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Intrauterine devices and endometrial cancer risk: A pooled analysis of the E pidemiology of E ndometrial C ancer C onsortium
Author(s) -
Felix Ashley S.,
Gaudet Mia M.,
Vecchia Carlo La,
Nagle Christina M.,
Shu Xiao Ou,
Weiderpass Elisabete,
Adami Hans Olov,
Beresford Shirley,
Bernstein Leslie,
Chen Chu,
Cook Linda S.,
Vivo Immaculata De,
Doherty Jennifer A.,
Friedenreich Christine M.,
Gapstur Susan M.,
Hill Dierdre,
HornRoss Pamela L.,
Lacey James V.,
Levi Fabio,
Liang Xiaolin,
Lu Lingeng,
Magliocco Anthony,
McCann Susan E.,
Negri Eva,
Olson Sara H.,
Palmer Julie R.,
Patel Alpa V.,
Petruzella Stacey,
Prescott Jennifer,
Risch Harvey A.,
Rosenberg Lynn,
Sherman Mark E.,
Spurdle Amanda B.,
Webb Penelope M.,
Wise Lauren A.,
Xiang YongBing,
Xu Wanghong,
Yang Hannah P.,
Yu Herbert,
ZeleniuchJacquotte Anne,
Brinton Louise A.
Publication year - 2014
Publication title -
international journal of cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.475
H-Index - 234
eISSN - 1097-0215
pISSN - 0020-7136
DOI - 10.1002/ijc.29229
Subject(s) - medicine , odds ratio , endometrial cancer , confidence interval , confounding , pooled analysis , epidemiology , logistic regression , gynecology , cancer
Intrauterine devices (IUDs), long‐acting and reversible contraceptives, induce a number of immunological and biochemical changes in the uterine environment that could affect endometrial cancer (EC) risk. We addressed this relationship through a pooled analysis of data collected in the Epidemiology of Endometrial Cancer Consortium. We combined individual‐level data from 4 cohort and 14 case‐control studies, in total 8,801 EC cases and 15,357 controls. Using multivariable logistic regression, we estimated pooled odds ratios (pooled‐ORs) and 95% confidence intervals (CIs) for EC risk associated with ever use, type of device, ages at first and last use, duration of use and time since last use, stratified by study and adjusted for confounders. Ever use of IUDs was inversely related to EC risk (pooled‐OR = 0.81, 95% CI = 0.74–0.90). Compared with never use, reduced risk of EC was observed for inert IUDs (pooled‐OR = 0.69, 95% CI = 0.58–0.82), older age at first use (≥35 years pooled‐OR = 0.53, 95% CI = 0.43–0.67), older age at last use (≥45 years pooled‐OR = 0.60, 95% CI = 0.50–0.72), longer duration of use (≥10 years pooled‐OR = 0.61, 95% CI = 0.52–0.71) and recent use (within 1 year of study entry pooled‐OR = 0.39, 95% CI = 0.30–0.49). Future studies are needed to assess the respective roles of detection biases and biologic effects related to foreign body responses in the endometrium, heavier bleeding (and increased clearance of carcinogenic cells) and localized hormonal changes.