Characteristics relating to ovarian cancer risk: Collaborative analysis of 12 us case-control studies: IV. The pathogenesis of epithlial ovarian cancer

Alice S. Whittemore, Robin Harris, Jacqueline Ltnyre

Research output: Contribution to journalArticle

247 Scopus citations

Abstract

Two hypotheses have been proposed to explain the reduced risk of epithelial ovarian cancer associated with pregnancy and oral contraceptive use. The first states that some sequelae of ovulation increase the likelihood of malignancy and that pregnancies and oral contraceptives protect by suppressing ovulation. The second hypothesis states that circulating levels of pituitary gonadotropins increase the risk of malignancy and that pregnancies and oral contraceptives protect by suppressing secretion of these hormones. The authors evaluate the two hypotheses in light of combined data from 12 United States case-oxitrol studies of epithelial ovarian cancer in white women conducted from 1956 to 1986. While a number of observations support both hypotheses, there are exceptions. Differential risk reduction associated with pregnancy and oral contraceptive use (pregnancy being the more effective in young women and the less effective in older women) conflicts with the first "ovulation" hypothesis, while reduced risk associated with breast feeding and absence of altered risk associated with estrogen replacement therapy conflicts with the second "gonadotropin" hypothesis. Several findings would not have been predicted by either hypothesis, e.g., only weak trends relate cancer risk to age at menarche, and, among older women, no clear trends relate risk to age at menopause. Odds ratio attenuation due to errors in reporting personal characteristics may be responsible for some of these inconsistencies. Multidisciplinary research is needed to clarify the etkrfogic roles of ovulation and gonadotropin stimulation, both of which may enhance carcinogenesis in the ovarian epithelium. Am J Epidemiol 1992: 136: 1212-20

Original languageEnglish (US)
Pages (from-to)1212-1220
Number of pages9
JournalAmerican journal of epidemiology
Volume136
Issue number10
DOIs
StatePublished - Nov 15 1992
Externally publishedYes

Keywords

  • Gonadotropins
  • Ovarian neoplasms
  • Ovulation
  • Reproductions

ASJC Scopus subject areas

  • Epidemiology

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