Reproductive Factors and Endometrial Cancer Risk Among Women

Ryoko Katagiri; Motoki Iwasaki; Sarah Krull Abe; Md Rashedul Islam; Md Shafiur Rahman; Eiko Saito; Melissa A. Merritt; Ji Yeob Choi; Aesun Shin; Norie Sawada; Akiko Tamakoshi; Woon Puay Koh; Ritsu Sakata; Ichiro Tsuji; Jeongseon Kim; Chisato Nagata; Sue K. Park; Sun Seog Kweon; Xiao Ou Shu; Yu Tang Gao; Shoichiro Tsugane; Takashi Kimura; Jian Min Yuan; Seiki Kanemura; Yukai Lu; Yumi Sugawara; Keiko Wada; Min Ho Shin; Habibul Ahsan; Paolo Boffetta; Kee Seng Chia; Keitaro Matsuo; You Lin Qiao; Nathaniel Rothman; Wei Zheng; Manami Inoue; Daehee Kang

doi:10.1001/jamanetworkopen.2023.32296

Reproductive Factors and Endometrial Cancer Risk Among Women

Ryoko Katagiri
, Motoki Iwasaki
, Sarah Krull Abe
, Md Rashedul Islam
, Md Shafiur Rahman
, Eiko Saito
, Melissa A. Merritt
, Ji Yeob Choi
, Aesun Shin
, Norie Sawada
, Akiko Tamakoshi
, Woon Puay Koh
, Ritsu Sakata
, Ichiro Tsuji
, Jeongseon Kim
, Chisato Nagata
, Sue K. Park
, Sun Seog Kweon
, Xiao Ou Shu
, Yu Tang Gao

Shoichiro Tsugane, Takashi Kimura, Jian Min Yuan, Seiki Kanemura, Yukai Lu, Yumi Sugawara, Keiko Wada, Min Ho Shin, Habibul Ahsan, Paolo Boffetta, Kee Seng Chia, Keitaro Matsuo, You Lin Qiao, Nathaniel Rothman, Wei Zheng, Manami Inoue, Daehee Kang

Family , Population and Preventative Medicine

National Cancer Center Japan
National Institutes of Biomedical Innovation, Health and Nutrition
Hitotsubashi University
Research Center for Child Mental Development
National Center for Global Health and Medicine
The University of Sydney
Seoul National University
Hokkaido University
National University of Singapore
Agency for Science, Technology and Research, Singapore
Radiation Effects Research Foundation Hiroshima
Tohoku University
National Cancer Center Korea
Gifu University
Chonnam National University
Vanderbilt University
Shanghai Cancer Institute
University of Pittsburgh
The University of Chicago
Aichi Cancer Center Hospital and Research Institute
Nagoya University
Chinese Academy of Medical Sciences
National Institutes of Health

Research output: Contribution to journal › Article › peer-review

85 Scopus citations

Abstract

IMPORTANCE Despite evidence of an association between reproductive factors and endometrial cancer risk, prospective studies have been conducted mainly in non-Asian countries. OBJECTIVE To assess the association between reproductive factors, such as number of deliveries, age at menarche, or menopause, and endometrial cancer risk. DESIGN, SETTING, AND PARTICIPANTS This cohort study used pooled individual data from 13 prospective cohort studies conducted between 1963 and 2014 in the Asia Cohort Consortium. Participants were Asian women. Data analysis was conducted from September 2019 to April 2023. EXPOSURES Reproductive factors were assessed using a questionnaire in each cohort. MAIN OUTCOMES AND MEASURES The main outcome was time to incidence of endometrial cancer. A Cox proportional hazards model was used to calculate hazard ratios (HRs) and 95% CIs. RESULTS A total of 1005 endometrial cancer cases were detected among 332 625 women (mean [SD] age, 54.3 [10.4] years) during a mean (SD) of 16.5 (6.4) years of follow-up. Increasing number of deliveries was associated with a decreased endometrial cancer risk in a dose-response manner (≥5 deliveries vs nulliparous [reference]: HR, 0.37; 95% CI, 0.26-0.53; P for trend < .001). Compared with menarche at younger than 13 years, menarche at 17 years or older had an HR of 0.64 (95% CI, 0.48-0.86; P for trend < .001). Late menopause (age ≥55 years) showed an HR of 2.84 (95% CI, 1.78-4.55; P for trend < .001) compared with the youngest age category for menopause (<45 years). Age at first delivery, hormone therapy, and breastfeeding were not associated with endometrial cancer risk. CONCLUSIONS AND RELEVANCE This large pooled study of individual participant data found that late menarche, early menopause, and a higher number of deliveries were significantly associated with a lower risk of endometrial cancer. These convincing results from Asian prospective studies add to the growing body of evidence for the association between reproductive factors and endometrial cancer.

Original language	English
Article number	e2332296
Journal	JAMA Network Open
Volume	6
Issue number	9
DOIs	https://doi.org/10.1001/jamanetworkopen.2023.32296
State	Published - Sep 2023

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10.1001/jamanetworkopen.2023.32296

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Katagiri, R., Iwasaki, M., Abe, S. K., Islam, M. R., Rahman, M. S., Saito, E., Merritt, M. A., Choi, J. Y., Shin, A., Sawada, N., Tamakoshi, A., Koh, W. P., Sakata, R., Tsuji, I., Kim, J., Nagata, C., Park, S. K., Kweon, S. S., Shu, X. O., ... Kang, D. (2023). Reproductive Factors and Endometrial Cancer Risk Among Women. JAMA Network Open, 6(9), Article e2332296. https://doi.org/10.1001/jamanetworkopen.2023.32296

@article{a8ed4d0d384c47f8bcd9f12f91dd755f,

title = "Reproductive Factors and Endometrial Cancer Risk Among Women",

abstract = "IMPORTANCE Despite evidence of an association between reproductive factors and endometrial cancer risk, prospective studies have been conducted mainly in non-Asian countries. OBJECTIVE To assess the association between reproductive factors, such as number of deliveries, age at menarche, or menopause, and endometrial cancer risk. DESIGN, SETTING, AND PARTICIPANTS This cohort study used pooled individual data from 13 prospective cohort studies conducted between 1963 and 2014 in the Asia Cohort Consortium. Participants were Asian women. Data analysis was conducted from September 2019 to April 2023. EXPOSURES Reproductive factors were assessed using a questionnaire in each cohort. MAIN OUTCOMES AND MEASURES The main outcome was time to incidence of endometrial cancer. A Cox proportional hazards model was used to calculate hazard ratios (HRs) and 95\% CIs. RESULTS A total of 1005 endometrial cancer cases were detected among 332 625 women (mean [SD] age, 54.3 [10.4] years) during a mean (SD) of 16.5 (6.4) years of follow-up. Increasing number of deliveries was associated with a decreased endometrial cancer risk in a dose-response manner (≥5 deliveries vs nulliparous [reference]: HR, 0.37; 95\% CI, 0.26-0.53; P for trend < .001). Compared with menarche at younger than 13 years, menarche at 17 years or older had an HR of 0.64 (95\% CI, 0.48-0.86; P for trend < .001). Late menopause (age ≥55 years) showed an HR of 2.84 (95\% CI, 1.78-4.55; P for trend < .001) compared with the youngest age category for menopause (<45 years). Age at first delivery, hormone therapy, and breastfeeding were not associated with endometrial cancer risk. CONCLUSIONS AND RELEVANCE This large pooled study of individual participant data found that late menarche, early menopause, and a higher number of deliveries were significantly associated with a lower risk of endometrial cancer. These convincing results from Asian prospective studies add to the growing body of evidence for the association between reproductive factors and endometrial cancer.",

author = "Ryoko Katagiri and Motoki Iwasaki and Abe, \{Sarah Krull\} and Islam, \{Md Rashedul\} and Rahman, \{Md Shafiur\} and Eiko Saito and Merritt, \{Melissa A.\} and Choi, \{Ji Yeob\} and Aesun Shin and Norie Sawada and Akiko Tamakoshi and Koh, \{Woon Puay\} and Ritsu Sakata and Ichiro Tsuji and Jeongseon Kim and Chisato Nagata and Park, \{Sue K.\} and Kweon, \{Sun Seog\} and Shu, \{Xiao Ou\} and Gao, \{Yu Tang\} and Shoichiro Tsugane and Takashi Kimura and Yuan, \{Jian Min\} and Seiki Kanemura and Yukai Lu and Yumi Sugawara and Keiko Wada and Shin, \{Min Ho\} and Habibul Ahsan and Paolo Boffetta and Chia, \{Kee Seng\} and Keitaro Matsuo and Qiao, \{You Lin\} and Nathaniel Rothman and Wei Zheng and Manami Inoue and Daehee Kang",

year = "2023",

month = sep,

doi = "10.1001/jamanetworkopen.2023.32296",

language = "English",

volume = "6",

journal = "JAMA Network Open",

issn = "2574-3805",

number = "9",

}

Katagiri, R, Iwasaki, M, Abe, SK, Islam, MR, Rahman, MS, Saito, E, Merritt, MA, Choi, JY, Shin, A, Sawada, N, Tamakoshi, A, Koh, WP, Sakata, R, Tsuji, I, Kim, J, Nagata, C, Park, SK, Kweon, SS, Shu, XO, Gao, YT, Tsugane, S, Kimura, T, Yuan, JM, Kanemura, S, Lu, Y, Sugawara, Y, Wada, K, Shin, MH, Ahsan, H, Boffetta, P, Chia, KS, Matsuo, K, Qiao, YL, Rothman, N, Zheng, W, Inoue, M & Kang, D 2023, 'Reproductive Factors and Endometrial Cancer Risk Among Women', JAMA Network Open, vol. 6, no. 9, e2332296. https://doi.org/10.1001/jamanetworkopen.2023.32296

TY - JOUR

T1 - Reproductive Factors and Endometrial Cancer Risk Among Women

AU - Katagiri, Ryoko

AU - Iwasaki, Motoki

AU - Abe, Sarah Krull

AU - Islam, Md Rashedul

AU - Rahman, Md Shafiur

AU - Saito, Eiko

AU - Merritt, Melissa A.

AU - Choi, Ji Yeob

AU - Shin, Aesun

AU - Sawada, Norie

AU - Tamakoshi, Akiko

AU - Koh, Woon Puay

AU - Sakata, Ritsu

AU - Tsuji, Ichiro

AU - Kim, Jeongseon

AU - Nagata, Chisato

AU - Park, Sue K.

AU - Kweon, Sun Seog

AU - Shu, Xiao Ou

AU - Gao, Yu Tang

AU - Tsugane, Shoichiro

AU - Kimura, Takashi

AU - Yuan, Jian Min

AU - Kanemura, Seiki

AU - Lu, Yukai

AU - Sugawara, Yumi

AU - Wada, Keiko

AU - Shin, Min Ho

AU - Ahsan, Habibul

AU - Boffetta, Paolo

AU - Chia, Kee Seng

AU - Matsuo, Keitaro

AU - Qiao, You Lin

AU - Rothman, Nathaniel

AU - Zheng, Wei

AU - Inoue, Manami

AU - Kang, Daehee

PY - 2023/9

Y1 - 2023/9

N2 - IMPORTANCE Despite evidence of an association between reproductive factors and endometrial cancer risk, prospective studies have been conducted mainly in non-Asian countries. OBJECTIVE To assess the association between reproductive factors, such as number of deliveries, age at menarche, or menopause, and endometrial cancer risk. DESIGN, SETTING, AND PARTICIPANTS This cohort study used pooled individual data from 13 prospective cohort studies conducted between 1963 and 2014 in the Asia Cohort Consortium. Participants were Asian women. Data analysis was conducted from September 2019 to April 2023. EXPOSURES Reproductive factors were assessed using a questionnaire in each cohort. MAIN OUTCOMES AND MEASURES The main outcome was time to incidence of endometrial cancer. A Cox proportional hazards model was used to calculate hazard ratios (HRs) and 95% CIs. RESULTS A total of 1005 endometrial cancer cases were detected among 332 625 women (mean [SD] age, 54.3 [10.4] years) during a mean (SD) of 16.5 (6.4) years of follow-up. Increasing number of deliveries was associated with a decreased endometrial cancer risk in a dose-response manner (≥5 deliveries vs nulliparous [reference]: HR, 0.37; 95% CI, 0.26-0.53; P for trend < .001). Compared with menarche at younger than 13 years, menarche at 17 years or older had an HR of 0.64 (95% CI, 0.48-0.86; P for trend < .001). Late menopause (age ≥55 years) showed an HR of 2.84 (95% CI, 1.78-4.55; P for trend < .001) compared with the youngest age category for menopause (<45 years). Age at first delivery, hormone therapy, and breastfeeding were not associated with endometrial cancer risk. CONCLUSIONS AND RELEVANCE This large pooled study of individual participant data found that late menarche, early menopause, and a higher number of deliveries were significantly associated with a lower risk of endometrial cancer. These convincing results from Asian prospective studies add to the growing body of evidence for the association between reproductive factors and endometrial cancer.

AB - IMPORTANCE Despite evidence of an association between reproductive factors and endometrial cancer risk, prospective studies have been conducted mainly in non-Asian countries. OBJECTIVE To assess the association between reproductive factors, such as number of deliveries, age at menarche, or menopause, and endometrial cancer risk. DESIGN, SETTING, AND PARTICIPANTS This cohort study used pooled individual data from 13 prospective cohort studies conducted between 1963 and 2014 in the Asia Cohort Consortium. Participants were Asian women. Data analysis was conducted from September 2019 to April 2023. EXPOSURES Reproductive factors were assessed using a questionnaire in each cohort. MAIN OUTCOMES AND MEASURES The main outcome was time to incidence of endometrial cancer. A Cox proportional hazards model was used to calculate hazard ratios (HRs) and 95% CIs. RESULTS A total of 1005 endometrial cancer cases were detected among 332 625 women (mean [SD] age, 54.3 [10.4] years) during a mean (SD) of 16.5 (6.4) years of follow-up. Increasing number of deliveries was associated with a decreased endometrial cancer risk in a dose-response manner (≥5 deliveries vs nulliparous [reference]: HR, 0.37; 95% CI, 0.26-0.53; P for trend < .001). Compared with menarche at younger than 13 years, menarche at 17 years or older had an HR of 0.64 (95% CI, 0.48-0.86; P for trend < .001). Late menopause (age ≥55 years) showed an HR of 2.84 (95% CI, 1.78-4.55; P for trend < .001) compared with the youngest age category for menopause (<45 years). Age at first delivery, hormone therapy, and breastfeeding were not associated with endometrial cancer risk. CONCLUSIONS AND RELEVANCE This large pooled study of individual participant data found that late menarche, early menopause, and a higher number of deliveries were significantly associated with a lower risk of endometrial cancer. These convincing results from Asian prospective studies add to the growing body of evidence for the association between reproductive factors and endometrial cancer.

UR - https://www.scopus.com/pages/publications/85169847931

U2 - 10.1001/jamanetworkopen.2023.32296

DO - 10.1001/jamanetworkopen.2023.32296

M3 - Article

C2 - 37669051

AN - SCOPUS:85169847931

SN - 2574-3805

VL - 6

JO - JAMA Network Open

JF - JAMA Network Open

IS - 9

M1 - e2332296

ER -

Reproductive Factors and Endometrial Cancer Risk Among Women

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