Evidence mapPaperPMID 42340350Full record

ArticleCancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology2026

A multi-state survival model to identify risk factors for lethal ovarian cancer.

Mary K Townsend, A Heather Eliassen, Kathryn L Terry, Shelley S Tworoger, Bernard Rosner

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Article in Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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1 · What the graph read from it

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2 · The registry

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3 · Its place in the literature

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4 · The record

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5 · Who and what money

Authors and funding

5 authors.

Mary K TownsendOregon Health & Science University Portland, OR United States.ORCID 0000-0003-2452-4477
A Heather EliassenBrigham and Women's Hospital Boston, MA United States.ORCID 0000-0002-3961-6609
Kathryn L TerryBrigham and Women's Hospital Boston, MA United States.ORCID 0009-0002-5848-4661
Shelley S TworogerOregon Health & Science University Portland, OR United States.ORCID 0000-0002-6986-7046
Bernard RosnerBrigham and Women's Hospital Boston, MA United States.ORCID 0000-0001-6907-0056

Funding

STATISTICAL INNOVATIONS IN RISK MODELINGP01CA087969 · BRIGHAM AND WOMEN'S HOSPITAL · 2000 to 2005
$22.5M
Life Course Cancer Epidemiology Cohort in WomenU01CA176726 · HARVARD UNIVERSITY D/B/A HARVARD SCHOOL OF PUBLIC HEALTH · 2025 to 2025
$6.4M
Methodologic Innovations in Cancer EpidemiologyR01CA272489 · BRIGHAM AND WOMEN'S HOSPITAL · 2025 to 2025
$447k
NCI NIH HHS P01 CA087969NCI NIH HHS R01 CA272489NCI NIH HHS U01 CA176726NCI NIH HHS UM1 CA186107
6 · The paper itself

Abstract

backgroundGiven primary prevention strategies for ovarian cancer, such as surgery and medications, have inherent risks, identifying those at high risk of lethal ovarian cancer is critical. We examined pre-diagnosis factors and risk of developing and dying from ovarian cancer among cancer-free women.

methodsAnalyses were conducted in three 12-year periods from 1980 to 2017 in the Nurses' Health Study (NHS) and NHSII cohorts. Potential risk factors were reproductive and hormonal variables, endometriosis history, smoking, low-dose aspirin, self-identified race, family history, depression, and adiposity over the life course. We used a multi-state survival model to estimate relative risks and 95% lower and upper confidence limits (RR, LCL-UCL) for lethal ovarian cancer among 211,420 cancer-free women, among whom 1,730 developed ovarian cancer and 660 died due to ovarian cancer in the same risk period as diagnosis.

resultsOf the 22 exposures evaluated, 10 were associated with lethal ovarian cancer. For example, nulliparity had an amplified association with lethal ovarian cancer (1.62, 1.23-2.13) due to associations with both incidence and mortality in the same direction. Oral contraceptive use ≥10 versus 0 years was associated with lethal ovarian cancer (0.65, 0.43-0.97) primarily due to association with incidence while ≥20 versus 0 pack-years of smoking was associated with lethal ovarian cancer (1.25, 1.02-1.53) primarily due to the mortality relationship.

conclusionsSeveral reproductive factors, depression, and self-identified race were associated with risk of lethal ovarian cancer. IMPACT: Evaluations of lethal ovarian cancer risk must consider differential associations of exposures with incidence and mortality.

Identifiers

PMID42340350
PMCPMC13379247

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.