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Grand Rounds

Does Duration of Pregnancy Impact Endometrial Cancer Risk?

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BACKGROUND AND PURPOSE:

  • Increased parity is associated with a reduction in risk of endometrial cancer
    • Mechanism regarding this protective effect is unclear  
  • Husby et al. (BMJ, 2019) examined the association between pregnancy duration and endometrial cancer risk to determine if whether simply being pregnant is protective or length of time one is pregnant is the protective factor

METHODS:

  • Nationwide cohort study
  • Participants
    • All Danish women born from 1935 to 2002
  • Data analysis
    • Relative risk (RR) estimated using log-linear Poisson regression
    • Adjustments made for following confounders: Pregnancy history | Educational attainment | Marital status | Socioeconomic variables
  • Primary outcomes
    • Relative risk of endometrial cancer by pregnancy number, type, and duration

RESULTS:

  • 2,311,332 women | 3,947,650 pregnancies | 57,347,622 person years of follow-up
    • Endometrial cancer: Diagnosed in 6,743 women
  • First pregnancy associated with reduced cancer risk
    • Induced abortion: adjusted RR 0.53 (95% CI, 0.45 to 0.64)
    • Childbirth: RR 0.66 (95% CI, 0.61 to 0.72)
  • Each subsequent pregnancy was associated with an additional risk reduction
    • Induced abortion: RR 0.81 (95% CI, 0.77 to 0.86)
    • Childbirth: RR 0.86 (95% CI, 0.84 to 0.89)
    • Each pregnancy from the second onward had a similar protective effect
  • The following did not impact the results
    • Duration of pregnancy | Age at pregnancy | Spontaneous abortions | Obesity | Maternal birth cohort | Fecundity | Socioeconomic factors

CONCLUSION:

  • Strong protective effect of first pregnancy and risk for endometrial cancer
  • Endometrial cancer risk is reduced even if pregnancy ends shortly after conception (induced abortion similar to pregnancies ending in childbirth)
  • Authors acknowledge that results diverge from ‘unopposed estrogen theory’ of endometrial cancer
    • Data suggests some effect early in pregnancy (perhaps elevated progesterone levels play a protective role)

Learn More – Primary Sources:

Pregnancy duration and endometrial cancer risk: nationwide cohort study

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Related ObG Topics:

Endometrial Cancer: Beyond The Basics
What is the Association Between Postmenopausal Bleeding and Risk for Endometrial Cancer?
Do IUDs Decrease the Risk of Cervical Cancer?
Do Lifestyle Characteristics Modify the Association between Duration of Oral Contraception Use and Related Cancers?

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