Intrauterine devices and endometrial cancer risk: A pooled analysis of the Epidemiology of Endometrial Cancer Consortium

Ashley S. Felix, Mia M. Gaudet, Carlo La Vecchia, Christina M. Nagle, Xiao Ou Shu, Elisabete Weiderpass, Hans Olov Adami, Shirley Beresford, Leslie Bernstein, Chu Chen, Linda S. Cook, Immaculata De Vivo, Jennifer A. Doherty, Christine M. Friedenreich, Susan M. Gapstur, Dierdre Hill, Pamela L. Horn-Ross, James V. Lacey, Fabio Levi, Xiaolin LiangLingeng Lu, Anthony Magliocco, Susan E. McCann, Eva Negri, Sara H. Olson, Julie R. Palmer, Alpa V. Patel, Stacey Petruzella, Jennifer Prescott, Harvey A. Risch, Lynn Rosenberg, Mark E. Sherman, Amanda B. Spurdle, Penelope M. Webb, Lauren A. Wise, Yong Bing Xiang, Wanghong Xu, Hannah P. Yang, Herbert Yu, Anne Zeleniuch-Jacquotte, Louise A. Brinton

Research output: Contribution to journalArticle

26 Scopus citations

Abstract

Intrauterine devices (IUDs), long-acting and reversible contraceptives, induce a number of immunological and biochemical changes in the uterine environment that could affect endometrial cancer (EC) risk. We addressed this relationship through a pooled analysis of data collected in the Epidemiology of Endometrial Cancer Consortium. We combined individual-level data from 4 cohort and 14 case-control studies, in total 8,801 EC cases and 15,357 controls. Using multivariable logistic regression, we estimated pooled odds ratios (pooled-ORs) and 95% confidence intervals (CIs) for EC risk associated with ever use, type of device, ages at first and last use, duration of use and time since last use, stratified by study and adjusted for confounders. Ever use of IUDs was inversely related to EC risk (pooled-OR=0.81, 95% CI=0.74-0.90). Compared with never use, reduced risk of EC was observed for inert IUDs (pooled-OR=0.69, 95% CI=0.58-0.82), older age at first use (≥35 years pooled-OR=0.53, 95% CI=0.43-0.67), older age at last use (≥45 years pooled-OR=0.60, 95% CI=0.50-0.72), longer duration of use (≥10 years pooled-OR=0.61, 95% CI=0.52-0.71) and recent use (within 1 year of study entry pooled-OR=0.39, 95% CI=0.30-0.49). Future studies are needed to assess the respective roles of detection biases and biologic effects related to foreign body responses in the endometrium, heavier bleeding (and increased clearance of carcinogenic cells) and localized hormonal changes.

Original languageEnglish (US)
Pages (from-to)E410-E422
JournalInternational Journal of Cancer
Volume136
Issue number5
DOIs
StatePublished - Mar 1 2015

Keywords

  • Contraception
  • Endometrial neoplasm
  • Etiology
  • Pooled analysis

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

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    Felix, A. S., Gaudet, M. M., La Vecchia, C., Nagle, C. M., Shu, X. O., Weiderpass, E., Adami, H. O., Beresford, S., Bernstein, L., Chen, C., Cook, L. S., De Vivo, I., Doherty, J. A., Friedenreich, C. M., Gapstur, S. M., Hill, D., Horn-Ross, P. L., Lacey, J. V., Levi, F., ... Brinton, L. A. (2015). Intrauterine devices and endometrial cancer risk: A pooled analysis of the Epidemiology of Endometrial Cancer Consortium. International Journal of Cancer, 136(5), E410-E422. https://doi.org/10.1002/ijc.29229