title: Reproductive factors and epithelial ovarian cancer survival in the EPIC cohort study.
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.
authors.affiliation: Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, Norfolk Place, London W2 1PG, UK.
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authors.affiliation: Inserm, Center for Research in Epidemiology and Population Health (CESP), U1018, Lifestyle, Genes and Health: Integrative Trans-generational Epidemiology, Villejuif F-94805, France.|Université Paris Sud, UMRS 1018, Villejuif F-94805, France.|Institut Gustave Roussy, Villejuif F-94805, France.
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authors.affiliation: Inserm, Center for Research in Epidemiology and Population Health (CESP), U1018, Lifestyle, Genes and Health: Integrative Trans-generational Epidemiology, Villejuif F-94805, France.|Université Paris Sud, UMRS 1018, Villejuif F-94805, France.|Institut Gustave Roussy, Villejuif F-94805, France.
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authors.affiliation: Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, Norfolk Place, London W2 1PG, UK.|Department for Determinants of Chronic Diseases (DCD), National Institute for Public Health and the Environment (RIVM), PO Box 1, Bilthoven 3720 BA, The Netherlands.|Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Heidelberglann 100, Utrecht 3584 cx, The Netherlands.|Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur 50603, Malaysia.
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authors.affiliation: Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, Norfolk Place, London W2 1PG, UK.|Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Huispost Str. 6.131, PO Box 85500, Utrecht 3508 GA, The Netherlands.
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authors.affiliation: Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, Norfolk Place, London W2 1PG, UK.
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mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001942:Breast Feeding; D000077216:Carcinoma, Ovarian Epithelial; D003276:Contraceptives, Oral / Q000627:therapeutic use; D015914:Estrogen Replacement Therapy; D005060:Europe / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008572:Menarche; D008593:Menopause; D008875:Middle Aged; D009375:Neoplasms, Glandular and Epithelial / Q000401:mortality* / Q000473:pathology*; D010051:Ovarian Neoplasms / Q000401:mortality* / Q000473:pathology*; D010298:Parity; D015996:Survival Rate
chemical_list: D003276:Contraceptives, Oral