2017 Jun;28(6):579-588. doi: 10.1007/s10552-017-0880-4. A recent commentary in The Lancet summarized the available evidence based on data in nulliparous women and concluded that the risk … Advanced age at first birth (30+ years) significantly decreased the risk of endometrial cancer in postmenopausal women. Multiple births, old age at first birth and a long birth period significantly reduced the risk of endometrial cancer in GM‐women. A practitioner's guide to meta‐analysis, Prolonged lactation and endometrial cancer. Immigration studies (migration studies), which examine the change in cancer risk in populations moving between countries with different rates of cancer, show that there is some environmental component to endometrial cancer. However, other definitions are also used. A reasonable definition of "grand multiparity" is a patient who has had ≥5 births (live or stillborn) at ≥20 weeks of gestation, with "great grand multiparity" defined as ≥10 births (live or stillborn) ≥20 weeks of gestation . Our results are thus in agreement with those of Schwartz et al.,26, 27 but they conflict with observations from Norway.22, 25. We investigated the significance of parity, age at first birth, intensity between births, length of time from the first to the last birth and length of delivery-free premenopausal period in a cohort of grand multiparous (GM) women, i.e., women with at least 5 births. The purpose of this study was to investigate the possibility that maternal immunization against fetal antigens might be elicited during pregnancy and, if so, to characterize antigens … Breast cancer Endometrial cancer Multiparity Cohort study Survival Electronic supplementary material The online version of this article (doi: 10.1007/s10552-015-0701-6 ) contains supplementary material, which is available to authorized users. Hence, part of the protective effect associated in earlier studies with multiparity7, 24 may actually be attributable to a long birth period. Conclusion: Multiparity turns out to be an unfavorable prognostic factor of survival in Polish women. The hormonal background of endometrial cancer is insufficiently characterised. (See 'Variability in the definition of parity' below.) Kwiatkowski F, Arbre M, Bidet Y, Laquet C, Uhrhammer N, Bignon YJ. There is no bias in cohort selection or cancer follow‐up because the national population and cancer registries in Finland are virtually complete 10 and computerised linkage procedures using personal identifiers as the key are very precise.11. The RR of endometrial cancer was 0.58 (95% CI 0.34-0.97) among women giving their first birth at an age of more than 30 years compared to women with first birth before the age of 20. Working off-campus? Hinkula M, Pukkala E, Kyyrönen P, Laukkanen P, Koskela P, Paavonen J, Lehtinen M, Kauppila A. Br J Cancer. Type II endometrial cancer is diagnosed more often in elderly and nonwhite women who have a history of multiparity, tobacco smoking, and tamoxifen-treated breast carcinoma. Int J Gynecol Cancer. Future investigations should focus on hormonal alterations underlying multiparity and late ages at a first birth in order to clarify processes involved in endometrial carcinogenesis. Moreover, breastfeeding, multiparity, consumption of combined oral contraceptives for 1-2 years during once a lifetime has been found to reduce the risk of endometrial cancer. Age at follow up of cancer was categorised into 3 groups, <50 years (“premenopausal” women), 50–64 years (“postmenopausal” women) and 65+ years. Hinkula M, Pukkala E, Kyyrönen P, Kauppila A. The RR of endometrial cancer also correlated with the length of premenopausal delivery-free period (RR = 0.61, 95% CI 0.44-0.86) for women with a short (<10 years) period compared to women with a long (>15 years) period. Unable to load your collection due to an error, Unable to load your delegates due to an error. Epub 2006 Apr 3. Because 79% of patients in our cohort were at least 55 years or older at the age of endometrial cancer diagnosis, the role of lactation remains minimal in this population. It was not feasible to put both variables into the model at the same time because they were highly correlated. 2014 Mar;24(3):384-93. doi: 10.1097/IGC.0000000000000075. In an alternative analysis among GM‐women aged 50+ whose history of reproduction was considered practically finished, we replaced birth intensity by the variable birth period, which was defined as the length of time from the first to the last birth. Reproductive factors and the risk of endometrial cancer. Parity, age, and previous uterine abrasion increase the risk of adenomyosis (the abnormal presence of endometrial tissue within the uterus muscular layer). The International Agency for Research on Cancer recently estimated that endometrial carcinoma is the commonest gynaecological cancer in the developed world,1 with a rising incidence in postmenopausal women. 2004 Mar 8;90(5):1025-9. doi: 10.1038/sj.bjc.6601650. The SIR for endometrial cancer among GM‐women was low [419 cases; SIR=0.57, 95% confidence interval (CI) 0.52–0.63]. Would you like email updates of new search results? Rarely, endometrial tissue may spread beyond pelvic organs.With endometriosis, displaced endometrial tissue continues to act as it normally would — it thickens, breaks down and bleeds with each menstrual cycle. Data of the Population Register of Finland (86,978 GM‐women) and the population‐based Finnish Cancer Registry were combined. Standardised incidence ratios (SIRs) were calculated by dividing the number of observed cancer cases by the expected number based on the national incidence rates. Risk factors for endometrial cancer: An umbrella review of the literature. Parity and risk of death from gallbladder cancer among a cohort of premenopausal parous women in Taiwan. To analyse the association between the length of the delivery‐free premenopausal period and endometrium cancer, we used individually matched case‐control data and the conditional logistic model. Data of the Population Register of Finland (86,978 GM-women) and the population-based Finnish Cancer Registry were combined. All calculations were performed using SAS (Cary, NC) statistical software. Women with Lynch syndrome tend to develop endometrial cancer at an earlier age, with the median age at diagnosis of 48 years. Use the link below to share a full-text version of this article with your friends and colleagues. When adjusted for the other study variables, these trends slightly sharpened, and the model also suggested a slight protective effect with increasing intensity between births (Table II). The SIRs for local (n = 303) and nonlocal (n = 58) endometrial cancers were identical at 0.58, and the respective 95% CIs were 0.51–0.65 and 0.44–0.76. In the univariate analysis, the SIR decreased by increasing parity and increasing age at first birth (Table I). RESULT(S): Multiparity had no effect on the progression of PD, and treatment of the disease during pregnancy appears to have been safe. The hormonal background of endometrial cancer is insufficiently characterised. It suggests that the development of sarcomas (or at least of the most common subtypes of sarcoma) is not affected by reproductive factors. Cancer Causes Control. Obesity and diabetes mellitus are well‐known risk factors for endometrial cancer, especially in postmenopausal women.14-16 Obesity and diabetic disorders are common in women with several pregnancies.17-19 Hence, the actual risk reduction of endometrial cancer in our population would have been larger than that shown, if we had been able to adjust our results for obesity and diabetes. Multivariate relative risks (RRs) were estimated by Poisson regression analysis. Albrektsen et al.25 and Lambe et al.5 suggest that mechanical shedding of malignant or premalignant endometrial cells at each delivery is the main factor in relation to reduced risk of endometrial cancer. The Iowa Women's Health Study, Data quality and quality control of a population‐based cancer registry. Endometriosis (en-doe-me-tree-O-sis) is an often painful disorder in which tissue that normally lines the inside of your uterus — the endometrium — grows outside your uterus. This study showed that six pregnancy-related factors—advanced maternal age, multiparity, multifetal pregnancy, cesarean section, delivery of a large-for-gestational-age infant, and preeclampsia—are positively correlated with future development of endometrial neoplasia, including endometrial hyperplasia or cancer. Parity and hormonal contraception use are risk factors for cervical cancer. Accessibility However, the number of cancer cases remained small in the subgroups of women who contracted cancer during the premenopausal period (n = 27), had histologic subtypes other than adenocarcinoma (n = 52) or had a clinically advanced malignancy (n = 58). If you do not receive an email within 10 minutes, your email address may not be registered, In premenopausal women, the trend appeared to be even stronger, though it was based on very sparse observations among those with first birth at higher ages and was not statistically significant. Kauppila A: Grand multiparity and incidence of endometrial cancer: a population-based study in Finland. Consequently, we assume that the parity‐dependent decrease in endometrial cancer risk of postmenopausal GM‐women is due to the several times repeated long‐term antiestrogenic endometrial influences of progesterone.2, 4 The protective effect of several pregnancies may be attributable to frequently repeated long‐term and continuous progesterone actions. Sustained proliferation and greater rates of DNA mutation ultimately result in malignant transformation. Worldwide, endometrial cancer is the seventh most common malignant disorder, but incidence varies among regions. Our findings, that a large number of births, old age at first birth, a long birth period and a short premenopausal delivery‐free period reduced the risk of postmenopausal endometrial cancer of GM‐women, emphasise the protective role of progesterone and the stimulatory role of estradiol in the hormonal background of this disease. For women 50 years or older, most of whom had already had their last child, we also analysed the significance of the length of (i) the entire birth period, i.e., years from the first to last birth in 4 categories (<10, 10–14.9, 15–19.9 and 20+ years) and (ii) the period between the last birth and age 50 years (approximate age of menopause) in 3 categories (<10, 10–14.9 and 15+ years). Endometriosis most commonly involves your ovaries, fallopian tubes and the tissue lining your pelvis. FOIA CONCLUSIONS: This study provides evidence that grand multiparity may confer a protective effect on the risk of death from cancers of the breast, endometrium and ovary. Experience in Finland, Time trends in socio‐economic differences in incidence rates of cancers of the breast and female genital organs (Finland, 1971–1995), Risk of endometrial cancer in relation to use of combined oral contraceptives. 57 Other routes of spread follow lymphatic channels. Cancer Causes Control. Endometrial cancer survival was, however, significantly reduced in grand multiparas. We assume that the protective effect is due to the shortened period of unopposed estrogen effect on the endometrium. This reduction is similar to that previously observed for breast cancer (45%) in the same cohort.21 In agreement with earlier results,8, 22 we found that multiparity powerfully reduced the risk of endometrial cancer. Follow‐up for endometrial cancer was done automatically through the files of the national, population‐based Finnish Cancer Registry with personal identifiers. Sponholtz TR, Palmer JR, Rosenberg L, Hatch EE, Adams-Campbell LL, Wise LA. The ACS recommends that all women older Conclusions: This study provides evidence that grand multiparity may confer a protective effect on the risk of death from cancers of the breast, endometrium and ovary. The mean length of follow‐up was 19.3 years. eCollection 2015. Epub 2017 Mar 30. Multivariate relative risks (RRs) were estimated by Poisson regression analysis. Some women with endometrial cancer don't have any known risk factors. Careers. Our findings, that a large number of births, old age at first birth, a long birth period and a short premenopausal delivery-free period reduced the risk of postmenopausal endometrial cancer of GM-women, emphasise the protective role of progesterone and the stimulatory role of estradiol in the hormonal background of this disease. Using this national population register of GM‐women and data of Finnish Cancer Registry, we studied the significance of parity, age at first birth, average intensity between births, birth period and premenopausal delivery‐free period as risk determinants of endometrial cancer. [ncbi.nlm.nih.gov] Prepare for clinical challenges and save time in addressing them thanks to expert advice on treatment options from international contributors. Am J Epidemiol. Epub 2020 Nov 17. Endometrial cancer has a very good prognosis amongst all other cancers in … 2001 Aug;12(6):491-500. doi: 10.1023/a:1011253527605. Please check your email for instructions on resetting your password. Endometrial adenocarcinoma or cancer of the uterine corpus accounts for more than 80% of endometrial cancers and is one of the most common female genital tract malignancies. 2019 Oct 1;145(7):1719-1730. doi: 10.1002/ijc.31961. Prognosis of endometrial cancer. Setiawan VW, Pike MC, Karageorgi S, Deming SL, Anderson K, Bernstein L, Brinton LA, Cai H, Cerhan JR, Cozen W, Chen C, Doherty J, Freudenheim JL, Goodman MT, Hankinson SE, Lacey JV Jr, Liang X, Lissowska J, Lu L, Lurie G, Mack T, Matsuno RK, McCann S, Moysich KB, Olson SH, Rastogi R, Rebbeck TR, Risch H, Robien K, Schairer C, Shu XO, Spurdle AB, Strom BL, Thompson PJ, Ursin G, Webb PM, Weiss NS, Wentzensen N, Xiang YB, Yang HP, Yu H, Horn-Ross PL, De Vivo I; Australian National Endometrial Cancer Study Group. When the birth period was longer than 20 years, the risk of endometrial cancer was 43% smaller than in women with a birth period shorter than 10 years (Table III). In postmenopausal women, the increase in parity from 5 to 6 decreased approximately 30% the RR of endometrial cancer, and the further births slightly strengthened this trend (p = 0.01). PLoS One. In ages 50+ (94% of endometrial cancer cases), the RR for women with at least 8 births was 0.63 (95% CI 0.44–0.92) compared to those with 5 births, and those with a birth period of 20+ years had RR=0.57 (95% CI 0.34–0.96) compared to those with a period of <10 years, while prolonged average intensity between births showed only a small protective effect. Standardised incidence ratios (SIRs) were calculated by dividing the number of observed cancer cases by the expected number based on the national incidence rates. Screening and Prevention . In addition, it is likely that the protective effect of multiple pregnancies on endometrial cancer extends at least to the sixth or even up to the eighth birth, i.e., higher than previously reported.4, 5, 8, 23 A study from Sweden showed that in childless women compared to uniparous women, the increase in risk for endometrial cancer is stronger in premenopausal than postmenopausal women.5 Our cohort, consisting only of GM‐ women, suggests that the protective effect of parity manifests only during the postmenopausal years. The average intensity between the first 5 births and the length of the premenopausal delivery‐free period were new and novel variables in our study. Long-lasting unopposed oestrogen exposure leads to endometrial hyperplasia, which increases the chance of development of atypical hyperplasia and eventually type-1 endometrial cancer. Using data from the Jerusalem Perinatal Cohort we were able to separate the components of mortality, comparing both incidence and survival after cancer onset. Cases of endometrial cancer and person‐years at risk were counted by 5‐year age groups and separately for 4 parity categories (5, 6, 7 and 8+ children), 4 categories by age at first birth (<20, 20–24, 25–29 and 30+ years) and 3 birth‐intensity categories (average interval between the first 5 deliveries <2.0, 2.0–3.0 and >3.0 years). The hormonal background of endometrial cancer is insufficiently characterised. ... more years and grand multiparity. The development of endometrial cancer is strongly linked to high levels of oestrogen production or the use of oestrogen based therapies in the absence of progestogen opposition. A case‐control study of risk factors for sarcomas of the uterus, Incidence of histological types of uterine sarcoma in relation to menstrual and reproductive history, Endometrial carcinoma; ovarian dysfunction—a risk factor in young women, Infertility‐associated endometrial cancer risk may be limited to specific subgroups of infertile women, Cancer incidence in a cohort of infertile women, Birth period, years from first to last birth, Premenopausal delivery‐free period (years). Incidence of ovarian cancer of grand multiparous women--a population-based study in Finland. Ninety‐four percent of the malignancies were diagnosed in women of 50 years or older. The risk of developing endometrial cancer is reduced with increasing parity. The prevalence of the disease is highest at around 60 years of age and most commonly presents with painless, post-menopausal bleeding. MAIN OUTCOME MEASURE(S): The effect of multiparity on PD. Hinkula M, Pukkala E, Kyyronen P, Kauppila A (2002) Grand multiparity and incidence of endometrial cancer: a population-based study in Finland. (2002). Age at first birth of more than 30 years diminished the RR of endometrial cancer by 38% among postmenopausal women compared to women with first birth before the age of 20 years (trend p = 0.03) (Table II). This finding is line with most,5, 24 but not all,4, 8 previous findings. Most women with endometrial cancer are diagnosed after menopause. The SIR for endometrial cancer among GM-women was low [419 cases; SIR=0.57, 95% confidence interval (CI) 0.52-0.63]. 1, 2 Lending support to this hypothesis, during the follicular phase of the menstrual cycle, progesterone levels are low, estradiol levels are at normal premenopausal levels, and increased endometrial proliferation is observed. Long‐term unopposed estrogen action; anovulatory cycles,24, 28, 29 which are common before menopause; and deficient secretion of progesterone 30 predispose the endometrium to unopposed estrogen stimulation, which in turn promotes the malignant transformation of the endometrium. The standardised incidence ratio (SIR) was calculated by dividing the number of observed cases by the number of expected cancers. The cancer registry data also included information about the histopathologic diagnosis made by local pathologists and clinical stage at diagnosis. Bethesda, MD 20894, Copyright In this model, the significance of parity weakened and the significance of age at first birth strengthened compared to the model including birth intensity (Table II). Nearly 88% of patients had adenocarcinoma. Prevention and treatment information (HHS). Even if a woman with endometrial cancer has one or more risk factors, there's no way to know which, if any, of them caused her cancer. 2 Similarly, women who undergo estrogen replacement without progesterone have an increased risk of endometrial cancer… 2006 Oct;103(1):207-11. doi: 10.1016/j.ygyno.2006.02.025. Raglan O, Kalliala I, Markozannes G, Cividini S, Gunter MJ, Nautiyal J, Gabra H, Paraskevaidis E, Martin-Hirsch P, Tsilidis KK, Kyrgiou M. Int J Cancer.