Previous epidemiologic observations consistently suggest that suppression of ovulation, tubal ligation, and hysterectomy reduce the risk of ovarian cancer and that perineal talc use increases the risk. We examined these and other risk factors in the context of a new hypothesis: that inflammation may play a role in ovarian cancer risk. Ovulation entails ovarian epithelial inflammation; talc, endometriosis, cysts, and hyperthyroidism may be associated with inflammatory responses of the ovarian epithelium; gynecologic surgery may preclude irritants from reaching the ovaries via ascension from the lower genital tract. We evaluated these risk factors in a population-based case-control study. Cases 20–69 years of age with a recent diagnosis of epithelial ovarian cancer (767) were compared with community controls (1367). We found that a number of reproductive and contraceptive factors that suppress ovulation, including gravidity, breast feeding, and oral contraception, reduced the risk of ovarian cancer. Environmental factors and medical conditions that increased risk included talc use, endometriosis, ovarian cysts, and hyperthyroidism. Gynecologic surgery including hysterectomy and tubal ligation were protective. Tubal ligation afforded a risk reduction even 20 or more years after the surgery. The spectrum of associations provides support for the hypothesis that inflammation may mediate ovarian cancer risk.
From 1Graduate School of Public Health, 2Center for Clinical Epidemiology and Biostatistics, 3Department of Pathology and Laboratory Medicine, and 4Department of Obstetrics and Gynecology, University of Pennsylvania, Pittsburgh Pennsylvania; and 5Sylvester Comprehensive Cancer Center, University of Miami, Coral Gables, Florida.
This research was supported by Grant #R01 CA61095 from National Cancer Institute.
Submitted May 11, 1999; final version accepted August 30, 1999.
Address reprint requests to: Roberta B. Ness, University of Pittsburgh, Graduate School of Public Health, 130 DeSoto Street, 517 Parran Hall, Pittsburgh, PA 15261.
See related editorial on page 97 of this issue.