AS297 - Associations of estrogens, estrogen metabolites, and androgens with risks of endometrial and ovarian cancers in a prospective case-cohort study

Investigator Names and Contact Information

Britton Trabert (britton.trabert@hci.utah.edu)

Introduction/Intent

Endogenous estrogens are recognized as causal agents in the etiologies of breast and endometrial cancers, and may also play a role in the pathogenesis of ovarian cancer. Studies of postmenopausal women have consistently shown that elevated circulating estrogens and androgens are associated with increased risk of endometrial cancer. Few studies of circulating sex-steroid hormones and risk of ovarian cancer have been conducted, and these have inconclusive findings due to limitations of experimental design and low case numbers. Metabolism of estrogens and androgens modulates their bioavailability, affinity to receptors and mutagenic potential. In addition, laboratory data indicate that particular metabolites may themselves have unique roles in physiologic and pathologic processes. Roles of hormone metabolism and of particular metabolites in cancer risk have not been studied in epidemiologic studies of endometrial or ovarian cancers, in part because of the need for a sensitive, reliable, and high through-put assay. We are proposing a nested case-control study of endometrial and ovarian cancers to assess the roles of estrogens, estrogen metabolites, and androgens in the etiologies of these cancers. Cases and shared controls will be drawn from the Women's Health Initiative Observational Study (WHIOS) cohort. Analytes will be measured with a recently developed liquid chromatography/ mass spectrometry (LC-MS) assay that can measure 15 estrogens and estrogen metabolites and four androgens with high sensitivity using limited amounts of serum. The proposed research would benefit from unique WHIOS resources including large numbers of cancer cases, prospectively collected serum and baseline data on important cancer risk factors; we expect that resulting data will be an important contribution to understanding the etiologies of endometrial and ovarian cancers, and of hormone-mediated carcinogenesis. Sharing of controls will make efficient use of WHIOS and laboratory resources. This study will provide a comprehensive assessment of estrogen and androgen exposures in the etiologies of endometrial and ovarian cancers, and will also be the largest prospective study of endogenous sex hormones and risk of these gynecologic cancers done to date.

Specific Aims

Primary Aim

  1. To study associations between circulating estrogens and estrogen metabolites (in conjugated and unconjugated forms) and androgens with risks of endometrial and ovarian cancers in postmenopausal women. Hormones and metabolites will be considered individually and in groups, based on biologic pathways of hormone metabolism.

Secondary aims include:

  1. To determine whether findings are similar or different in subgroups stratified in tum, by histologic subtypes (ovarian cancer), obesity (endometrial cancer), and follow-up time.

  2. To assess co-variation between hormone levels and cancer risk factors, such as anthropometric measures, and reproductive and menstrual histories, and to determine whether effects of obesity or reproductive variables on cancer risk are mediated through their effects on hormone profiles.

Related Papers

Adiposity, height, and serum androgen metabolism among postmenopausal women in the Women’s Health Initiative Observational Study

Approved Manuscript, Oh, Hannah et al., 2021/4 MSID: 3918
Keywords: Body Mass Index; Height; Weight; Waist To Hip Ratio; Body Composition; Adiposity; Androgen; Sex Hormones
Related Studies: 297

Oral contraceptive use, gravidity, and circulating markers of androgen metabolism among postmenopausal women in the Women’s Health Initiative Observational Study

Approved Proposal, Michels, Kara A. et al., 2018/6 MSID: 3644
Keywords: Androgens; Oral Contraceptives; Parity; Pregnancy; Hormones
Related Studies: 297

Androgen metabolism and ovarian and endometrial cancer risks among women using menopausal hormone therapy

Approved Proposal, Madigan, M. Patricia et al., 2021/1 MSID: 4390
Keywords: Ovarian Cancer; Endometrial Cancer; Circulating Androgens And Androgen Metabolites; Relative Risk; Menopausal Hormone Therapy; Hormonal Carcinogenesis
Related Studies: 297

Estrogen metabolism in menopausal hormone users in the Women's Health Initiative Observational Study: does it differ between estrogen plus progestin and estrogen alone?

Roni Falk et al., 2018/9 PubMed #30183089 MSID: 2762
The WHI found an unexpected reduced breast cancer risk in women using CEE alone. We hypothesized CEE alone induces estrogen hydroxylation along the 2-pathway rather than the competing 16-pathway, a pattern linked to reduced postmenopausal breast cancer risk. 1864 women in a WHIOS case-control study of estrogen metabolism and ovarian and endometrial cancer were studied of whom 609 were current E+P users (351 used CEE+MPA), while 272 used E alone (162 used CEE). Fifteen EM were measured, and analy...
Keywords: Breast Cancer; Endometrial Cancer; Ovarian Cancer; Estrogen; Estrogen Metabolites; Menopausal Hormone Therapy
Related Studies: 297

Alcohol and oestrogen metabolites in postmenopausal women in the Women’s Health Initiative Observational Study

Mary Playdon et al., 2017/12 PubMed #29235567 MSID: 3053
BACKGROUND: Alcohol consumption is associated with an increased risk of several cancers. Potential mechanisms include altered oestrogen metabolism. Parent oestrogens metabolise into alternate pathways of oestrogen metabolites that may have variable effects on cancer pathogenesis. We examined associations of alcohol consumption with circulating oestrogen/oestrogen metabolites in postmenopausal women in the Women's Health Initiative (WHI)-Observational Study (OS). METHODS: We conducted a cross-sec...
Keywords: Alcohol; Estrogen; Estrogen Metabolites; Hormones
Related Studies: 297

Postmenopausal androgen metabolism and endometrial cancer risk in the Women’s Health Initiative Observational Study

Kara A. Michels et al., 2019/9 PubMed #31371379 MSID: 3367
Background: After menopause, several androgens continue to be produced primarily by the adrenal glands; these can be converted into estrogens via aromatization or into androgen metabolites. It is unclear if androgens are associated with endometrial cancer risk independently of their being precursors to estrogens or if alternative metabolic pathways influence risk. Methods: We measured prediagnostic serum concentrations of 12 androgens and their metabolites using highly sensitive liquid chromatog...
Keywords: Endometrial Cancer; Androgen; Androgen Metabolites; Risk; Hormonal Carcinogenesis
Related Studies: 297

Circulating androgen and estrogen metabolites associated with urogenital menopausal symptoms in the Women’s Health Initiative Observational Study

Approved Proposal, Michels, Kara A. et al., 2018/6 MSID: 3619
Keywords: Menopause; Androgens; Estrogens; Urogenital; Vulvovaginal Atrophy; Sexual Activity
Related Studies: 297

Recreational physical activity, sitting, and androgen metabolism among postmenopausal women in the Women’s Health Initiative Observational Study

Approved Manuscript, Oh, Hannah et al., 2021/5 MSID: 3917
Keywords: Physical Activity; Sitting; Sedentary Time; Androgen; Androgen Metabolites; Sex Hormones
Related Studies: 297

Circulating androgen and estrogen metabolites associated with hot flashes and sleep disturbances in the Women’s Health Initiative Observational Study

Approved Proposal, Michels, Kara A. et al., 2018/6 MSID: 3643
Keywords: Menopause; Androgens; Estrogens; Hot Flashes; Sleep; Insomnia
Related Studies: 297

Circulating androgens and postmenopausal ovarian cancer risk in the Women’s Health Initiative Observational Study

Britton Trabert et al., 2019/1 PubMed #30684389 MSID: 3366
Our knowledge of epidemiologic risk factors for ovarian cancer supports a role for androgens in the pathogenesis of this disease; however, few studies have examined associations between circulating androgens and ovarian cancer risk. Using highly sensitive LC-MS/MS assays, we evaluated associations between pre-diagnostic serum levels of 12 androgens, including novel androgen metabolites that reflect androgen activity in tissues, and ovarian cancer risk among postmenopausal women in a nested case-...
Keywords: Ovarian Cancer; Androgen; Androgen Metabolites; Risk; Hormonal Carcinogenesis
Related Studies: 297

Sitting, physical activity, and serum oestrogen metabolism in postmenopausal women: the Women's Health Initiative Observational Study

Hannah Oh et al., 2017/8 PubMed #28817836 MSID: 2763
BACKGROUND: Prolonged sitting and lower levels of physical activity have been associated with increased levels of parent oestrogens (oestrone and oestradiol), the key hormones in female cancers, in postmenopausal women. However, it is unknown whether sitting and physical activity are associated with circulating oestrogen metabolite levels. METHODS: Among 1804 postmenopausal women enrolled in the Women's Health Initiative Observational Study, 15 serum oestrogens/oestrogen metabolites were quantif...
Keywords: Physical Activity; Sedentary Time; Estrogen; Estrogen Metabolites
Related Studies: 297

Estrogen metabolism and smoking in postmenopausal women

Approved Proposal, Yang, Hannah et al., 2015/6 MSID: 2764
Related Studies: 297

The association of prior oral contraceptive use and reproductive factors with estrogen metabolism in postmenopausal women

Approved Manuscript, Trabert, Britton et al., 2017/7 MSID: 2766
Keywords: Parity; Duration Of And Time Since Last Oral Contraceptive Use; Age At First Birth; Breast Feeding; Age At Menopause; Menopausal Hormone Therapy Use/Recency; Estrogens And Estrogen Metabolites
Related Studies: 297

Analgesic use and circulating estrogens, androgens, and their metabolites in the Women's Health Initiative Observational Study

Lauren Hurwitz et al., 2021/12 PubMed #34893532 MSID: 4177
Though studies have observed inverse associations between use of analgesics (aspirin, non-aspirin nonsteroidal anti-inflammatory drugs [NSAIDs], and acetaminophen) and the risk of several cancers, the potential biological mechanisms underlying these associations are unclear. We investigated the relationship between analgesic use and serum concentrations of estrogens, androgens, and their metabolites among postmenopausal women to provide insights on whether analgesic use might influence endogenou...
Keywords: Aspirin; Analgesics; Circulating Sex Hormones; Androgens; Estrogens
Related Studies: 297

Circulating estrogens and postmenopausal ovarian and endometrial cancer risk among current hormone users in the Women’s Health Initiative Observational Study

Britton Trabert et al., 2019/9 PubMed #31542834 MSID: 2947
PURPOSE: Menopausal hormone therapy (MHT) use induces alterations in circulating estrogens/estrogen metabolites, which may contribute to the altered risk of reproductive tract cancers among current users. Thus, the current study assessed associations between circulating estrogens/estrogen metabolites and ovarian and endometrial cancer risk among MHT users. METHODS: We conducted a nested case-control study among postmenopausal women using MHT at baseline in the Women's Health Initiative Observati...
Keywords: Ovarian Cancer; Endometrial Cancer; Estrogen; Estrogen Metabolites; Hormones
Related Studies: 297

Associations of tubal ligation and hysterectomy with serum androgen and estrogen metabolites among postmenopausal women in the Women’s Health Initiative Observational Study

Ashley M. Geczik et al., 2024/5 PubMed #38772931 MSID: 3732
Purpose: Hysterectomy is associated with subsequent changes in circulating hormone levels, but the evidence of an association for tubal ligation is unclear. We evaluated whether circulating concentrations of androgens and estrogens differ by tubal ligation or hysterectomy status in postmenopausal women from the Women's Health Initiative (WHI)-Observational Study (OS). Methods: Serum androgens and estrogens were measured in 920 postmenopausal women who did not use menopausal hormone therapy at th...
Keywords: Androgen; Estrogen; Tubal Ligation; Hysterectomy; Postmenopausal
Related Studies: 297

Identification of genetic and lifestyle determinants of estrogen metabolism profiles

Approved Proposal, Yuan, Fangcheng et al., 2023/5 MSID: 4935
Keywords: Genome-Wide Association Study; Lifestyles; Estrogen; Estrogen Metabolites; Sex Hormones
Related Studies: 297

Circulating estrogens and postmenopausal ovarian cancer risk in the Women’s Health Initiative Observational Study

Britton Trabert et al., 2016/2 PubMed #26908437 MSID: 2389
BACKGROUND: Hormonal and reproductive factors contribute to the development of ovarian cancer, but few studies have examined associations between circulating estrogens and estrogen metabolites and ovarian cancer risk. We evaluated whether serum estrogens and estrogen metabolite levels are associated with ovarian cancer risk among postmenopausal women in a nested case-control study in the Women's Health Initiative (WHI) Observational Study (OS). METHODS: We selected all 169 eligible epithelial ov...
Keywords: Ovarian Cancer; Estrogen Metabolism
Related Studies: 297

Serum estrogen and estrogen metabolites and endometrial cancer risk among postmenopausal women

Louise Brinton et al., 2016/4 PubMed #27197275 MSID: 2390
BACKGROUND: Although endometrial cancer is clearly influenced by hormonal factors, few epidemiologic studies have investigated the role of endogenous estrogens or especially estrogen metabolites. METHODS: We conducted a nested case-control study within the Women's Health Initiative Observational Study (WHI-OS), a cohort of 93,676 postmenopausal women recruited between 1993-1998. Using baseline serum samples from women who were non-current hormone users with intact uteri, we measured 15 estrogens...
Keywords: Endometrial Cancer; Estrogen Metabolism
Related Studies: 297

Anthropometric measures and serum estrogen metabolism in postmenopausal women: the Women’s Health Initiative Observational Study

Hannah Oh et al., 2017/3 PubMed #28284224 MSID: 2765
BACKGROUND: Several anthropometric measures have been associated with hormone-related cancers. However, it is unknown whether estrogen metabolism plays an important role in these relationships. We examined whether measured current body mass index (BMI), waist-to-hip ratio (WHR), height, and self-reported BMI at age 18 years were associated with serum estrogens/estrogen metabolites using baseline, cross-sectional data from 1835 postmenopausal women enrolled in the Women's Health Initiative Observ...
Keywords: Bmi; Estrogen; Estrogen Metabolites; Height; Postmenopausal; Sex Hormones; Whr
Related Studies: 297