Reproductive Risk Factors for Cutaneous Melanoma in Women: A Case-Control Study

Abstract

Reproductive hormonal factors may have a potential role in cutaneous melanoma. This study estimated the risk of melanoma in women related to self-reported changes in nevi during pregnancy, while using oral contraceptives and/or hormone replacement therapy. Trained interviewers administered a questionnaire obtaining information about oral contraceptive use, hormone replacement therapy, reproductive history, sun exposure, occupation, and medical history from 318 Caucasian women newly diagnosed between 1991 and 1992 from two pigmented lesion clinics in San Francisco, California, and Philadelphia, Pennsylvania. A total of 395 frequency-matched control participants were recruited from hospital-affiliated outpatient clinics. Clinicians conducted skin examinations to assess the number and type of nevi, extent of freckling, solar damage, and skin type. For women aged less than 55 years, there was an association between a livebirth 5 years before diagnosis (odds ratio = 2.6, 95% confidence interval: 1.3, 5.3) and between number of births and melanoma risk (for > or = 3 births: odds ratio = 3.3, 95% confidence interval: 1.7, 6.5; ptrend < 0.001). Changes in nevi during recent pregnancies were a risk factor for melanoma, based upon small numbers (odds ratio = 2.9, 95% confidence interval: 1.1, 8.1). Oral contraceptive use and hormone replacement therapy were not associated with melanoma risk.

Anthropometric factors and risk of melanoma in women: A pooled analysis

“…Moreover, only a few studies have examined associations according to histologic subtype 14,15,25 or menopausal status, 7,8 which may be important given the possible link between reproductive and hormonal factors and risk of melanoma in women. 6,14,[26][27][28][29][30][31] The prevalence of overweight and obesity is growing dramatically in most parts of the world, and generally is higher in women than in men. 32 This is predicted to have major consequences on the incidence of obesity-related diseases.…”

Prenatal Risk Factors for Cutaneous Malignant Melanoma: Follow-up of 2,594,783 Danes Born from 1950 to 2002

“…In a Swedish registry-based study of the risk of cutaneous malignant melanoma in mothers, similar results for the effects of age at first birth and parity (family size) were reported (15). However, one recent case-control study reported increasing risk of cutaneous malignant melanoma in mothers by parity (30).…”

Prognostic Factors in Cutaneous Melanoma

“…Moreover, a large French study of 460 women with melanoma, as compared with controls in a Cox proportional hazard analysis, suggested a modest reduction in the relative risk for melanoma associated with parity ≥3 pregnancies [ 154 ]. In contrast, the melanoma case-control study of Lea et al [ 148 ] reported an increased risk of melanoma in women less than 55 years of age associated with live birth 5 years before diagnosis (OR = 2.6) and with the history of ≥3 births (OR = 3.3, p for trend <0.001) [ 148 ]. Suffi ce it to say that the data remain confl icting but that the preponderance of the evidence does not indicate an increased risk of melanoma, or worsened prognosis from melanoma, associated with pregnancy or parity.…”

“…A retrospective, population-based study of 412 melanomas diagnosed during or within 1 year after pregnancy and agematched, nonpregnant women from a California registry uncovered no differences in disease stage at presentation of melanoma or in melanomarelated survival by multivariate and Kaplan-Meier product limit analyses [ 147 ]. A review of the subject published in 2009 asserted that prognosis for localized primary melanoma does not appear to be adversely affected by pregnancy [ 152 ], nor is there evidence that hormone replacement therapy increases a woman's risk of melanoma [ 148 ].…”