Cancer Epidemiology Program, University of Hawaii Cancer Center, Honolulu, Hawaii.
Department of Preventive Medicine, University of Southern California Keck School of Medicine, Los Angeles, California.
Cancer Epidemiol Biomarkers Prev. 2020 Oct;29(10):2019-2025. doi: 10.1158/1055-9965.EPI-20-0569. Epub 2020 Jul 30.
Incidence rates of epithelial ovarian cancer (EOC) vary across racial/ethnic groups, yet little is known about the impact of hormone-related EOC risk factors in non-Whites.
Among 91,625 female Multiethnic Cohort Study participants, 155 incident EOC cases were diagnosed in Whites, 93 in African Americans, 57 in Native Hawaiians, 161 in Japanese Americans, and 141 in Latinas. We used Cox proportional hazards regression models to estimate hazard ratios (HR) and 95% confidence intervals (CI) for associations between race/ethnicity and EOC risk and between hormone-related factors and EOC risk across racial/ethnic groups.
Compared with Whites, African Americans and Japanese Americans had a lower multivariable-adjusted EOC risk; Native Hawaiians had a suggestive higher risk. Parity and oral contraceptive (OC) use were inversely associated with EOC risk ( race/ethnicity ≥ 0.43); associations were strongest among Japanese Americans (e.g., ≥4 vs. 0 children; HR = 0.45; CI, 0.26-0.79). Age at natural menopause and postmenopausal hormone (PMH) use were not associated with EOC risk in the overall population, but were positively associated with risk in Latinas (e.g., ≥5 years vs. never PMH use; HR = 2.13; CI, 1.30-3.49).
We observed strong associations with EOC risk for parity and OC use in Japanese Americans and PMH use and age at natural menopause in Latinas. However, differences in EOC risk among racial/ethnic groups were not fully explained by established hormone-related risk factors.
Our study indicates there are racial/ethnic differences in EOC risk and risk factors, and could help improve prevention strategies for non-White women.
上皮性卵巢癌（EOC）的发病率在不同种族/民族群体中存在差异，但对于非白人中与激素相关的 EOC 风险因素的影响知之甚少。
在 91625 名女性多民族队列研究参与者中，白人中有 155 例 EOC 病例确诊，非裔美国人中有 93 例，夏威夷原住民中有 57 例，日裔美国人中有 161 例，拉丁裔中有 141 例。我们使用 Cox 比例风险回归模型来估计种族/民族与 EOC 风险之间的风险比（HR）和 95%置信区间（CI），以及激素相关因素与不同种族/民族群体中 EOC 风险之间的关联。
与白人相比，非裔美国人和日裔美国人的多变量调整后 EOC 风险较低；夏威夷原住民的风险提示较高。生育次数和口服避孕药（OC）使用与 EOC 风险呈负相关（种族/民族≥0.43）；在日裔美国人中关联最强（例如，生育≥4 个孩子与生育 0 个孩子相比；HR=0.45；CI，0.26-0.79）。自然绝经年龄和绝经后激素（PMH）使用与总体人群中的 EOC 风险无关，但与拉丁裔人群的风险呈正相关（例如，绝经后激素使用≥5 年与从不使用绝经后激素相比；HR=2.13；CI，1.30-3.49）。
我们观察到在日裔美国人中生育次数和 OC 使用与 EOC 风险呈强关联，在拉丁裔人群中 PMH 使用和自然绝经年龄与 EOC 风险呈正相关。然而，不同种族/民族群体之间的 EOC 风险差异不能完全用已确定的与激素相关的风险因素来解释。
我们的研究表明，EOC 风险和风险因素在不同种族/民族群体中存在差异，并可能有助于改善针对非白人女性的预防策略。
