A meta-analysis of estrogen replacement therapy and risk of epithelial ovarian cancer

Citation
Ss. Coughlin et al., A meta-analysis of estrogen replacement therapy and risk of epithelial ovarian cancer, J CLIN EPID, 53(4), 2000, pp. 367-375
Citations number
39
Language
INGLESE
art.tipo
Article
Categorie Soggetti
Envirnomentale Medicine & Public Health","Medical Research General Topics
Journal title
JOURNAL OF CLINICAL EPIDEMIOLOGY
ISSN journal
0895-4356 → ACNP
Volume
53
Issue
4
Year of publication
2000
Pages
367 - 375
Database
ISI
SICI code
0895-4356(200004)53:4<367:AMOERT>2.0.ZU;2-V
Abstract
Estrogen replacement therapy (ERT) has not been associated with epithelial ovarian cancer in most reported epidemiologic studies that have looked for an association. Some studies may have found weak statistically nonsignifica nt associations because the number of cases or number of women who reported estrogen use was small. We performed a meta-analysis of data from 15 case- control studies that provided data on ERT and risk of epithelial ovarian ca ncer. The 15 combined studies were statistically heterogeneous (chi(2) (14) = 26.3, P < 0.05) in terms of the effect they found. When we combined thes e studies using a random effects model, we did not End a significant associ ation of ERT with ovarian cancer (odds ratio = 1.1, 95% confidence interval = 0.9-1.3). There was no clear evidence of a dose-response relation with i ncreasing duration of estrogen use in a subset of five studies that reporte d estrogen use by duration (overall slope = 0.0012, 95% confidence interval = -0.0055 to 0.0080). The influences of statistical outliers, study design (hospital or clinic controls vs. community controls), and location (U.S. a nd Canada vs. Europe and Australia) were examined. The odds ratio was 1.3 ( 95% confidence interval = 1.0-1.6) in the relatively homogeneous subset of four U.S. case-control studies with community controls, but we cannot rule out the possibility of uncontrolled confounding. The odds ratios for estrog en use for other subgroups defined by geographic location and type of contr ol group were not significantly different from one. (C) 2000 Elsevier Scien ce Inc. All rights reserved.