Harris Holly R, Lind Kimberly, Fest Sable, Thomson Cynthia A, Saquib Nazmus, Shadyab Aladdin H, Schnatz Peter F, Robles-Morales Rogelio, Qi Lihong, Strickler Howard D, Roe Denise J, Farland Leslie V
Program in Epidemiology, Division of Public Health Sciences, Fred Hutchinson Cancer Center, 1100 Fairview Avenue North, M4-B859, Seattle, WA, 98109-1024, USA.
Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA, USA.
Cancer Causes Control. 2025 Jun;36(6):617-624. doi: 10.1007/s10552-025-01962-z. Epub 2025 Jan 29.
There is a consistent relationship with greater ovulation frequency and increased risk of ovarian cancer. However, prior research on infertility, which may be associated with ovulation frequency through multiple mechanisms, and ovarian cancer has yielded conflicting results, possibly due to prior research conflating fertility treatment with infertility and restricting follow-up to premenopausal cases. Our objective was to determine the association between infertility and risk of postmenopausal ovarian cancer, overall and by histotype, in a population that had not received treatment with IVF.
We utilized data from the Women's Health Initiative (n = 112,925 postmenopausal participants) with over 25 years of follow-up. At baseline, participants were asked whether they had ever tried to become pregnant for more than one year without becoming pregnant and whether a reason was found. Cox proportional hazards models were used to calculate hazard ratios (HRs) of incident adjudicated ovarian cancer comparing participants with a history of infertility to fertile participants overall and by histotype.
17% of participants reported a history of infertility at baseline and 1,109 ovarian cancer cases were diagnosed during follow-up. No statistically significant association was observed between infertility and risk of any ovarian cancer (HR: 1.09, 95% CI 0.92-1.29), but those reporting infertility had a 90% higher risk of endometrioid and clear cell ovarian cancers (HR: 1.90 95% CI 1.09-3.34) compared to fertile participants. The reported reason(s) for infertility had no discernable impact on these associations.
Infertility may be associated with clear cell and endometrioid ovarian cancer but not other ovarian tumor histotypes.
排卵频率增加与卵巢癌风险升高之间存在一致的关联。然而，先前关于不孕症（其可能通过多种机制与排卵频率相关）与卵巢癌的研究结果相互矛盾，这可能是因为先前的研究将生育治疗与不孕症混为一谈，并且将随访限制在前更年期病例。我们的目标是在未接受体外受精治疗的人群中，确定不孕症与绝经后卵巢癌风险之间的总体关联以及按组织学类型划分的关联。
我们利用了来自女性健康倡议（112925名绝经后参与者）的数据，随访时间超过25年。在基线时，询问参与者是否曾尝试怀孕一年以上但未成功，以及是否找到原因。使用Cox比例风险模型计算经判定的卵巢癌发病风险比（HR），比较有不孕症病史的参与者与总体上以及按组织学类型划分的有生育能力的参与者。
17%的参与者在基线时报告有不孕症病史，随访期间诊断出1109例卵巢癌病例。未观察到不孕症与任何卵巢癌风险之间存在统计学上的显著关联（HR：1.09，95%CI 0.92 - 1.29），但与有生育能力的参与者相比，报告有不孕症的参与者患子宫内膜样和透明细胞卵巢癌的风险高90%（HR：1.90，95%CI 1.09 - 3.34）。报告的不孕原因对这些关联没有明显影响。
不孕症可能与透明细胞和子宫内膜样卵巢癌相关，但与其他卵巢肿瘤组织学类型无关。
