Multiple miscarriages are associated with the risk of ovarian cancer: Results from the European prospective investigation into cancer and nutrition

Marieke G M Braem, N. Charlotte Onland-Moret, Leo J. Schouten, Roy F P M Kruitwagen, Annekatrin Lukanova, Naomi E. Allen, Petra A. Wark, Anne Tjønneland, Louise Hansen, Christina Marie Braüner, Kim Overvad, Françoise Clavel-Chapelon, Nathalie Chabbert-Buffet, Birgit Teucher, Anna Floegel, Heiner Boeing, Antonia Trichopoulou, George Adarakis, Maria Plada, Sabina Rinaldi & 28 others Veronika Fedirko, Isabelle Romieu, Valeria Pala, Rocco Galasso, Carlotta Sacerdote, Domenico Palli, Rosario Tumino, H. Bas Bueno-de-Mesquita, Inger Torhild Gram, Oxana Gavrilyuk, Eiliv Lund, Maria José Sánchez, Catalina Bonet, Maria Dolores Chirlaque, Nerea Larrañaga, Aurelio Barricarte Gurrea, Jose R. Quirós, Annika Idahl, Nina Ohlson, Eva Lundin, Karin Jirström, Salma Butt, Konstantinos K. Tsilidis, Kay Tee Khaw, Nick Wareham, Elio Riboli, Rudolf Kaaks, Petra H M Peeters

    Research output: Contribution to journalArticle

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    Abstract

    While the risk of ovarian cancer clearly reduces with each full-term pregnancy, the effect of incomplete pregnancies is unclear. We investigated whether incomplete pregnancies (miscarriages and induced abortions) are associated with risk of epithelial ovarian cancer. This observational study was carried out in female participants of the European Prospective Investigation into Cancer and Nutrition (EPIC). A total of 274,442 women were followed from 1992 until 2010. The baseline questionnaire elicited information on miscarriages and induced abortions, reproductive history, and lifestyle-related factors. During a median follow-up of 11.5 years, 1,035 women were diagnosed with incident epithelial ovarian cancer. Despite the lack of an overall association (ever vs. never), risk of ovarian cancer was higher among women with multiple incomplete pregnancies (HR≥4vs.0: 1.74, 95% CI: 1.20-2.70; number of cases in this category: n = 23). This association was particularly evident for multiple miscarriages (HR≥4vs.0: 1.99, 95% CI: 1.06-3.73; number of cases in this category: n = 10), with no significant association for multiple induced abortions (HR≥4vs.0: 1.46, 95% CI: 0.68-3.14; number of cases in this category: n = 7). Our findings suggest that multiple miscarriages are associated with an increased risk of epithelial ovarian cancer, possibly through a shared cluster of etiological factors or a common underlying pathology. These findings should be interpreted with caution as this is the first study to show this association and given the small number of cases in the highest exposure categories.

    Original languageEnglish
    Article numbere37141
    JournalPLoS ONE
    Volume7
    Issue number5
    DOIs
    Publication statusPublished - 18 May 2012

    Fingerprint

    abortion (animals)
    ovarian neoplasms
    Induced Abortion
    Spontaneous Abortion
    Nutrition
    Ovarian Neoplasms
    induced abortion
    nutrition
    neoplasms
    pregnancy
    Pregnancy
    Neoplasms
    Multiple Pregnancy
    Reproductive History
    Pathology
    Observational Studies
    Life Style
    observational studies
    lifestyle
    questionnaires

    ASJC Scopus subject areas

    • Medicine(all)
    • Biochemistry, Genetics and Molecular Biology(all)
    • Agricultural and Biological Sciences(all)

    Cite this

    Braem, M. G. M., Onland-Moret, N. C., Schouten, L. J., Kruitwagen, R. F. P. M., Lukanova, A., Allen, N. E., ... Peeters, P. H. M. (2012). Multiple miscarriages are associated with the risk of ovarian cancer: Results from the European prospective investigation into cancer and nutrition. PLoS ONE, 7(5), [e37141]. https://doi.org/10.1371/journal.pone.0037141

    Multiple miscarriages are associated with the risk of ovarian cancer : Results from the European prospective investigation into cancer and nutrition. / Braem, Marieke G M; Onland-Moret, N. Charlotte; Schouten, Leo J.; Kruitwagen, Roy F P M; Lukanova, Annekatrin; Allen, Naomi E.; Wark, Petra A.; Tjønneland, Anne; Hansen, Louise; Braüner, Christina Marie; Overvad, Kim; Clavel-Chapelon, Françoise; Chabbert-Buffet, Nathalie; Teucher, Birgit; Floegel, Anna; Boeing, Heiner; Trichopoulou, Antonia; Adarakis, George; Plada, Maria; Rinaldi, Sabina; Fedirko, Veronika; Romieu, Isabelle; Pala, Valeria; Galasso, Rocco; Sacerdote, Carlotta; Palli, Domenico; Tumino, Rosario; Bueno-de-Mesquita, H. Bas; Gram, Inger Torhild; Gavrilyuk, Oxana; Lund, Eiliv; Sánchez, Maria José; Bonet, Catalina; Chirlaque, Maria Dolores; Larrañaga, Nerea; Gurrea, Aurelio Barricarte; Quirós, Jose R.; Idahl, Annika; Ohlson, Nina; Lundin, Eva; Jirström, Karin; Butt, Salma; Tsilidis, Konstantinos K.; Khaw, Kay Tee; Wareham, Nick; Riboli, Elio; Kaaks, Rudolf; Peeters, Petra H M.

    In: PLoS ONE, Vol. 7, No. 5, e37141, 18.05.2012.

    Research output: Contribution to journalArticle

    Braem, MGM, Onland-Moret, NC, Schouten, LJ, Kruitwagen, RFPM, Lukanova, A, Allen, NE, Wark, PA, Tjønneland, A, Hansen, L, Braüner, CM, Overvad, K, Clavel-Chapelon, F, Chabbert-Buffet, N, Teucher, B, Floegel, A, Boeing, H, Trichopoulou, A, Adarakis, G, Plada, M, Rinaldi, S, Fedirko, V, Romieu, I, Pala, V, Galasso, R, Sacerdote, C, Palli, D, Tumino, R, Bueno-de-Mesquita, HB, Gram, IT, Gavrilyuk, O, Lund, E, Sánchez, MJ, Bonet, C, Chirlaque, MD, Larrañaga, N, Gurrea, AB, Quirós, JR, Idahl, A, Ohlson, N, Lundin, E, Jirström, K, Butt, S, Tsilidis, KK, Khaw, KT, Wareham, N, Riboli, E, Kaaks, R & Peeters, PHM 2012, 'Multiple miscarriages are associated with the risk of ovarian cancer: Results from the European prospective investigation into cancer and nutrition' PLoS ONE, vol. 7, no. 5, e37141. https://doi.org/10.1371/journal.pone.0037141
    Braem, Marieke G M ; Onland-Moret, N. Charlotte ; Schouten, Leo J. ; Kruitwagen, Roy F P M ; Lukanova, Annekatrin ; Allen, Naomi E. ; Wark, Petra A. ; Tjønneland, Anne ; Hansen, Louise ; Braüner, Christina Marie ; Overvad, Kim ; Clavel-Chapelon, Françoise ; Chabbert-Buffet, Nathalie ; Teucher, Birgit ; Floegel, Anna ; Boeing, Heiner ; Trichopoulou, Antonia ; Adarakis, George ; Plada, Maria ; Rinaldi, Sabina ; Fedirko, Veronika ; Romieu, Isabelle ; Pala, Valeria ; Galasso, Rocco ; Sacerdote, Carlotta ; Palli, Domenico ; Tumino, Rosario ; Bueno-de-Mesquita, H. Bas ; Gram, Inger Torhild ; Gavrilyuk, Oxana ; Lund, Eiliv ; Sánchez, Maria José ; Bonet, Catalina ; Chirlaque, Maria Dolores ; Larrañaga, Nerea ; Gurrea, Aurelio Barricarte ; Quirós, Jose R. ; Idahl, Annika ; Ohlson, Nina ; Lundin, Eva ; Jirström, Karin ; Butt, Salma ; Tsilidis, Konstantinos K. ; Khaw, Kay Tee ; Wareham, Nick ; Riboli, Elio ; Kaaks, Rudolf ; Peeters, Petra H M. / Multiple miscarriages are associated with the risk of ovarian cancer : Results from the European prospective investigation into cancer and nutrition. In: PLoS ONE. 2012 ; Vol. 7, No. 5.
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    abstract = "While the risk of ovarian cancer clearly reduces with each full-term pregnancy, the effect of incomplete pregnancies is unclear. We investigated whether incomplete pregnancies (miscarriages and induced abortions) are associated with risk of epithelial ovarian cancer. This observational study was carried out in female participants of the European Prospective Investigation into Cancer and Nutrition (EPIC). A total of 274,442 women were followed from 1992 until 2010. The baseline questionnaire elicited information on miscarriages and induced abortions, reproductive history, and lifestyle-related factors. During a median follow-up of 11.5 years, 1,035 women were diagnosed with incident epithelial ovarian cancer. Despite the lack of an overall association (ever vs. never), risk of ovarian cancer was higher among women with multiple incomplete pregnancies (HR≥4vs.0: 1.74, 95{\%} CI: 1.20-2.70; number of cases in this category: n = 23). This association was particularly evident for multiple miscarriages (HR≥4vs.0: 1.99, 95{\%} CI: 1.06-3.73; number of cases in this category: n = 10), with no significant association for multiple induced abortions (HR≥4vs.0: 1.46, 95{\%} CI: 0.68-3.14; number of cases in this category: n = 7). Our findings suggest that multiple miscarriages are associated with an increased risk of epithelial ovarian cancer, possibly through a shared cluster of etiological factors or a common underlying pathology. These findings should be interpreted with caution as this is the first study to show this association and given the small number of cases in the highest exposure categories.",
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    AU - Kruitwagen, Roy F P M

    AU - Lukanova, Annekatrin

    AU - Allen, Naomi E.

    AU - Wark, Petra A.

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    AU - Hansen, Louise

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    AU - Ohlson, Nina

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    AU - Jirström, Karin

    AU - Butt, Salma

    AU - Tsilidis, Konstantinos K.

    AU - Khaw, Kay Tee

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    AB - While the risk of ovarian cancer clearly reduces with each full-term pregnancy, the effect of incomplete pregnancies is unclear. We investigated whether incomplete pregnancies (miscarriages and induced abortions) are associated with risk of epithelial ovarian cancer. This observational study was carried out in female participants of the European Prospective Investigation into Cancer and Nutrition (EPIC). A total of 274,442 women were followed from 1992 until 2010. The baseline questionnaire elicited information on miscarriages and induced abortions, reproductive history, and lifestyle-related factors. During a median follow-up of 11.5 years, 1,035 women were diagnosed with incident epithelial ovarian cancer. Despite the lack of an overall association (ever vs. never), risk of ovarian cancer was higher among women with multiple incomplete pregnancies (HR≥4vs.0: 1.74, 95% CI: 1.20-2.70; number of cases in this category: n = 23). This association was particularly evident for multiple miscarriages (HR≥4vs.0: 1.99, 95% CI: 1.06-3.73; number of cases in this category: n = 10), with no significant association for multiple induced abortions (HR≥4vs.0: 1.46, 95% CI: 0.68-3.14; number of cases in this category: n = 7). Our findings suggest that multiple miscarriages are associated with an increased risk of epithelial ovarian cancer, possibly through a shared cluster of etiological factors or a common underlying pathology. These findings should be interpreted with caution as this is the first study to show this association and given the small number of cases in the highest exposure categories.

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