Endometriosis and Ovarian Cancer Risk

All studies included in this pooled analysis had approval from ethics committees, and written informed consent was obtained from all study participants. Study characteristics are reported in the appendix.
We used primary data from all studies in the OCAC at the time this analysis was initiated; the study questionnaires included questions about endometriosis. Data for endometriosis were reported in 13 case–control studies of ovarian cancer. One study was undertaken in Australia,⁹ (link) three in Europe,26 (link), 27 (link), 28 (link) and nine in the USA.5 (link), 8 (link), 29 (link), 30 (link), 31 (link), 32 (link), 33 (link), 34 (link), 35 (link), 36 (link) The characteristics of the 13 studies are presented in table 1. Data for endometriosis were self-reported in all studies. Women with missing endometriosis data and those with non-epithelial tumours were excluded. Data for origin of endometriosis (endometrioma, peritoneal, or deep infiltrating disease) were not available. Our analysis dataset consisted of data from 23 144 women (7911 with invasive ovarian cancer, 1907 with borderline ovarian cancer, and 13 326 controls). Subsets of data from five studies have been reported previously (Australian Cancer Study, Australian Ovarian Cancer Study [AUS],⁹ (link) Diseases of the Ovary and their Evaluation Study [DOV],⁵ (link) Hawaii Ovarian Cancer Study [HAW],⁷ (link) Malignant Ovarian Cancer Study [MAL],⁷ (link) and University of Southern California, Study of Lifestyle and Women's Health [USC]⁸ (link)). We excluded one OCAC study (from Poland³⁷ (link)) from this analysis because the investigators thought that the endometriosis data were not reliable.Table 1

Description of studies included in the analysis

	Study name	Study abbreviation	Study type	Method of data collection	Ascertainment period
Asia-Pacific
Australia	Australian Cancer Study†, Australian Ovarian Cancer Study†⁹ (link)	AUS	Population based	Self-completed questionnaire, checked by trained research nurse	2002–06
Europe
Germany	German Ovarian Cancer Study†²⁶ (link)	GER	Population based	Self-completed questionnaire	1992–98
Denmark	Malignant Ovarian Cancer Study²⁷ (link)	MAL	Population based	In-person or phone interview	1994–99
UK	United Kingdom Ovarian Cancer Population Study²⁸ (link)	UKO	Population based	Self-completed questionnaire	2006–07
USA
CT	Connecticut Ovary Study²⁹ (link)	CON	Population based	In-person interview	1999–2003
WA	Diseases of the Ovary and their Evaluation Study†⁵ (link)	DOV	Population based	In-person interview	2002–05
HI	Hawaii Ovarian Cancer Study³⁰ (link)	HAW	Population based	In-person interview	1994–2007
Western PA, northeast OH, western NY	Hormones and Ovarian Cancer Prediction Study†³¹ (link)	HOP	Population based	In-person interview	2003–08
North central states (MN, SD, ND, IL, IA, WI)	Mayo Clinic Ovarian Cancer Study³² (link)	MAY	Clinic based	In-person interview	2000–08
NC	North Carolina Ovarian Cancer Study†³³ (link)	NCO	Population based	In-person interview	1999–2008
NH and eastern MA	New England Case-Control Study of Ovarian Cancer†³⁴ (link)	NEC	Population based	In-person interview	1999–2008
Orange County and San Diego County, CA	University of California, Irvine Ovarian Cancer Study³⁵ (link)	UCI	Population based	Self-completed questionnaire	1995–2005
Los Angeles County, CA	University of Southern California, Study of Lifestyle and Women's Health†8 (link), 36 (link)	USC	Population based	In-person interview	1993–2005

Combined for the purpose of the analysis.

†

Data for timing of endometriosis available.

In each study, information was provided about potential confounding variables that were previously noted to be related to ovarian cancer risk: age, ethnic origin, parity, breastfeeding, duration of oral contraceptive use, family history of ovarian cancer, weight, height, and history of tubal ligation. All data were cleaned and checked for internal consistency and clarifications were requested from the original investigators when needed.

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Pearce C.L., Templeman C., Rossing M.A., Lee A., Near A.M., Webb P.M., Nagle C.M., Doherty J.A., Cushing-Haugen K.L., Wicklund K.G., Chang-Claude J., Hein R., Lurie G., Wilkens L.R., Carney M.E., Goodman M.T., Moysich K., Kjaer S.K., Hogdall E., Jensen A., Goode E.L., Fridley B.L., Larson M.C., Schildkraut J.M., Palmieri R.T., Cramer D.W., Terry K.L., Vitonis A.F., Titus L.J., Ziogas A., Brewster W., Anton-Culver H., Gentry-Maharaj A., Ramus S.J., Anderson A.R., Brueggmann D., Fasching P.A., Gayther S.A., Huntsman D.G., Menon U., Ness R.B., Pike M.C., Risch H., Wu A.H, & Berchuck A. (2012). Association between endometriosis and risk of histological subtypes of ovarian cancer: a pooled analysis of case–control studies. The Lancet. Oncology, 13(4), 385-394.

Publication 2012

Cancer Cancer of ovarian Diseases of ovary Endometrioma Endometriosis Epithelial tumours Ethics committees Ethnic origin Oral contraceptive Ovary Peritoneal Tubal ligation Women

Corresponding Organization : University of Southern California

Other organizations : Fred Hutch Cancer Center, Georgetown University Medical Center, Georgetown University, QIMR Berghofer Medical Research Institute, German Cancer Research Center, Heidelberg University, University of Cologne, University of Hawaiʻi at Mānoa, University of Hawaii System, Cancer Research Center, Roswell Park Comprehensive Cancer Center, University of Copenhagen, Rigshospitalet, Danish Cancer Society, Mayo Clinic, Duke University Hospital, Duke Medical Center, University of North Carolina at Chapel Hill, Brigham and Women's Hospital, Dartmouth College, University of California, Irvine, University College Hospital, University College London, University of Giessen, University of California, Los Angeles, Universitätsklinikum Erlangen, BC Cancer Agency, Vancouver General Hospital, The University of Texas Health Science Center at Houston, Memorial Sloan Kettering Cancer Center, Yale University

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Variable analysis

independent variables

Endometriosis

dependent variables

Invasive ovarian cancer
Borderline ovarian cancer

control variables

Ethnic origin
Parity
Breastfeeding
Duration of oral contraceptive use
Family history of ovarian cancer
Weight
Height
History of tubal ligation

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