Article Text

Download PDFPDF
Menstrual and reproductive factors and gastric cancer risk in a large prospective study of women
  1. Neal D Freedman1,
  2. Wong-Ho Chow2,
  3. Yu-Tang Gao3,
  4. Xiao-Ou Shu4,
  5. Bu-Tian Ji2,
  6. Gong Yang4,
  7. Jay H Lubin2,
  8. Hong-Lan Li3,
  9. Nathaniel Rothman2,
  10. Wei Zheng4,
  11. Christian C Abnet2
  1. 1
    Cancer Prevention Fellowship Program, Division of Cancer Prevention, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
  2. 2
    Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, Maryland, USA
  3. 3
    Department of Epidemiology, Shanghai Cancer Institute, Shanghai, People’s Republic of China
  4. 4
    Department of Medicine, Vanderbilt-Ingram Cancer Center, Vanderbilt University, School of Medicine, Nashville, Tennessee, USA
  1. Dr Neal Freedman, Cancer Prevention Fellow, Nutritional Epidemiology Branch, Division of Cancer Epidemiology and Genetics, 6120 Executive Boulevard, EPS/320, MSC 7232, Rockville, MD 20852, USA; freedmanne{at}


Background: Gastric cancer incidence rates are consistently lower in women than men in both high and low-risk regions worldwide. Sex hormones, such as progesterone and estrogen, may protect women against gastric cancer.

Objective: To investigate the association of menstrual and reproductive factors and gastric cancer risk.

Methods: These associations were prospectively investigated in 73 442 Shanghai women. After 419 260 person-years of follow-up, 154 women were diagnosed with gastric cancer. Hazard ratios (HR) and 95% confidence intervals (CI) were calculated using Cox proportional hazards models adjusted for age, body mass index, education, income, and cigarette use.

Results: No associations were observed between gastric cancer risk and age of menarche, number of children, breast feeding, or oral contraceptive use. In contrast, associations were observed with age of menopause (HR 0.80 per five-year increase in menopausal age, 95% CI 0.66–0.97), years of fertility (participants with less than 30 years of fertility were at increased risk compared with those with 30–36 years of fertility, HR 1.90, 95% CI 1.25–2.90), years since menopause (HR 1.26 per five years, 95% CI 1.03–1.53), and intrauterine device use (HR for users 1.61, 95% CI 1.08–2.39).

Conclusions: These results support the hypothesis that female hormones play a protective role in gastric cancer risk.

  • stomach neoplasms
  • cohort studies
  • prospective studies
  • hormones

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • Ethical approval: Institutional review boards for human research in Shanghai Cancer Institute, People’s Republic of China, National Cancer Institute, USA, and Vanderbilt University, USA.

  • Funding: This research was supported by National Institute of Health research grant R01 CA70867 and by the Intramural Research Program contract N02 CP1101066.

  • Conflict of interest: None declared.

  • Abbreviations:
    cytotoxin-associated gene A
    hazard ratio
    hormone replacement therapy
    interquartile range
    intrauterine device