Association between the age-adjusted visceral adiposity index (AVAI) and gynecologic malignancies: a cross-sectional study based on NHANES data

This study aims to analyze the association between the weight-adjusted waist index (WWI) and the risk of gynecologic cancers, using data collected from the National Health and Nutrition Examination Survey (NHANES) from 2011 to 2016. We employed multiple logistic regression analysis to investigate the relationship between WWI and risk of gynecologic cancers. Subsequent subgroup analyses were performed on specific populations of interest. A restricted cubic spline model was used to explore potential non-linear relationships. Additionally, the effectiveness of WWI in predicting sarcopenia was assessed through Receiver Operating Characteristic (ROC) curve analysis. K-fold cross-validation was applied for model assessment. Among the 4,144 participants, 98 self-reported having gynecologic cancers. In the fully adjusted model, WWI was significantly associated with the prevalence of gynecologic cancers (OR = 1.38, 95% CI: 1.02-1.88, p = 0.0344). Our findings indicate a linear positive association between WWI and the risk of gynecologic cancers. Subgroup analysis revealed that WWI had the strongest association with cervical cancer (OR = 1.46, 95% CI: 0.97-2.18, p = 0.0354) and endometrial cancer (OR = 1.39, 95% CI: 0.81-2.39, p = 0.0142). No significant association was found between WWI and the risk of ovarian cancer (OR = 1.16, 95% CI: 0.48-2.72, p = 0.5359). Restricted cubic spline analysis confirmed a linear relationship between WWI and the risk of cervical, endometrial, and ovarian cancers. ROC curve analysis demonstrated that WWI had superior predictive capability for gynecologic cancers. Elevated levels of WWI were significantly associated with an increased risk of gynecologic cancers in American women, displaying a stronger association than other obesity markers. Therefore, WWI may serve as a distinct and valuable biomarker for assessing the risk of gynecologic cancers, particularly cervical and endometrial cancers.

We studied the effect of new environment on the risk in and mortality of gynecological cancers in first- and second-generation immigrants in Sweden. We used the nationwide Swedish Family-Cancer Database to calculate standardized incidence/mortality ratios (SIRs/SMRs) of cervical, endometrial and ovarian cancers among immigrants in comparison to the native Swedes. Risk of cervical cancer increased among first-generation immigrants with Danish (SIR = 1.64), Norwegian (1.33), former Yugoslavian (1.21) and East European (1.35) origins, whereas this risk decreased among Finns (0.88) and Asians (SIRs varies from 0.11 in Iranians to 0.54 in East Asians). Risk of endometrial (SIRs varies from 0.28 in Africans to 0.86 in Finns) and ovarian (SIRs varies from 0.23 in Chileans to 0.82 in Finns) cancers decreased in first-generation immigrants. The overall gynecological cancer risk for the second-generation immigrants, independent of the birth region, was almost similar to that obtained for the first generations. The birth region-specific SMRs of gynecological cancers in first- and second-generation immigrants co-varied with the SIRs. Risk of gynecological cancers among the first-generation immigrants is similar to that in their original countries, except for cervical cancer among Africans and endometrial cancer among North Americans and East Europeans. Our findings show that risk and mortality of gynecological cancers observed in the first-generation immigrants remain in the second generation. We conclude that the risk and protective factors of gynecological cancers are preserved upon immigration and through generations, suggesting a role for behavioral factors or familial aggregation in the etiology of these diseases.

Observational studies have shown that cholelithiasis and cholecystectomy are associated with the risk of breast cancer (BC) and gynecological cancers, but whether these relationships are causal has not been established and remains controversial. Our study began with a meta-analysis that synthesized data from prior observational studies to examine the association between cholelithiasis, cholecystectomy, and the risk of BC and gynecological cancers. Subsequently, a two-sample Mendelian randomization (MR) analysis was conducted utilizing genetic variant data to investigate the potential causal relationship between cholelithiasis, cholecystectomy, and the aforementioned cancers. The results of the meta-analysis demonstrated a significant association between cholecystectomy and the risk of BC (risk ratio [RR]=1.04, 95% confidence interval [CI]: 1.01-1.06, p=0.002) and endometrial cancer (EC) (RR=1.26, 95% CI: 1.02-1.56, p=0.031). Conversely, no significant association was observed between cholelithiasis and the risk of BC, EC, and ovarian cancer. The MR analysis revealed no discernible causal connection between cholelithiasis and overall BC (p=0.053), as well as BC subtypes (including estrogen receptor-positive/negative). Similarly, there was no causal effect of cholecystectomy on BC risk (p=0.399) and its subtypes. Furthermore, no causal associations were identified between cholelithiasis, cholecystectomy, and the risk of gynecological cancers (ovarian, endometrial, and cervical cancer [CC]) (all p>0.05). This study does not support a causal link between cholelithiasis and cholecystectomy and an increased risk of female cancers such as breast, endometrial, ovarian, and CC.

Arterial stiffness is measured by pulse wave velocity (PWV), which has a well-established correlation with a number of health consequences. Nevertheless, it is still unknown how estimated pulse wave velocity (ePWV) and the risk and mortality of gynecological cancer (GC) are related. This study examined the association between ePWV and GC risk and mortality using data from the National Health and Nutrition Examination Survey (NHANES) conducted between 2003 and 2016. We initially performed a cross-sectional study in which we separated participants into 3 groups based on their ePWV tertiles in order to assess the relationship between ePWV and GC risk. A survival analysis was conducted to examine the relationship between ePWV and mortality risk in patients with GC. Multivariable logistic regression, Cox proportional hazards models and restricted cubic splines (RCS) were performed for analysis. A total of 19,590 participants were included in the study, with 464 diagnosed with GC (238 cervical cancer, 88 ovarian cancer, and 157 uterine cancer). Compared to the lowest ePWV group, the highest ePWV group had a 70% increased risk of GC (odds ratio (OR): 1.70, 95% confidence interval (CI): 1.10–2.62). RCS analysis revealed a nonlinear positive association between ePWV and GC risk (P for nonlinear = .044). The predictive value of ePWV for GC risk was 59.1% (area under the curve (AUC): 0.591, 95% CI: 0.567–0.616). Among GC patients, the highest ePWV group had a 6.45-fold increased risk of death compared to the lowest ePWV group (hazard ratio (HR): 6.45, 95% CI: 1.32–31.53). RCS analysis further showed a linear positive association between ePWV and mortality in GC patients (P for nonlinear = .131). The predictive value of ePWV for mortality risk in GC patients was 80.6% (AUC: 0.806, 95% CI: 0.756–0.855). Higher levels of ePWV are associated with an increased risk of GC and higher mortality in GC patients, although ePWV exhibits relatively poor discriminatory ability for GC risk. ePWV may serve as a useful predictor of both cancer risk and prognosis, highlighting its potential as a clinical marker for identifying at-risk individuals and improving patient management.

Atypical glandular cells (AGC) are rare abnormalities found on cervical cytology associated with a range of lesions of the female reproductive system. We compared the risk of cervical and other gynecologic cancers following AGC on cervical cytology with the risk following squamous cell abnormalities of comparable severity. We used data from the Dutch Pathology Archive (PALGA) from 2000 to 2015 to categorize cervical cytology tests into groups based on most severe cytologic abnormality and correlated follow-up advice (normal cytology and "no follow-up" advice, squamous-cell-based, AGC-based, and combined AGC/squamous-cell based each with either repeat testing or referral advice). Cancer data were linked from the Netherlands Cancer Registry. Cox proportional hazard models were calculated stratified by age [younger (<50 years) and older (50+ years)], adjusted for number of previous primary cytology tests. 8,537,385 cytology smears and 9,061 cancers were included. When repeat cytology testing was advised, HRs of cervical cancer (younger women: HR, 6.91; 95% CI, 5.48-8.71; older women: HR, 3.98; 95% CI, 2.38-6.66) or other gynecologic cancer diagnosis in younger women (HR, 2.82; 95% CI, 1.39-5.74) were significantly higher after an AGC-based abnormality compared with squamous-based abnormalities. Hazards were also significantly higher for "referral" advice cytology, except for cervical cancer among older women (HR, 0.88; 95% CI, 0.63-1.21). AGC indicates an increased risk of gynecologic cancer compared with squamous-based abnormalities of comparable severity. Gynecologists should be alert for cervical and endometrial cancers when examining women referred following AGC.

Depression is one of the leading sources of disease burden globally and plays a significant role in the occurrence and development of many cancers, representing an important health risk. However, the relationship between depression and the risk of gynecologic cancers has not been fully assessed. This study aims to explore the association between depression and the risk of gynecologic cancers. We selected 11,574 participants from the NHANES 2009-2018 cycles, among which 274had gynecologic cancer (GC), 137had cervical cancer (CC), 48had ovarian cancer (OC), and 89had endometrial cancer (EC). Box plots were used to assess the differences in PHQ-9 depression scores between cancer and non-cancer groups. Logistic regression models and restricted cubic spline (RCS) models were employed to evaluate the relationship between PHQ-9 scores and gynecologic cancers. Subgroup analyses and interaction tests examined the consistency of the association across different characteristics. There was a significant difference in PHQ-9 scores between the cancer group and the non-cancer group. In the multivariable logistic regression analysis, PHQ-9 scores were positively correlated with GC, OC, and EC, while no significant association was found with CC risk. Additionally, the RCS model also indicated no nonlinear association between PHQ-9 scores and CC risk. Additionally, subgroup analyses suggested that the relationship between PHQ-9 scores and CC and OC was consistent across groups, whereas the association between PHQ-9 scores and GC and EC showed heterogeneity in relation to race and marital status. Depression is positively correlated with gynecologic cancers. Specifically, higher levels of depression are associated with an increased risk of OC and EC, while no significant association was found with CC risk. Future attention should be given to the impact of depression on the incidence of gynecologic cancers, particularly OC and EC.

Endometrial, ovarian, and cervical cancers are the most common gynecological cancers, with 1.4 million diagnoses worldwide in 2022. Statins are widely used for cardiovascular conditions and have been studied for their association with gynecological cancer risk, but results to date have been inconclusive. We conducted a population-based cohort study including data from the Norwegian Prescription Database and the Cancer Registry of Norway, and followed women aged ≥50 years from 2004 to 2018. We examined the association between statin use overall and by type (lipophilic, hydrophilic), and the risk of endometrial, ovarian, and cervical cancers overall and by age groups and histologic subgroup using Cox proportional hazard models. The cohort study included 1083629 women. During a median follow-up of 11.6 years, 334582 (31%) used statins at least once. There were 7709 cases of endometrial, 4415 cases of ovarian, and 1603 cases of cervical cancers. Statin use was associated with reduced risk of endometrial cancer [current use hazard ratio (HR) = 0.90, 95% confidence interval (CI): 0.85-0.96; past use HR = 0.79, 95% CI: 0.71-0.88]; associations were observed only for the lipophilic statins, and with similar associations by age groups and for type I and II endometrial cancer. No consistent associations were found for ovarian or cervical cancers. We found no trends for cumulative defined daily doses of current use or time since cessation for any cancer type. Statin use was associated with a reduced risk of endometrial cancer but not with the risk of ovarian cancer or cervical cancer.

Incidence and survival of multiple primary cancers in United States women (349)

The effect of lifestyle factors on gynaecological cancer

Background: In 2015, it has been estimated that 54,870 new cases of endometrial cancer will be diagnosed and about 10,170 women will die from it in United States. Previous studies suggested that high levels of coffee consumption may be associated with reduced risk of endometrial cancer among women ages 50–71. Although caffeine is a major ingredient of coffee, one study stated this inverse association does not differ according to caffeine content (regular coffee/decaffeinated coffee). However, the specific measurement of caffeine intake was not clear in that previous study. This study tries to investigate endometrial cancer risk in relation to caffeine intake and coffee consumption. Methods: The National Health and Nutrition Examination Survey (NHANES) 2003–2012 surveys were used in this study. A total of 5,847 postmenopausal women with valid cancer status were included in this study. Chi-square tests and t -tests were used to examine differences in proportions. Multiple logistic regression models were used to determine whether there was an association between the caffeine intake and endometrial cancer, after adjustment of various potential confounding variables. Weighting is supplied by NHANES data. Results: Among the women in the study, 1.37% of them were diagnosed with endometrial cancer. After multivariate adjustment, compared to women who did not have any caffeine intake, a significant increase in endometrial cancer was found in all levels of caffeine intake [OR =25.646 (≤93 mg/day vs . non-taken), 95% CI: 3.248–202.481; OR =17.299 (>93 mg/day vs . non-taken), 95% CI: 2.210–135.434] and coffee consumption [OR =42.865 (≤358 g/day vs . non-taken), 95% CI: 5.260–349.347; OR =16.354 (>358 g/day vs . non-taken), 95% CI: 1.880–142.301]. The results also showed that black women and women using birth control pills were less likely to get endometrial cancer, but women who are excessively obese have a significantly higher risk of getting endometrial cancer. Conclusions: Our findings suggested that caffeine intake was associated with endometrial cancer. Compared to no caffeine intake, all level of coffee consumption and caffeine intake were risk factors of endometrial cancer. Black women had lower risk of endometrial cancer. A history of birth control pill use was a protected factor, while excess obesity was risk factor of endometrial cancer.

ObjectiveThe impact of different physical activity (PA) patterns, including the less-studied “weekend warrior” pattern, on gynecologic cancer risk remains unclear. This study aimed to examine the associations of regular and “weekend warrior” PA patterns with the risk of cervical cancer (CC), ovarian cancer (OC), and uterine cancer (UC).MethodsA total of 13,675 women from the 2007–2018 National Health and Nutrition Examination Survey (NHANES) cycles were included in this cross-sectional analysis. Weighted multivariable logistic regression models were applied to assess associations between PA patterns and the prevalence of gynecologic cancers. Subgroup analyses stratified by PA patterns and cancer subtypes were performed to explore potential interactions. In addition, restricted cubic spline (RCS) regression was used to examine possible nonlinear relationships between PA patterns and gynecologic cancer risk.ResultsAmong the 13,675 participants, 331 women self-reported a gynecologic cancer diagnosis, including 172 cases of CC, 58 cases of OC, and 101 cases of UC. In fully adjusted models, regular PA was significantly associated with a lower prevalence of gynecologic cancers (OR = 0.635, 95% CI: 0.448–0.901; p = 0.012), whereas the weekend warrior pattern PA showed a non-significant association with cancer risk (OR = 0.544, 95% CI: 0.162–1.824, p = 0.32). RCS analysis demonstrated a significant nonlinear association between PA patterns and gynecologic cancer risk (p for nonlinearity < 0.001). Subgroup analyses further identified a significant interaction with race/ethnicity (p for interaction = 0.038).ConclusionOur findings suggest that regular PA may be inversely associated with the risk of gynecologic cancers. Although the weekend warrior PA pattern did not show a statistically significant association, the wide confidence interval indicates limited statistical power, and the true effect cannot be reliably estimated. These results highlight the potential importance of consistent PA for cancer prevention, while emphasizing the need for larger studies to clarify the impact of weekend warrior PA patterns.

The objective of the paper was to summarize the literature findings on alcohol consumption with regard to risk of various gynecological cancers. A Medline search was performed considering available cohort and case-control studies published until 31st March 2009 examining the association between the consumption of alcoholic beverages and cancers of the cervix uteri, corpus uteri, endometrium, ovaries, vagina, and vulva. The number of prospective population-based studies with adequate information on confounding factors is low, particularly for cancers of the cervix, corpus uteri, vulva and vagina. Several register studies have found a higher risk of cervical, vulvar, and vaginal cancers among alcoholics than in the general population. However, these findings have not been confirmed in population-based studies in which confounding factors have been adjusted for. Endometrial, corpus uteri, and ovarian cancers do not seem to be related to alcohol consumption. Analyses regarding the dose-response relationship, source of alcohol (wine, beer, spirits) and interaction with other risk factors have not revealed any further associations. In conclusion, the current body of evidence, which is inadequate for several sites, suggests no association between alcohol consumption and risk of gynecological cancers.

5033 POSTER Feasibility and pharmacokinetics of intraoperative hyperthermic intraperitoneal chemotherapy (HIPEC) with paclitaxel following cytoreductive surgery in ovarian cancer patients

ObjectivesThe relationship between hepatitis B virus (HBV) infection and gynecologic cancers is controversial. We aimed to evaluate the risk of gynecologic cancers associated with HBV infection using a meta-analysis.MethodsTwo independent reviewers identified publications in the PubMed, Embase and Cochrane Library databases that reported an association between HBV and the risk of gynecologic malignancy from inception to December 31, 2022. The Newcastle-Ottawa Scale (NOS) was used to evaluate the quality of the included articles. Pooled odds ratios (ORs) and 95% corresponding confidence intervals (CIs) were calculated using a fixed effects model or random effects model.ResultsWe collected data from 7 studies that met the inclusion criteria, including 2 cohort studies and 5 case-control studies. HBV was significantly associated with the risk of cervical cancer in the general population (OR 1.22, 95% CI 1.09–1.38, P = 0.001), although the same trend was not found in endometrial cancer (OR 1.30, 95% CI 0.95–1.77, P = 0.105) and ovarian cancer (OR 1.03, 95% CI 0.79–1.35, P = 0.813). Subgroup analysis showed that HBV infection was positively associated with the risk of cervical cancer (OR 1.27, 95% CI 1.13–1.44, P = 0.000) in case-control studies. Asian women infected with HBV have a significantly increased risk of cervical cancer (OR 1.24, 95% CI 1.10–1.40, P = 0.001) and endometrial cancer (OR 1.46, 95% CI 1.07–1.99, P = 0.018). Hospital-based studies were found to be associated with an increased risk of cervical cancer (OR 1.30, 95% CI 1.14–1.47, P = 0.000) and endometrial cancer (OR 1.61, 95% CI 1.04–2.49, P = 0.032). The results of Begg’s and Egger’s tests showed no publication bias.ConclusionsThis meta-analysis shows a positive association between HBV infection and cervical cancer. HBV is positively correlated with the risk of cervical cancer and endometrial cancer in Asian women and hospital-based populations. More multicenter prospective studies are required to confirm the findings.

Health hazards of obesity have been recognized for centuries, appearing, for example, in writings attributed to Hippocrates. From the later decades of the 20th century through the present, there have been numerous epidemiological studies of the relationship between excess weight and the total, or all-cause, mortality rate,1 a critical cumulative measure of the public health impact of any health condition. Using body mass index (BMI), an indicator of relative weight for height (weight [kg]/height [m]2) and a frequently used surrogate for assessment of excess body fat, these studies have found linear, U-shaped, or J-shaped relationships between total mortality and BMI. That is, in some studies, both the thin and the obese were more likely to die than those in between. There is, however, always a point at which increasing BMI is associated with increasing mortality risk, but the BMI at which this occurs varies across studies and populations.2 Currently,3 overweight in adults is defined as a BMI of 25.0 to <30.0 kg/m2 and obesity as a BMI of ≥30.0 kg/m2 (Table 1). A number of studies have found no significant relationship between BMI in the overweight range and mortality rate4 and have shown the nadir of mortality risk to be in the overweight range. In particular, commentaries in both the lay press5–7 and scientific literature2,8,9 subsequent to recent reports from National Health and Nutrition Examination Surveys (NHANES)10,11 have highlighted the confusion and controversy regarding this issue. Some have interpreted the recent data to mean that overweight is not detrimental to health and is not in itself a public health concern and that drawing attention to the need for weight loss in this range will have negative effects on the health and well-being of the general population.8 Others have argued …