sep;102(3):565-70
references.pmid: 12962944