Reproductive risk factors and their association with melanoma: a population-based case-control study among Ontario women
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Authors
Chakravaram, Naga Satyasree
Date
2024-04-29
Type
thesis
Language
eng
Keyword
melanoma , polycystic ovary syndrome (PCOS) , endometriosis , fibroids , parity , premature ovarian insufficiency (POI)
Alternative Title
Abstract
Objective: To determine whether there is an association between selected reproductive risk factors (polycystic ovary syndrome-PCOS, endometriosis, parity, fibroids and premature ovarian insufficiency-POI) and melanoma.
Methods and materials: A population-based case-control study was conducted using health care administrative databases in the province of Ontario, Canada. Women 15-49 years diagnosed with melanoma during the period of January 1, 1997 - December 31, 2011 (Cases, n = 4578) were identified from the Ontario Cancer Registry. Each case was individually matched by age (as calendar year of birth) and census subdivision to four randomly selected controls (n = 18,312). The presence of selected reproductive risk factors was ascertained retrospectively until January 1, 1992 from the Ontario Health Insurance Plan (OHIP) database using billing diagnostic codes. PCOS was identified using OHIP codes ICD9-256 (for PCOS diagnosis), or ICD9-709 (for hirsutism), and ICD9-626 (for irregular menses). Endometriosis was identified using two ambulatory encounters coded as OHIP codes ICD9-617 or a hospital admission or a surgical procedure coded as ICD9-617 or ICD10-N80. A history of fibroids was identified using OHIP code ICD9-218, and POI as the presence of an OHIP code ICD9-627 (for menopause) before age 40 years. Information on parity was obtained from the MOMBABY database, an ICES derived cohort. The association between selected reproductive risk factors and melanoma was quantified, simultaneously, by odds ratios derived using conditional logistic regression, and adjusted for income quintiles and immigration status based on stepwise selection method (aOR).
Results: Mean age at melanoma diagnosis was 38 years. Relative to controls, women with melanoma had a similar proportion of prior endometriosis diagnosis (4.3% vs. 4.6%), nulliparity (55.74% vs. 53.7%), history of fibroids (4.6% vs. 4.5%), and POI (3.7% vs. 3.8%), and a higher proportion of PCOS diagnosis (21.9% vs. 35.1%). In the adjusted models, PCOS was associated with a higher odds of melanoma (aOR 1.93, 95% CI 1.79-2.08). None of the other selected reproductive risk factors were associated with melanoma.
Conclusion: PCOS is a potential reproductive risk factor associated with melanoma. Further studies are needed to confirm this association and elucidate possible mechanisms.