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A Prospective Study of the Transient Decrease in Ovarian Cancer Risk Following Childbirth

¹ Division of Biostatistics and Epidemiology, Cancer Center, University of Massachusetts Medical School, Worcester, Massachusetts; ² Department of Medical Epidemiology and Biostatistics, Karolinska Institutet; ³ Program in Clinical Epidemiology, Karolinska Hospital, Stockholm, Sweden; ⁴ Department of Obstetrics and Gynecology, Falu Hospital, Falun, Sweden; and ⁵ Center for Clinical Research, Dalarna, Sweden

Requests for reprints: Chung-Cheng Hsieh, Division of Biostatistics and Epidemiology, University of Massachusetts Cancer Center, 364 Plantation Street, LRB 427, Worcester, MA 01605. Phone: 508-856-4780; Fax: 508-856-2212. E-mail: chung.hsieh{at}umassmed.edu

Epidemiologic evidence shows that the risk of ovarian cancer is decreased following childbirth. We examined the time points when the decreased risk of postpartum maternal ovarian cancer reaches the lowest point and whether the protective effect diminishes over time. A case-control study nested within the Swedish Fertility Register included 10,086 cases of epithelial ovarian cancer recorded in the Swedish Cancer Register from 1961 to 2001. From the Fertility Register, 49,249 eligible subjects matched to the cases by age were selected as controls. The analysis contrasted risk between adjacent parities through logistic regression models that included indicator variables representing each year of age, age at delivery, and time since delivery. Compared with nulliparous women, uniparous women had a transient decrease in maternal ovarian cancer risk at 2 years after delivery (spline-derived odds ratio, 0.71; 95% confidence interval, 0.53-0.95, for those delivered at age 25 years) and maintained a lower risk for 4 years postpartum. Similar transient decreases were observed in biparous women compared with uniparous women and in women with three parities compared with biparous women. The protective effect of childbearing seemed to diminish with time. The transient decrease in postpartum ovarian cancer risk may define the latent period required for pregnancy hormones in clearing out ovarian cells that have undergone early stages of malignant transformation. The period before the risk increases again could indicate the period required for ovarian cancer induction. (Cancer Epidemiol Biomarkers Prev 2006;15(12):2508–13)

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