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American Journal of Epidemiology Advance Access originally published online on November 30, 2005
American Journal of Epidemiology 2006 163(3):236-244; doi:10.1093/aje/kwj028
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American Journal of Epidemiology Copyright © 2005 by the Johns Hopkins Bloomberg School of Public Health All rights reserved; printed in U.S.A.

Original Contribution

Hormonal and Reproductive Factors and the Risk of Bladder Cancer in Women

Monica McGrath1,2,3, Dominique S. Michaud1,2 and Immaculata De Vivo1,2,3

1 Department of Epidemiology, Harvard School of Public Health, Boston, MA
2 Channing Laboratory, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
3 Program in Molecular and Genetic Epidemiology, Harvard School of Public Health, Boston, MA

Correspondence to Dr. Monica McGrath, Channing Laboratory, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, 181 Longwood Avenue, Boston, MA 02115 (e-mail: mmcgrath{at}hsph.harvard.edu).

Gender and cigarette smoking are among the most consistent predictors of bladder cancer risk. After adjustment for known risk factors, an excess risk remains for males, suggesting that other factors may be responsible for the gender differences. Given limited data on hormonal or reproductive factors and bladder cancer risk, the authors examined these factors among women in the US Nurses' Health Study cohort. During 26 years of follow-up (1976–2002), 336 incident cases of bladder cancer were diagnosed. Cox proportional hazards models were used to estimate incidence rate ratios and 95% confidence intervals between hormonal and reproductive factors and bladder cancer risk. Postmenopausal women, compared with premenopausal women, were at increased risk (incidence rate ratio = 1.93, 95% confidence interval: 0.99, 3.78). For postmenopausal women, early age at menopause (≤45 years) compared with late age at menopause (≥50 years) was associated with a statistically significant increased risk of bladder cancer (incidence rate ratio = 1.63, 95% confidence interval: 1.20, 2.23). The association between age at menopause and bladder cancer risk was modified by cigarette smoking status (p for interaction = 0.01). The authors observed no significant associations of age at menarche, parity, age at first birth, and exogenous hormone use with bladder cancer risk. Findings suggest that menopausal status and age at menopause may play a role in modifying bladder cancer risk among women.

bladder neoplasms; estrogens; female; hormones; menopause

Abbreviations: CI, confidence interval; HRT, hormone replacement therapy; IRR, incidence rate ratio


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