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      Reproductive factors and risks of biliary tract cancers and stones: a population-based study in Shanghai, China

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          Abstract

          Background:

          Parity has been linked to gallbladder cancer and gallstones, but the effects of other reproductive factors are less clear.

          Methods:

          We examined 361 incident biliary tract cancer cases, 647 biliary stone cases, and 586 healthy women in a population-based study in Shanghai.

          Results:

          The effects of parity (odds ratios, OR ⩾3 vs 1 child =2.0, 95% confidence interval (CI) 0.7–5.1), younger age at first birth (OR per 1-year decrease=1.2, 95% CI 0.99–1.6), and older age at menarche (OR per 1-year increase=1.4, 95% CI 1.1–1.8) on gallbladder cancer risk were more pronounced among women with stones, but the interactions were not significant.

          Conclusion:

          Our results provide support for high parity, younger age at first birth, and late age at menarche in the development of gallbladder cancer, particularly among women with biliary stones.

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          Most cited references51

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          Prevalence and risk factors of gallstone disease in an adult population of Taiwan: an epidemiological survey.

          D Chou, Chiu-Kue Nien, Gina Etheredge … (2006)
          The aim of this study was to determine the prevalence and risk factors of gallstone disease (GSD) in an adult population of Taiwan through a population-based screening study. A cross-sectional community study in a rural village of Taiwan was conducted in 3333 Chinese adults (aged > or = 18 years) undergoing ultrasonography. A questionnaire on personal history was completed to ascertain whether the removed gallbladder contained stones in all cholecystectomized subjects, the dietary habits (vegetarian/non-vegetarian diet), the history of GSD in the participant's first-degree relatives, the history of gastrointestinal surgery (vagotomy, gastrectomy for peptic ulcer disease, or ileal resection), parity, and use of oral contraceptives. The demographic characteristics and biochemical parameters were recorded. The overall prevalence of GSD was 5.0% (4.6% in men, 5.4% in women) with no significant sex differences (men/women: odds ratio [OR] 0.71, 95% confidence interval [CI] 0.50-1.01, P = 0.058). Logistic regression analysis showed that increasing age (men: 40-64 years, OR 7.38, 95% CI 2.59-21.01, P or = 65 years, OR 14.16, 95% CI 4.84-41.47, P or = 65 years, OR 6.78, 95% CI 2.97-15.46, P or = 126 mg/dL (OR 2.11, 95% CI 1.16-3.83, P = 0.014), history of GSD in the first-degree relatives (OR 7.47, 95% CI 2.22-25.12, P = 0.001), and use of oral contraceptives (OR 10.71, 95% CI 3.06-37.49, P or = 126 mg/dL was only correlated to GSD without controlling for other confounding factors in men. Other demographic characteristics and biochemical parameters, such as high body mass index (> or = 25 kg/m2), increased parity, hypercholesterolemia, hypertriglyceridemia, hyperuricemia, hepatitis C infection and cirrhosis, did not exhibit any correlation to GSD in logistic regression analysis, although they appeared to be related to GSD in women in univariate analysis. Age and fatty liver in both sexes were found to be risk factors for GSD in the study population. The finding of a correlation between fatty liver and GSD is an important addition to the literature concerning the risk factors of GSD. Diabetes mellitus, history of GSD in the first-degree relatives, and use of oral contraceptives were also risk factors for GSD in women.
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            Epidemiologic aspects of gallbladder cancer: a case-control study of the SEARCH Program of the International Agency for Research on Cancer.

            Caitlin G Howe, P Ghadirian, P A Baghurst … (1997)
            There are few previous epidemiologic studies of gallbladder cancer, a rare but nearly always lethal gastrointestinal cancer with a demonstrated greater frequency in adult women and older subjects of both sexes, and also in the members of populations throughout central and eastern Europe and certain racial groups such as native American Indians. Unfortunately, the prospects for the prevention of this form of cancer are poor. Our purpose in conducting this study was to investigate possible new risk factors for gallbladder cancer and to strengthen our understanding of established causal agents that may be involved in this disease. A large, collaborative, multicenter, case-control study of cancer of the gallbladder was conducted in five centers located in Australia (Adelaide), Canada (Montreal and Toronto), The Netherlands (Utrecht), and Poland (Opole) from January 1983 through July 1988. Case subjects with gallbladder cancer were accrued by the centers from hospital pathology records and from reports to regional cancer registries. Cancer diagnosis was confirmed by either biopsy, cholecystectomy, or at the time of autopsy. Control subjects were randomly assigned at each center from the population. The pooled analysis included 196 case subjects and 1515 control subjects (who did not report previous cholecystectomy). Ninety-eight percent of the subjects were white. Personal interviews of case subjects, control subjects, and surrogates (spouse or next of kin) were conducted by trained personnel. After adjusting for potential confounding factors (age, sex, center, type of interview, years of schooling, alcohol intake, and lifetime cigarette smoking), a history of gallbladder symptoms requiring medical attention (e.g., reduced bile secretion from the gallbladder into the small intestine due to obstructions of the common bile or cystic ducts) was the major risk factor associated with this form of cancer (odds ratio [OR] = 4.4; 95% confidence interval [CI] = 2.6-7.5). This association was present even in subjects who had their first gallbladder examination because of symptoms present more than 20 years earlier (OR = 6.2; 95% CI = 2.8-13.4). Other variables associated with gallbladder cancer risk included an elevated body mass index, high total energy intake, high carbohydrate intake (after adjustment for total energy intake), and chronic diarrhea. All of these risk factors have been previously associated with gallstone disease. These findings are consistent with a major role of gallstones, or risk factors for gallstones, in the cause of gallbladder cancer. Additional information on whether or not screening high-risk subjects for gallstones or gallbladder cancer is needed.
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              Association of menstrual and reproductive factors with breast cancer risk: results from the Shanghai Breast Cancer Study.

              R Bostick, Y. Gao, X. Ruan … (2000)
              The incidence of breast cancer among women in Shanghai, a traditionally low-risk population, has increased substantially over the past 20 years. To evaluate the association of menstrual and reproductive factors with breast cancer risk and the influence of these factors on the temporal trend of breast cancer incidence, we analyzed data from the Shanghai Breast Cancer Study, a population-based case-control study of breast cancer recently completed among Chinese women in urban Shanghai. In-person interviews were completed for 1,459 women newly diagnosed with breast cancer between ages 25 and 64 and for 1,556 controls frequency-matched to cases by age. Unconditional logistic regression was employed to estimate adjusted odds ratios (ORs) and 95% confidence intervals (CIs) related to menstrual and reproductive factors. Earlier menarcheal age, nulliparity, and later age at first live birth were associated with increased risk of breast cancer among both pre- and post-menopausal women, while never having breast-fed and later age at menopause were associated with elevated risk only among post-menopausal women. Among controls, 32% of younger women ( 40 years) reported starting menarche at age of 13 or younger, and this factor contributed to 44% of cases diagnosed among younger women and 26% to 28% of cases in older women. Older age at first live birth or at menopause explained a considerable portion of cases diagnosed in older, but not younger, women. Our study suggests that the changes in menstrual and reproductive patterns among women in Shanghai have contributed to the recent increase in breast cancer incidence, particularly among younger women. Copyright 2000 Wiley-Liss, Inc.
              Article 0 comments Cited 43 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): Br J Cancer
                Title: British Journal of Cancer
                Publisher: Nature Publishing Group
                ISSN (Print): 0007-0920
                ISSN (Electronic): 1532-1827
                Publication date (Electronic): 09 March 2010
                Publication date Collection: 30 March 2010
                Publication date (Print): 30 March 2010
                Volume: 102
                Issue: 7
                Pages: 1185-1189
                Affiliations
                [1 ]Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, DHHS Bethesda, MD, USA
                [2 ]Department of Preventive Medicine, Northwestern University Chicago, IL, USA
                [3 ]Department of Epidemiology, Shanghai Cancer Institute Shanghai, China
                [4 ]Department of Pathology, MD Anderson Cancer Center Houston, TX, USA
                [5 ]Department of Epidemiology and Biostatistics, University of Pennsylvania Philadelphia, PA, USA
                [6 ]Shanghai Tumor Hospital, Fudan University Shanghai, China
                [7 ]Zhongshan Hospital, Fudan University Shanghai, China
                [8 ]Department of Surgery, Ruijin Hospital, Second Medical University Shanghai, China
                [9 ]Institute of Oriental Hepatobiliary Surgery, Second Military University Shanghai, China
                [10 ]Department of Epidemiology, University of Washington Seattle, WA, USA
                Author notes
                [* ]Author for correspondence: andreotg@ 123456mail.nih.gov
                Article
                Publisher Item ID: 6605597
                DOI: 10.1038/sj.bjc.6605597
                PMC ID: 2853091
                PubMed ID: 20216539
                SO-VID: 51b22a3d-e18c-4f23-9d3e-a3f3ef443317
                Copyright © Copyright 2010, Cancer Research UK
                History
                Date received : 25 November 2009
                Date revision received : 26 January 2010
                Date accepted : 15 February 2010
                Categories
                Subject: Epidemiology

                ScienceOpen disciplines: Oncology & Radiotherapy
                Keywords: biliary tract cancer,gallstones,reproductive factors
                Data availability:
                ScienceOpen disciplines: Oncology & Radiotherapy
                Keywords: biliary tract cancer, gallstones, reproductive factors

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