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Gynecol Oncol. 2019 Mar 29. pii: S0090-8258(19)30275-6. doi: 10.1016/j.ygyno.2019.03.102. [Epub ahead of print]

The preventable burden of endometrial and ovarian cancers in Australia: A pooled cohort study.

Author information

1
Centre for Big Data Research in Health, University of New South Wales, Sydney, Australia. Electronic address: m.laaksonen@unsw.edu.au.
2
Centre for Big Data Research in Health, University of New South Wales, Sydney, Australia.
3
Cancer Research Division, Cancer Council New South Wales, Sydney, Australia; School of Public Health, University of Sydney, Sydney, Australia; Prince of Wales Clinical School, University of New South Wales, Sydney, Australia.
4
Cancer Epidemiology and Intelligence Division, Cancer Council Victoria, Melbourne, Australia; Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia.
5
Research Centre for Generational Health and Ageing, University of Newcastle, Newcastle, Australia.
6
ANU College of Medicine, Biology and Environment, Australian National University, Canberra, Australia.
7
Clinical Diabetes Laboratory, Baker Heart and Diabetes Institute, Melbourne, Australia.
8
Centre for Vision Research, Westmead Institute for Medical research, University of Sydney, Sydney, Australia.
9
Diabetes and Population Health Laboratory, Baker Heart and Diabetes Institute, Melbourne, Australia.
10
Adelaide Medical School, University of Adelaide, Adelaide, Australia.
11
Breast Cancer Network Australia, Melbourne, Australia.
12
Cancer Research Division, Cancer Council New South Wales, Sydney, Australia; Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia.
13
School of Public Health, University of Sydney, Sydney, Australia; School of Life and Environmental Sciences Charles Perkins Centre, University of Sydney, Sydney, Australia.
14
School of Public Health, University of Sydney, Sydney, Australia; ANZAC Research Institute, University of Sydney and Concord Hospital, Sydney, Australia.

Abstract

OBJECTIVE:

Evidence on the endometrial and ovarian cancer burden preventable through modifications to current causal behavioural and hormonal exposures is limited. Whether the burden differs by population subgroup is unknown.

METHODS:

We linked pooled data from six Australian cohort studies to national cancer and death registries, and quantified exposure-cancer associations using adjusted proportional hazards models. We estimated exposure prevalence from representative health surveys. We then calculated Population Attributable Fractions (PAFs) with 95% confidence intervals (CIs), accounting for competing risk of death, and compared PAFs for population subgroups.

RESULTS:

During a median 4.9 years follow-up, 510 incident endometrial and 303 ovarian cancers were diagnosed. Overweight and obesity explained 41.9% (95% CI 32.3-50.1) of the endometrial cancer burden and obesity alone 34.5% (95% CI 27.5-40.9). This translates to 12,800 and 10,500 endometrial cancers in Australia in the next 10 years, respectively. The body fatness-related endometrial cancer burden was highest (49-87%) among women with diabetes, living remotely, of older age, lower socio-economic status or educational attainment and born in Australia. Never use of oral contraceptives (OCs) explained 8.1% (95% CI 1.8-14.1) or 2500 endometrial cancers. A higher BMI and current long-term MHT use increased, and long-term OC use decreased, the risk of ovarian cancer, but the burden attributable to overweight, obesity or exogenous hormonal factors was not statistically significant.

CONCLUSIONS:

Excess body fatness, a trait that is of high and increasing prevalence globally, is responsible for a large proportion of the endometrial cancer burden, indicating the need for effective strategies to reduce adiposity.

KEYWORDS:

Cohort; Endometrial cancer; Ovarian cancer; Population attributable fraction; Preventable; Risk factors

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