Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
BMC Cancer
Published in: BMC Cancer 1/2024

Open Access 01-12-2024 | Lung Cancer | Research

Reproductive factors and risk of lung cancer among 300,000 Chinese female never-smokers: evidence from the China Kadoorie Biobank study

Authors: Marwa M. A. Elbasheer, Bastian Bohrmann, Yiping Chen, Jun Lv, Dianjianyi Sun, Xia Wu, Xiaoming Yang, Daniel Avery, Liming Li, Zhengming Chen, Christiana Kartsonaki, Ka Hung Chan, Ling Yang

Published in: BMC Cancer | Issue 1/2024

Login to get access

Abstract

Background

Lung cancer is the leading cause of cancer mortality among Chinese females despite the low smoking prevalence among this population. This study assessed the roles of reproductive factors in lung cancer development among Chinese female never-smokers.

Methods

The prospective China Kadoorie Biobank (CKB) recruited over 0.5 million Chinese adults (0.3 million females) from 10 geographical areas in China in 2004–2008 when information on socio-demographic/lifestyle/environmental factors, physical measurements, medical history, and reproductive history collected through interviewer-administered questionnaires. Cox proportional hazard regression was used to estimate adjusted hazard ratios (HRs) of lung cancer by reproductive factors. Subgroup analyses by menopausal status, birth year, and geographical region were performed.

Results

During a median follow-up of 11 years, 2,284 incident lung cancers occurred among 282,558 female never-smokers. Ever oral contraceptive use was associated with a higher risk of lung cancer (HR = 1.16, 95% CI: 1.02–1.33) with a significant increasing trend associated with longer duration of use (p-trend = 0.03). Longer average breastfeeding duration per child was associated with a decreased risk (0.86, 0.78–0.95) for > 12 months compared with those who breastfed for 7–12 months. No statistically significant association was detected between other reproductive factors and lung cancer risk.

Conclusion

Oral contraceptive use was associated with an increased risk of lung cancer in Chinese female never-smokers. Further studies are needed to assess lung cancer risk related to different types of oral contraceptives in similar populations.
Appendix
Available only for authorised users
Literature
1.
Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, et al. Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA Cancer J Clin. 2021;71(3):209–49.CrossRefPubMed
2.
Zhang G, Zhan J, Fu H. Trends in Smoking Prevalence and Intensity between 2010 and 2018: Implications for Tobacco Control in China. Int J Environ Res Public Health. 2022;19(2):670.PubMedPubMedCentralCrossRef
3.
Chen ZM, Peto R, Iona A, Guo Y, Chen YP, Bian Z, et al. Emerging tobacco-related cancer risks in China: A nationwide, prospective study of 0.5 million adults. Cancer. 2015;121(S17):3097–106.PubMedCrossRef
4.
5.
Gao S, Li N, Wang S, Zhang F, Wei W, Li N, et al. Lung cancer in People’s Republic of China. J Thorac Oncol. 2020;15(10):1567–76.PubMedCrossRef
6.
7.
8.
He Y, Li D, Song G, Li Y, Liang D, Jin J, et al. Lung cancer burden has increased during the last 40 years in Hebei Province. China Thoracic Cancer. 2016;7(3):323–32.PubMedCrossRef
9.
Cheng ES, Chan KH, Weber M, Steinberg J, Young J, Canfell K, et al. Solid Fuel, Secondhand Smoke, and Lung Cancer Mortality: A Prospective Cohort of 323,794 Chinese Never-Smokers. Am J Respir Crit Care Med. 2022;206(9):1153–62.PubMedPubMedCentralCrossRef
10.
Stapelfeld C, Dammann C, Maser E. Sex-specificity in lung cancer risk. Int J Cancer. 2020;146(9):2376–82.PubMedCrossRef
11.
Siegfried JM, Stabile LP. Estrogenic steroid hormones in lung cancer. Semin Oncol. 2014;41(1):5–16.PubMedCrossRef
12.
13.
Cheng ES, Velentzis LS, Weber M, Steinberg J, Canfell K, Yu XQ. Female reproductive and hormonal factors and lung cancer mortality among never-smokers: A prospective cohort study of 287 408 Chinese women. Int J Cancer. 2023;152(12):2528–40.PubMedCrossRef
14.
Dahabreh IJ, Trikalinos TA, Paulus JK. Parity and risk of lung cancer in women: Systematic review and meta-analysis of epidemiological studies. Lung Cancer. 2012;76(2):150–8.PubMedCrossRef
15.
Ben Khedher S, Neri M, Papadopoulos A, Christiani DC, Diao N, Harris CC, et al. Menstrual and reproductive factors and lung cancer risk: A pooled analysis from the international lung cancer consortium. Int J Cancer. 2017;141(2):309–23.PubMedCrossRef
16.
Yin X, Zhu Z, Hosgood HD, Lan Q, Seow WJ. Reproductive factors and lung cancer risk: a comprehensive systematic review and meta-analysis. BMC Public Health. 2020;20(1):1458.PubMedPubMedCentralCrossRef
17.
Zhang Y, Yin Z, Shen L, Wan Y, Zhou B. Menstrual factors, reproductive factors and lung cancer risk: a meta-analysis. Zhongguo Fei Ai Za Zhi. 2012;15(12):701–19.PubMedPubMedCentral
18.
Huang J, Yue N, Shi N, Wang Q, Cui T, Ying H, et al. Influencing factors of lung cancer in nonsmoking women: systematic review and meta-analysis. J Public Health (Oxf). 2022;44(2):259–68.PubMedCrossRef
19.
IARC Working Group on the Evaluation of Carcinogenic Risks to Humans. Pharmaceuticals. IARC Monogr Eval Carcinog Risks Hum. 2012;100(Pt A):1–401.
20.
Vessey M, Yeates D. Oral contraceptive use and cancer: final report from the Oxford-Family Planning Association contraceptive study. Contraception. 2013;88(6):678–83.PubMedCrossRef
21.
Bae JM, Kim EH. Hormonal Replacement Therapy and the Risk of Lung Cancer in Women: An Adaptive Meta-analysis of Cohort Studies. J Prev Med Public Health. 2015;48(6):280–6.PubMedPubMedCentralCrossRef
22.
Jin C, Lang B. Hormone replacement therapy and lung cancer risk in women: a meta-analysis of cohort studies: Hormone replacement therapy and lung cancer risk. Medicine (Baltimore). 2019;98(51):e17532.PubMedCrossRef
23.
Greiser CM, Greiser EM, Dören M. Menopausal hormone therapy and risk of lung cancer—Systematic review and meta-analysis. Maturitas. 2010;65(3):198–204.PubMedCrossRef
24.
Wu W, Yin Z-H, Guan P, Ren Y-W, Zhou B-S. Association of oral contraceptives use and lung cancer risk among women: an updated meta-analysis based on cohort and case-control studies. Asian Pac J Cancer Prev. 2014;15(3):1205–10.PubMedCrossRef
25.
Iversen L, Sivasubramaniam S, Lee AJ, Fielding S, Hannaford PC. Lifetime cancer risk and combined oral contraceptives: the Royal College of General Practitioners’ Oral Contraception Study. Am J Obstet Gynecol. 2017;216(6):580.e1–581.e9.PubMedCrossRef
26.
Chlebowski RT, Schwartz AG, Wakelee H, Anderson GL, Stefanick ML, Manson JE, et al. Oestrogen plus progestin and lung cancer in postmenopausal women (Women’s Health Initiative trial): a post-hoc analysis of a randomised controlled trial. The Lancet. 2009;374(9697):1243–51.CrossRef
27.
The Coronary Drug Project. Findings Leading to Discontinuation of the 25-mg/day Estrogen Group. JAMA. 1973;226(6):652–7.CrossRef
28.
Brenner AV, Wang Z, Kleinerman RA, Lei S, Metayer C, Wang W, et al. Menstrual and reproductive factors and risk of lung cancer among Chinese women, Eastern Gansu Province, 1994–1998. J Epidemiol. 2003;13(1):22–8.PubMedCrossRef
29.
Weiss JM, Lacey JV Jr, Shu X-O, Ji B-T, Hou L, Yang G, et al. Menstrual and reproductive factors in association with lung cancer in female lifetime nonsmokers. Am J Epidemiol. 2008;168(11):1319–25.PubMedPubMedCentralCrossRef
30.
Gallagher LG, Rosenblatt KA, Ray RM, Li W, Gao DL, Applebaum KM, et al. Reproductive factors and risk of lung cancer in female textile workers in Shanghai. China Cancer Causes & Control. 2013;24:1305–14.CrossRef
31.
Chen Z, Chen J, Collins R, Guo Y, Peto R, Wu F, et al. China Kadoorie Biobank of 0.5 million people: survey methods, baseline characteristics and long-term follow-up. Int J Epidemiol. 2011;40(6):1652–66.PubMedPubMedCentralCrossRef
32.
Chen Z, Lee L, Chen J, Collins R, Wu F, Guo Y, et al. Cohort Profile: The Kadoorie Study of Chronic Disease in China (KSCDC). Int J Epidemiol. 2005;34(6):1243–9.PubMedCrossRef
33.
Fritz A, Percy C, Jack A, Shanmugaratnam K, Sobin LH, Parkin DM, et al. International classification of diseases for oncology. 3rd ed. Geneva: World Health Organization; 2000.
34.
Sun S, Schiller JH, Gazdar AF. Lung cancer in never smokers — a different disease. Nat Rev Cancer. 2007;7(10):778–90.PubMedCrossRef
35.
Yang L, Li L, Millwood IY, Lewington S, Guo Y, Sherliker P, et al. Adiposity in relation to age at menarche and other reproductive factors among 300 000 Chinese women: findings from China Kadoorie Biobank study. Int J Epidemiol. 2016;46(2):502–12.PubMedCentral
36.
Lewington S, Li L, Murugasen S, Hong LS, Yang L, Guo Y, et al. Temporal trends of main reproductive characteristics in ten urban and rural regions of China: the China Kadoorie Biobank study of 300 000 women. Int J Epidemiol. 2014;43(4):1252–62.PubMedPubMedCentralCrossRef
37.
38.
Jeon KH, Shin DW, Han K, Kim D, Yoo JE, Jeong S-M, et al. Female reproductive factors and the risk of lung cancer in postmenopausal women: a nationwide cohort study. Br J Cancer. 2020;122(9):1417–24.PubMedPubMedCentralCrossRef
39.
Jin K, Hung RJ, Thomas S, Le Marchand L, Matsuo K, Seow A, et al. Hormonal factors in association with lung cancer among Asian women: A pooled analysis from the International Lung Cancer Consortium. Int J Cancer. 2021;148(9):2241–54.PubMedCrossRef
40.
Baik CS, Strauss GM, Speizer FE, Feskanich D. Reproductive Factors, Hormone Use, and Risk for Lung Cancer in Postmenopausal Women, the Nurses’ Health Study. Cancer Epidemiol Biomark Prev. 2010;19(10):2525–33.CrossRef
41.
He F, Xie JX, Liu CL, Xiong WM, Xu QP, Liu ZQ, et al. The relationship of lung cancer with menstrual and reproductive factors may be influenced by passive smoking, cooking oil fumes, and tea intake: A case-control study in Chinese women. Medicine (Baltimore). 2017;96(46):e8816.PubMedCrossRef
42.
Liu Y, Inoue M, Sobue T, Tsugane S. Reproductive factors, hormone use and the risk of lung cancer among middle-aged never-smoking Japanese women: A large-scale population-based cohort study. Int J Cancer. 2005;117(4):662–6.PubMedCrossRef
43.
Tan HS, Tan M-H, Chow KY, Chay WY, Lim W-Y. Reproductive factors and lung cancer risk among women in the Singapore Breast Cancer Screening Project. Lung Cancer. 2015;90(3):499–508.PubMedCrossRef
44.
Wilunda C, Sawada N, Yamaji T, Iwasaki M, Inoue M, Tsugane S. Reproductive Factors and Lung Cancer Risk among Never-Smoking Japanese Women with 21 Years of Follow-Up: A Cohort Study. Cancer Epidemiol Biomark Prev. 2021;30(6):1185–92.CrossRef
45.
Schwartz AG, Ray RM, Cote ML, Abrams J, Sokol RJ, Hendrix SL, et al. Hormone Use, Reproductive History, and Risk of Lung Cancer: The Women’s Health Initiative Studies. J Thorac Oncol. 2015;10(7):1004–13.PubMedPubMedCentralCrossRef
46.
Zhang J. The Evolution of China’s One-Child Policy and Its Effects on Family Outcomes. Journal of Economic Perspectives. 2017;31(1):141–60.CrossRef
47.
Rodriguez-Lara V, Hernandez-Martinez JM, Arrieta O. Influence of estrogen in non-small cell lung cancer and its clinical implications. J Thorac Dis. 2018;10(1):482–97.PubMedPubMedCentralCrossRef
48.
49.
Schwartz AG, Prysak GM, Murphy V, Lonardo F, Pass H, Schwartz J, et al. Nuclear Estrogen Receptor β in Lung Cancer: Expression and Survival Differences by Sex. Clin Cancer Res. 2005;11(20):7280–7.PubMedCrossRef
50.
Hsu L-H, Liu K-J, Tsai M-F, Wu C-R, Feng A-C, Chu N-M, et al. Estrogen adversely affects the prognosis of patients with lung adenocarcinoma. Cancer Sci. 2015;106(1):51–9.PubMedCrossRef
51.
52.
Barrett ES, Parlett LE, Windham GC, Swan SH. Differences in ovarian hormones in relation to parity and time since last birth. Fertil Steril. 2014;101(6):1773–80.e1.PubMedPubMedCentralCrossRef
Metadata
Title
Reproductive factors and risk of lung cancer among 300,000 Chinese female never-smokers: evidence from the China Kadoorie Biobank study
Authors
Marwa M. A. Elbasheer
Bastian Bohrmann
Yiping Chen
Jun Lv
Dianjianyi Sun
Xia Wu
Xiaoming Yang
Daniel Avery
Liming Li
Zhengming Chen
Christiana Kartsonaki
Ka Hung Chan
Ling Yang
Publication date
01-12-2024
Publisher
BioMed Central
Published in
BMC Cancer / Issue 1/2024
Electronic ISSN: 1471-2407
DOI
https://doi.org/10.1186/s12885-024-12133-9

Other articles of this Issue 1/2024

BMC Cancer 1/2024 Go to the issue

Research

Integrating trans-omics, cellular experiments and clinical validation to identify ILF2 as a diagnostic serum biomarker and therapeutic target in gastric cancer

Research

Obstetric and neonatal outcomes following taxane use during pregnancy: a systematic review

Research

Awareness and associated factors of venous thromboembolism in breast cancer surgical patients: a cross-sectional study

Research

Exosomes derived from cancer-associated fibroblasts promote tumorigenesis, metastasis and chemoresistance of colorectal cancer by upregulating circ_0067557 to target Lin28

Research

p90RSK pathway inhibition synergizes with cisplatin in TMEM16A overexpressing head and neck cancer

Research

A combined nomogram based on radiomics and hematology to predict the pathological complete response of neoadjuvant immunochemotherapy in esophageal squamous cell carcinoma
Webinar | 19-02-2024 | 17:30 (CET)

Keynote webinar | Spotlight on antibody–drug conjugates in cancer

Watch now

Antibody–drug conjugates (ADCs) are novel agents that have shown promise across multiple tumor types. Explore the current landscape of ADCs in breast and lung cancer with our experts, and gain insights into the mechanism of action, key clinical trials data, existing challenges, and future directions.

Dr. Véronique Diéras
Prof. Fabrice Barlesi
Developed by: Springer Medicine
Image Credits