Risk factors for ovarian cancer by histological phenotype in the Million Women Study

There is growing evidence that the different histological types of ovarian cancer have diverse origins. Many high-grade serous tumours (the most common type) are hypothesised to arise from the fallopian tubes, while endometrioid and clear cell tumours are hypothesised to develop from endometriosis, and the origins of mucinous tumours are uncertain. If these hypotheses are true, then the population-level risk factors for the ovarian cancer histotypes should likewise vary - but few epidemiological studies have sufficient cases to explore this. This thesis investigates the association between ovarian cancer and various exposures (including tubal ligation and reproductive factors), in a cohort of 1.3 million women, with 8,000 incident ovarian cancers. Participants completed a questionnaire at recruitment, and were followed up for routinely collected information on cancers and deaths using national registries. Cox proportional hazards models were used to estimate adjusted relative risks of ovarian cancer in women by different exposures. Tubal ligation was associated with reduced risks of cancers of the ovary, and also of the peritoneum and fallopian tube; parity and breastfeeding were also associated with reduced ... (continues)