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Role of reproductive factors in hepatocellular carcinoma: Impact on hepatitis B– and C–related risk
Author(s) -
Yu MingWhei,
Chang HungChuen,
Chang ShunChiao,
Liaw YunFan,
Lin ShiMing,
Liu ChunJen,
Lee ShouDong,
Lin ChihLin,
Chen PeiJer,
Lin SheeChan,
Chen ChienJen
Publication year - 2003
Publication title -
hepatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 5.488
H-Index - 361
eISSN - 1527-3350
pISSN - 0270-9139
DOI - 10.1016/j.hep.2003.09.041
Subject(s) - medicine , hbsag , hepatocellular carcinoma , risk factor , menopause , gynecology , menarche , hormone replacement therapy (female to male) , multivariate analysis , hepatitis b virus , oncology , obstetrics , immunology , testosterone (patch) , virus
Hepatocellular carcinoma (HCC) is more prevalent in men than in women. Estrogen may play some role in the development of HCC. We conducted a multicenter case‐control study to evaluate the effects of reproductive factors on HCC risk, and to assess whether the association between each factor and HCC differs between hepatitis B surface antigen (HBsAg)‐positive and ‐negative women, in which hepatitis C virus (HCV) is the major cause of HCC. The study included 218 women with HCC and 729 control women selected from nonbiological and first‐degree female relatives of patients with HCC. The risk of HCC was inversely related to the number of full‐term pregnancies (FTP) ( P trend = .0216) and age at natural menopause ( P trend = .0251 among women aged 45‐55 without prior surgical menopause). Oophorectomy at age ≤50 during premenopausal years was also a risk factor (multivariate‐adjusted OR, 2.57; 95% CI, 1.42‐4.63). Use of hormone replacement therapy (HRT) (multivariate‐adjusted OR, 0.46; 95% CI, 0.27‐0.79) was associated with a lower risk of HCC, and there was a trend in the risk with increasing duration of HRT ( P trend = 0.0013). All reproductive factors had a similar impact on HBsAg‐positive and ‐negative women except for an early menarche (≤12 vs. ≥16 years), which increased HCC risk in HBsAg carriers (multivariate‐adjusted OR, 6.96; 95% CI, 2.52‐19.18) but posed no increased risk in noncarriers ( P interaction = .0053). In conclusion, increased exposure to estrogen during adulthood may provide a protective effect against HCC. Nevertheless, an early menarche, which results in early estrogen exposure, does not confer protection for HBsAg carriers.