Cancer Causes & Control

, Volume 17, Issue 7, pp 949–955 | Cite as

Menstrual and reproductive factors in relation to risk of endometrial cancer in Chinese women

  • Karen J. Wernli
  • Roberta M. Ray
  • Dao Li Gao
  • Anneclaire J. De Roos
  • Harvey Checkoway
  • David B. Thomas
Original Paper


Menstrual, reproductive and contraceptive factors have been associated with risk of endometrial cancer in populations where the incidence of this tumor is high. To investigate associations between these factors in a low-risk population with a low prevalence of hormone replacement therapy, we conducted a cohort study among 267,400 women employed in the textile industry in Shanghai, China. Menstrual, reproductive and other factors were ascertained at baseline in 1989–1991, and women were followed for incident endometrial cancer through 31 December 1998 (n = 206). Cox proportional hazards modeling was used to estimate hazard ratios (HR) and 95% confidence intervals (CI). Risk of endometrial cancer decreased with increasing age at menarche (p-trend = 0.004). Among menopausal women, risk increased with age at menopause and increasing years of menstruation. Compared to women with one live birth, risk was increased in relation to nulliparity (Hazard ratio = 3.95, 95% CI 1.43–10.86). Risk was decreased with increasing age at first live birth (p-trend = 0.03). There was a decreased risk associated with ever use of an intrauterine device (HR = 0.56, 95% CI 0.35–0.88) and use of oral contraceptives for ≥2 years (HR = 0.50, 95% CI 0.23–1.07). This prospective study confirms findings from previous case–control studies relating menstrual, reproductive, and contraceptive factors and endometrial carcinoma.


Cohort Endometrial Intrauterine device Menarche Neoplasm 



This research was supported by grant R01CA80180 from the U.S. National Cancer Institute, National Institutes of Health, Department of Health and Human Services, and U.S. National Institute of Environmental Health Sciences Training Grant ES07262 (K.J.W.). We thank Drs. Fan Liang Chen, Yong Wei Hu, Guan Lin Zhao, and Lei Dan Pan for their ongoing support of this cohort. We thank Wang Wen Wan for her project management; the numerous field and medical workers in collecting baseline questionnaires and confirming diagnoses; and Dawn Fitzgibbons, Wenjin Li, Georgia Green, Shirley Zhang, Wendy Langeberg, Richard Gandolfo, and Ted Grichuhin for their technical and administrative support.


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Copyright information

© Springer Science+Business Media B.V. 2006

Authors and Affiliations

  • Karen J. Wernli
    • 1
    • 2
  • Roberta M. Ray
    • 1
  • Dao Li Gao
    • 3
  • Anneclaire J. De Roos
    • 1
    • 2
  • Harvey Checkoway
    • 2
    • 4
  • David B. Thomas
    • 1
    • 2
  1. 1.Program in EpidemiologyFred Hutchinson Cancer Research CenterSeattleUSA
  2. 2.Department of Epidemiology, School of Public Health and Community MedicineUniversity of WashingtonSeattleUSA
  3. 3.Department of EpidemiologyZhong Shan Hospital Cancer CenterShanghaiChina
  4. 4.Department of Occupational and Environmental Health Sciences, School of Public Health and Community MedicineUniversity of WashingtonSeattleUSA

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