Psychosocial Factors, Lifestyle and Risk of Ovarian Cancer

Abstract

Current prevention recommendations for ovarian cancer are limited, and the underlying etiology is not fully elucidated. The associations of common modifiable factors, such as psychosocial and lifestyle factors, with ovarian cancer risk need to be more fully evaluated. Thus, I examined the association of ovarian cancer with depression, physical activity, hypertension, and antihypertensive medication use among participants from two prospective cohort studies: the Nurses' Health Study and Nurses' Health Study II. Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for these associations. Depression was associated with about 30% increased risk of ovarian cancer (HR = 1.30, 95% CI 1.05-1.60). Higher risk was also observed among women with persistent positive depression status than women intermittently positive or persistently negative for depression. Contrary to the hypothesis that physical activity may lower ovarian cancer risk, we observed that both low and high physical activity was associated with a modest increase in ovarian cancer risk (HR for ≥27 [approximately equivalent to 1 hr/day of brisk walking] versus 3-9 MET-hrs/week = 1.26, 95% CI 1.02, 1.55; HR for <3 versus 3-9 MET-hrs/week = 1.19, 95% CI 0.94, 1.52). However, these associations were only restricted to premenopausal physical activity, and postmenopausal activity was not associated with ovarian cancer risk. While hypertension was not associated with risk (HR = 1.03, 95% CI 0.87, 1.21), use of thiazide diuretics was associated with an increased risk of ovarian cancer (HR = 1.35, 95% CI 1.04, 1.74), and use of calcium channel blockers was associated with a suggestively lower risk (HR = 0.73, 95% CI 0.53, 1.01). Our results need to be confirmed by other studies, but suggest that these common modifiable factors may have a moderate impact on ovarian cancer risk. This represents an opportunity to broaden our understanding of ovarian cancer etiology and potentially improve prevention strategies for ovarian cancer.