Harris Holly R, Saboda Kathylynn, Thomson Cynthia A, Saquib Nazmus, Shadyab Aladdin H, Schnatz Peter F, Robles-Morales Rogelio, Qi Lihong, Roe Denise J, Farland Leslie V
Program in Epidemiology, Division of Public Health Sciences, Fred Hutchinson Cancer Center, Seattle, Washington.
Department of Epidemiology, School of Public Health, University of Washington, Seattle, Washington.
Cancer Epidemiol Biomarkers Prev. 2024 Dec 2;33(12):1683-1689. doi: 10.1158/1055-9965.EPI-24-0717.
Several studies have suggested an association between infertility and risk of endometrial cancer. However, most studies have evaluated this relationship in premenopausal people, yet the mean age of endometrial cancer is 60 years, after the average age of menopause.
Our study included Women's Health Initiative participants who self-reported whether they had a history of infertility. Cox proportional hazards models were used to examine the association between infertility and incident endometrial cancer. Given that all infertility diagnoses occurred prior to study enrollment, we conducted secondary analyses using logistic regression examining prevalent endometrial cancer cases diagnosed before study baseline.
Approximately 18% of participants reported a history of infertility. No statistically significant association was observed between infertility and risk of incident endometrial cancer overall [incident cases = 1,622; HR = 1.12; 95% confidence interval (CI) = 0.99-1.26]. Although point estimates suggested an increase in risk of endometrial cancer among women with body mass index (BMI) ≥25 (HR = 1.15; 95% CI = 0.99-1.33), none of the associations were statistically significant. There was an association between history of infertility and prevalent endometrial cancer cases (OR = 1.19; 95% CI = 1.06-1.34), with the strongest association for infertility diagnosis due to endometriosis (OR 2.42; 95% CI = 1.83-3.19).
In a population of postmenopausal participants, we observed a modest, but not statistically significant, association between overall infertility and incident endometrial cancer, with the suggestion of a higher risk among those with a BMI ≥ 25.
Our findings highlight, as observed in previous studies, that risk factors for endometrial cancer may vary by BMI.
多项研究表明不孕症与子宫内膜癌风险之间存在关联。然而，大多数研究在绝经前人群中评估了这种关系，而子宫内膜癌的平均发病年龄为60岁，在绝经平均年龄之后。
我们的研究纳入了女性健康倡议参与者，这些参与者自行报告是否有不孕症病史。采用Cox比例风险模型来检验不孕症与子宫内膜癌发病之间的关联。鉴于所有不孕症诊断均在研究入组前发生，我们使用逻辑回归进行了二次分析，以检查在研究基线之前诊断出的现患子宫内膜癌病例。
约18%的参与者报告有不孕症病史。总体上，未观察到不孕症与子宫内膜癌发病风险之间存在统计学显著关联[发病病例 = 1622；风险比（HR）= 1.12；95%置信区间（CI）= 0.99 - 1.26]。尽管点估计表明体重指数（BMI）≥25的女性患子宫内膜癌的风险有所增加（HR = 1.15；95% CI = 0.99 - 1.33），但这些关联均无统计学显著性。不孕症病史与现患子宫内膜癌病例之间存在关联（比值比（OR）= 1.19；95% CI = 1.06 - 1.34），其中因子宫内膜异位症导致的不孕症诊断关联最强（OR 2.42；95% CI = 1.83 - 3.19）。
在绝经后参与者群体中，我们观察到总体不孕症与子宫内膜癌发病之间存在适度但无统计学显著性的关联，提示BMI≥25者风险更高。
正如先前研究中所观察到的，我们的研究结果凸显了子宫内膜癌的风险因素可能因BMI而异。
