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abstract
We tested the hypothesis that irregular
menstruation predicts lower risk for ovarian cancer, possibly due to
less frequent ovulation.
We conducted a
50-year prospective study of 15,528 mothers in the Child Health and
Development Studies cohort recruited from the Kaiser Foundation Health
Plan from 1959-1966. Irregular menstruation was classified via medical
record and self-report at age 26. We identified 116 cases and 84 deaths
due to ovarian cancer through 2011 via linkage to the California Cancer
Registry and Vital Statistics.
Contrary to
expectation, women with irregular menstrual cycles had a higher risk of
ovarian cancer incidence and mortality over the 50-year follow-up.
Associations increased with age (p <0.05). We observed a 2-fold
increased incidence and mortality by age 70 (95% Confidence Interval
(CI) = 1.1, 3.4) rising to a 3-fold increase by age 77 (95% CI = 1.5,
6.7 for incidence; 95% CI = 1.4, 5.9 for mortality). We also found a
3-fold higher risk of mortality for high-grade serous tumors (95% CI =
1.3, 7.6) that did not vary by age.
This
is the first prospective study to show an association between irregular
menstruation and ovarian cancer – we unexpectedly found higher risk for
women with irregular cycles. These women are easy to identify and many
may have polycystic ovarian syndrome. Classifying high-risk phenotypes
such as irregular menstruation creates opportunities to find novel early
biomarkers, refine clinical screening protocols and potentially develop
new risk reduction strategies. These efforts can lead to earlier
detection and better survival for ovarian cancer.
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