A role of hormone-related factors in renal cell cancer (RCC) etiology has been hypothesized, but the epidemiological evidence is inconsistent. The present study aimed at evaluating the effect of reproductive, menstrual and other gender-specific variables on RCC risk among women. This study is part of a larger hospitalbased, case-control study on RCC risk, conducted in northern, central and southern Italy. Cases were 273 women, below age 80, with histologically confirmed, incident RCC. Controls were 546 women hospitalized for acute, nonneoplastic conditions, frequency-matched to cases by age and center. Odds ratios (OR) and 95% confidence intervals (CI) were computed using multiple logistic regression models. RCC risk was inversely related to age at first birth (OR 5 0.7, 95% CI 0.5-1.0, for ≥25 years vs. <25 years). Hysterectomy was found to double RCC risk (OR 5 2.3, 95% CI 1.3-4.2). A negative association of borderline-statistical significance emerged for age at menarche, whereas, no associations were found between RCC risk and parity, menopausal status, age at menopause and use of hormone replacement therapy or oral contraceptives. Our findings give support to a role of hysterectomy in increasing RCC risk without corroborating, however, a major role of female hormone-related factors. ' 2008 Wiley-Liss, Inc.Key words: kidney cancer; reproductive and menstrual factors; hormones; hysterectomy; case-control study The kidney is among the 10 most common cancer sites in more developed countries. Worldwide, incidence rates are lower in women than in men, with 1:2 ratio. Such difference is recorded in Italy also, where the world-standardized incidence rates per 100,000 person-years are 11.5 and 4.6 among men and women, respectively. 1 Cigarette smoking, obesity and hypertension are the only established risk factors for renal cell cancer (RCC) (i.e., the most common type of kidney cancer) in both sexes. 2-5 Among potential risk factors, a role of hormone-related dynamics on RCC development has been hypothesized. To our knowledge, human studies have never examined endogenous estrogens with RCC risk. However, steroid hormone receptors have been found in normal and cancerous renal cell tissue, indicating possible hormonal regulations 6 ; this line of reasoning is strengthened by the observation that polymorphisms of the estrogen receptor gene were hypothesized to play a role in the pathogenesis of RCC. 7 Animal studies have shown that estrogens can promote or induce kidney cancer development. 8 In addition, obesity, which is consistently associated to RCC, provides a major source of estrogens in postmenopausal women. 9 To evaluate the role of menstrual and reproductive history, exogenous hormone use, and gynecologic surgery in RCC etiology in women, we conducted a multicentre, case-control study in Italy.
Material and methodsThis study is part of a hospital-based, case-control study on RCC risk in both sexes, which has been described in details elsewhere. 10,11 The study was conducted between 1992 and 2004 in 4 Italian a...