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Title: Intrauterine devices and endometrial cancer risk: a pooled analysis of the Epidemiology of Endometrial Cancer Consortium.
Authors: Felix AS,  Gaudet MM,  La Vecchia C,  Nagle CM,  Shu XO,  Weiderpass E,  Adami HO,  Beresford S,  Bernstein L,  Chen C,  Cook LS,  De Vivo I,  Doherty JA,  Friedenreich CM,  Gapstur SM,  Hill D,  Horn-Ross PL,  Lacey JV,  Levi F,  Liang X,  Lu L,  Magliocco A,  McCann SE,  Negri E,  Olson SH,  Palmer JR,  Patel AV,  Petruzella S,  Prescott J,  Risch HA,  Rosenberg L,  Sherman ME,  Spurdle AB,  Webb PM,  Wise LA,  Xiang YB,  Xu W,  Yang HP,  Yu H,  Zeleniuch-Jacquotte A,  Brinton LA
Journal: Int J Cancer
Date: 2015 Mar 1
Branches: , MEB
PubMed ID: 25242594
PMC ID: PMC4267918
Abstract: Intrauterine devices (IUDs), long-acting and reversible contraceptives, induce a number of immunological and biochemical changes in the uterine environment that could affect endometrial cancer (EC) risk. We addressed this relationship through a pooled analysis of data collected in the Epidemiology of Endometrial Cancer Consortium. We combined individual-level data from 4 cohort and 14 case-control studies, in total 8,801 EC cases and 15,357 controls. Using multivariable logistic regression, we estimated pooled odds ratios (pooled-ORs) and 95% confidence intervals (CIs) for EC risk associated with ever use, type of device, ages at first and last use, duration of use and time since last use, stratified by study and adjusted for confounders. Ever use of IUDs was inversely related to EC risk (pooled-OR = 0.81, 95% CI = 0.74-0.90). Compared with never use, reduced risk of EC was observed for inert IUDs (pooled-OR = 0.69, 95% CI = 0.58-0.82), older age at first use (≥ 35 years pooled-OR = 0.53, 95% CI = 0.43-0.67), older age at last use (≥ 45 years pooled-OR = 0.60, 95% CI = 0.50-0.72), longer duration of use (≥ 10 years pooled-OR = 0.61, 95% CI = 0.52-0.71) and recent use (within 1 year of study entry pooled-OR = 0.39, 95% CI = 0.30-0.49). Future studies are needed to assess the respective roles of detection biases and biologic effects related to foreign body responses in the endometrium, heavier bleeding (and increased clearance of carcinogenic cells) and localized hormonal changes.