Abstract
This study aimed to verify the association between ovarian cancer (OC) and reproductive- and lifestyle-related risk factors stratified by the subtype of OC. In this matched case-control study derived from the Korean epithelial ovarian cancer study (Ko-EVE), we calculated the risk of OC subtypes using odds ratios (ORs) and 95% confidence intervals (95% CIs) in a logistic regression model. As a result of matching, 531 cases and 2,124 controls were selected. Smoking had positive association with high-grade serous (HGS) OC (OR=2.69, 95% CI=1.15-6.30), whereas alcohol consumption had positive association with mucinous type (MUC) (OR=3.63, 95% CI=1.39-9.49). Obesity (≥30 kg/m2 ) was associated with clear cell type (CLC) (OR=4.57, 95% CI=1.06-19.77). Spontaneous abortion was negatively associated with CLC (OR=0.34, 95% CI=0.13-0.90), in contrast to HGS (OR=1.43, 95% CI=0.96-2.15). Tubal ligation, hysterectomy, and oophorectomy were associated with decreased risk of HGS (OR=0.14, 95% CI=0.05-0.39; OR=0.23, 95% CI=0.07-0.73; OR=0.28, 95% CI=0.08-0.97, respectively). Early menarche was strongly associated with increased risk of CLC, but not MUC (OR=6.11, 95% CI=1.53-24.42; OR=3.23, 95% CI=0.98-10.86). Further, childbirth (≥2 times) was negatively associated with endometrioid type OC and CLC (OR=0.11, 95% CI=0.04-0.35; OR=0.12, 95% CI=0.02-0.37, respectively). Oral contraceptives and hormone replacement therapy were negatively associated with OC (OR=0.61, 95% CI=0.40-0.93; OR=0.51, 95% CI=0.32-0.80, respectively), and similar negative associations were also observed in HGS (OR=0.69; OR=0.60, respectively). Associations between family history of breast cancer and OC, regular exercise (≥5/week), and artificial abortion and OC were similar across all subtypes (OR=3.92; OR=0.41; OR=0.72, respectively). A heterogeneous association between some risk factors and the incidence of each subtype of epithelial OC was observed, suggesting that the carcinogenic mechanisms of each subtype may be partly different.
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