Body mass index modifies bladder cancer risk associated with low estrogen exposure among Egyptian women after menopause

  • Sania AmrEmail author
  • Beverly J. Wolpert
  • Diane Marie St. George
  • India James
  • Christopher A. Loffredo
Original Paper



Investigators have reported inconsistent findings regarding associations between body mass index (BMI) and bladder cancer risk, and they have postulated that sex steroids mediate such associations. We assessed the impact of BMI on the relationship between bladder cancer risk and combinations of age at first childbirth, parity, and age at menopause, among Egyptian women.


We used data from our multicenter case–control study of 419 cases and 786 controls in logistic regression models to estimate adjusted odds ratios (AORs) and 95% confidence intervals (CIs) of such associations.


Age > 18 years at first childbirth and parity ≤ 6 were significantly associated with bladder cancer risk, which was higher when both factors (AOR = 2.31, 95% CI = 1.55–3.43) and age at menopause < 45 years (AOR = 3.51, 95% CI = 1.88–6.55) were present. Early menopause was associated with higher bladder cancer risk in obese (AOR = 2.90, 95% CI = 1.40–5.98) but not normal weight women (AOR = 0.98, 95% CI = 0.58–1.65; Pinteraction = 0.11), and the risk was greatest when both first childbirth at age > 18 years and parity ≤ 6 were present (AOR = 7.60, 95% CI = 1.84–31.35); however, overweight and obesity were associated with significantly lower bladder cancer risk (AOR = 0.59, 95% CI = 0.43–0.81, and AOR = 0.26, 95% CI = 0.18–0.38, respectively).


Body mass index appears to modify bladder cancer risk in Egyptian women after menopause by slightly enhancing the risk associated with low estrogen exposure among the obese only. Longitudinal studies of the BMI role in bladder malignancy in this distinctive population are required.


Bladder cancer Body mass index Estrogen exposure Early menopause Egyptian women 



The authors thank Sameera Ezzat, Tamer El Hifnawy, and Doa’a Salah, who supervised the recruitment of subjects for this study. Iman Gouda, Iman Loay, and Bhaskar Kallakury performed the expert pathology review of the cases. Nabiel N. Mikhail provided data management services.


A grant from the National Cancer Institute, National Institutes of Health (R01-CA115618 to CAL), supported this study.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

The institutional review boards of the 3 cancer referral centers (the National Cancer Institute in Cairo, the Oncology Center at Minia University, and the South Egypt Cancer Institute in Assiut), Egypt’s Ministry of Health, the University of Maryland, Baltimore, and Georgetown University approved the protocols.

Informed consent

Written informed consent was obtained from all participants.


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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Department of Epidemiology and Public HealthUniversity of Maryland School of MedicineBaltimoreUSA
  2. 2.Marlene and Stuart Greenebaum Comprehensive Cancer CenterUniversity of Maryland School of MedicineBaltimoreUSA
  3. 3.U.S. Food and Drug Administration (FDA), Center for Food Safety and Applied NutritionCollege ParkUSA
  4. 4.Lombardi Comprehensive Cancer CenterGeorgetown UniversityWashingtonUSA

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