American Journal of Epidemiology Vol. 144, No. 4: 363-372
Copyright © 1996 by The Johns Hopkins University School of Hygiene and Public Health
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Differences in Risk Factors for Epithelial Ovarian Cancer by Histologic Type
Results of a Case-Control Study
1 Department of Epidemiology and Public Hearth, School of Medicine, Yale University New Haven, CT
2 Ontario Cancer Treatment and Research Foundation Toronto, Ontario, Canada
3 NCIC Epidemiology Unit, Department of Preventive Medicine and Biostattstics, Faculty of Medicine, University of Toronto Toronto, Ontario, Canada
4 Division of Epidemiology, School of Public Health, Columbia University New York, NY
Reprint requests to Dr. Harvey A. Risch, Department of Epidemiology and Public Health, Yale University School of Medicine, 60 College Street, P.O. Box 208034, New Haven, CT 06520-8034.
A case-control study of associations between dietary and reproductive factors and cancer of the ovary was conducted during 1989–1992 in metropolitan Toronto and nearby areas of southern Ontario, Canada. In total, 450 women aged 35–79 years with historically verified new primary epithelial ovarian cancers were interviewed concerning their reproductive history and dietary practices. Over the same time period, 564 randomly selected population controls, frequency-matched to the cases according to three 15-year age groups, were also interviewed. Continuous unconditional logistic regression methods were used for analysis. it was found that childbearing and use of oral contraceptives were associated with significant decreasing trends in the risk of epithelial ovarian cancer of all principal histologic types except mucinous tumors. For each full-term pregnancy, the odds ratio was 0.76 (95% confidence interval (Cl) 0.69–0.85) for nonmucinous tumors and 1.03 (95% Cl 0.88–1.21) for mucinous tumors; for each year of oral contraceptive use, the odds ratio was 0.89 (95% Cl 0.85–0.93) for nonmucinous tumors and 0.98 (95% Cl 0.93–1.04) for mucinous tumors (p = 0.00051 and p = 0.0040, respectively, for the difference in odds ratios between mucinous and nonmucinous tumors). Saturated fat intake also appeared to convey greater increased risk for women with mucinous tumors than for women with neoplasms of other histologic types (p = 0.029). Among women with nonmucinous tumors, increasing trends in risk of invasive serous cancer (p = 0.018), and particularly endometrioid cancer (p = 0.0041), were seen with use of noncontraceptive estrogens. Otherwise, borderline-malignant neoplasms seemed to have a similar spectrum of risk factor associations as invasive cancers. On the basis of this study and a number of others, the authors suggest that mucinous ovarian tumors may be etiologically unrelated to other types of epithelial tumors, and thus should be considered separately in studies of ovarian cancer. Am J Epidemiol 1996; 144: 363–72.
contraception; diet; histology; ovarian neoplasms; parity; pregnancy; retrospective studies
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