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Catherine M Olsen Cancer and Population Studies Group, School of Population Health, Queensland Institute of Medical Research, Brisbane, 4029, Australia
Cancer and Population Studies Group, School of Population Health, Queensland Institute of Medical Research, Brisbane, 4029, Australia

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Adèle C Green Cancer and Population Studies Group, School of Population Health, Queensland Institute of Medical Research, Brisbane, 4029, Australia

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Christina M Nagle Cancer and Population Studies Group, School of Population Health, Queensland Institute of Medical Research, Brisbane, 4029, Australia

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Susan J Jordan Cancer and Population Studies Group, School of Population Health, Queensland Institute of Medical Research, Brisbane, 4029, Australia
Cancer and Population Studies Group, School of Population Health, Queensland Institute of Medical Research, Brisbane, 4029, Australia

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David C Whiteman Cancer and Population Studies Group, School of Population Health, Queensland Institute of Medical Research, Brisbane, 4029, Australia

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Christopher J Bain Cancer and Population Studies Group, School of Population Health, Queensland Institute of Medical Research, Brisbane, 4029, Australia

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Penelope M Webb Cancer and Population Studies Group, School of Population Health, Queensland Institute of Medical Research, Brisbane, 4029, Australia

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on behalf of the Australian Cancer Study Group (Ovarian Cancer) and the Australian Ovarian Cancer Study Group
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In 1998, Risch proposed a hypothesis for the pathogenesis of ovarian cancer relating to the role of androgens in stimulating epithelial cell proliferation. Although this hypothesis has been widely discussed, direct evidence to support it is scant. To address this issue, we have conducted a detailed analysis of factors possibly associated with high circulating levels of androgens, including polycystic ovary syndrome (PCOS), hirsutism and acne (all clinically associated with hyperandrogenism) using the data collected in an Australia-wide, population-based case-control study. Cases aged 18–79 years with a new diagnosis of invasive epithelial ovarian cancer (n=1276) or borderline malignant tumour (n=315) were identified through a network of clinics and cancer registries throughout Australia. Controls (n=1508) were selected from the National Electoral Roll. Women self-reported a history of PCOS, acne, hirsutism and also use of testosterone supplements or the androgenic medication Danazol. We found no evidence that a history of PCOS, acne or hirsutism was associated with ovarian cancer overall, or with specific subtypes, with the exception of serous borderline tumours that were positively associated with a history of PCOS (OR 2.6; 95% CI 1.0–6.1). Women who had ever used testosterone supplements had an increased risk of ovarian cancer (OR 3.7; 95% CI 1.1–12.0); however, use of the androgenic medication Danazol did not increase risk (OR 1.0; 95% CI 0.4–2.9). Overall, our results do not support the hypothesis that androgen-related disorders increase the risk of ovarian cancer.

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Catherine M Olsen Queensland Institute of Medical Research, School of Public Health, Department of Preventive Medicine, Department of Epidemiology and Biostatistics, Program in Epidemiology, Obstetrics and Gynecology Epidemiology Center, Peter MacCallum Cancer Centre, Department of Epidemiology and Public Health, Cancer Epidemiology Program, Division of Cancer Epidemiology, Department of Obstetrics and Gynecology, Department of Biomedical Sciences, Department of Obstetrics and Gynecology, Roswell Park Cancer Center, Virus, Gynecologic Clinic, Department of Health Sciences Research, Department of Community and Family Medicine, Robert Wood Johnson Medical School, School of Public Health, National Cancer Institute, Division of Genetics and Epidemiology, Department of Cancer Epidemiology and Prevention, Department of Epidemiology, Department of Gynaecological Oncology, Royal Brisbane Hospital, Locked Bag 2000, Brisbane, Queensland 4029, Australia

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Christina M Nagle Queensland Institute of Medical Research, School of Public Health, Department of Preventive Medicine, Department of Epidemiology and Biostatistics, Program in Epidemiology, Obstetrics and Gynecology Epidemiology Center, Peter MacCallum Cancer Centre, Department of Epidemiology and Public Health, Cancer Epidemiology Program, Division of Cancer Epidemiology, Department of Obstetrics and Gynecology, Department of Biomedical Sciences, Department of Obstetrics and Gynecology, Roswell Park Cancer Center, Virus, Gynecologic Clinic, Department of Health Sciences Research, Department of Community and Family Medicine, Robert Wood Johnson Medical School, School of Public Health, National Cancer Institute, Division of Genetics and Epidemiology, Department of Cancer Epidemiology and Prevention, Department of Epidemiology, Department of Gynaecological Oncology, Royal Brisbane Hospital, Locked Bag 2000, Brisbane, Queensland 4029, Australia

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David C Whiteman Queensland Institute of Medical Research, School of Public Health, Department of Preventive Medicine, Department of Epidemiology and Biostatistics, Program in Epidemiology, Obstetrics and Gynecology Epidemiology Center, Peter MacCallum Cancer Centre, Department of Epidemiology and Public Health, Cancer Epidemiology Program, Division of Cancer Epidemiology, Department of Obstetrics and Gynecology, Department of Biomedical Sciences, Department of Obstetrics and Gynecology, Roswell Park Cancer Center, Virus, Gynecologic Clinic, Department of Health Sciences Research, Department of Community and Family Medicine, Robert Wood Johnson Medical School, School of Public Health, National Cancer Institute, Division of Genetics and Epidemiology, Department of Cancer Epidemiology and Prevention, Department of Epidemiology, Department of Gynaecological Oncology, Royal Brisbane Hospital, Locked Bag 2000, Brisbane, Queensland 4029, Australia

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Roberta Ness Queensland Institute of Medical Research, School of Public Health, Department of Preventive Medicine, Department of Epidemiology and Biostatistics, Program in Epidemiology, Obstetrics and Gynecology Epidemiology Center, Peter MacCallum Cancer Centre, Department of Epidemiology and Public Health, Cancer Epidemiology Program, Division of Cancer Epidemiology, Department of Obstetrics and Gynecology, Department of Biomedical Sciences, Department of Obstetrics and Gynecology, Roswell Park Cancer Center, Virus, Gynecologic Clinic, Department of Health Sciences Research, Department of Community and Family Medicine, Robert Wood Johnson Medical School, School of Public Health, National Cancer Institute, Division of Genetics and Epidemiology, Department of Cancer Epidemiology and Prevention, Department of Epidemiology, Department of Gynaecological Oncology, Royal Brisbane Hospital, Locked Bag 2000, Brisbane, Queensland 4029, Australia

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Celeste Leigh Pearce Queensland Institute of Medical Research, School of Public Health, Department of Preventive Medicine, Department of Epidemiology and Biostatistics, Program in Epidemiology, Obstetrics and Gynecology Epidemiology Center, Peter MacCallum Cancer Centre, Department of Epidemiology and Public Health, Cancer Epidemiology Program, Division of Cancer Epidemiology, Department of Obstetrics and Gynecology, Department of Biomedical Sciences, Department of Obstetrics and Gynecology, Roswell Park Cancer Center, Virus, Gynecologic Clinic, Department of Health Sciences Research, Department of Community and Family Medicine, Robert Wood Johnson Medical School, School of Public Health, National Cancer Institute, Division of Genetics and Epidemiology, Department of Cancer Epidemiology and Prevention, Department of Epidemiology, Department of Gynaecological Oncology, Royal Brisbane Hospital, Locked Bag 2000, Brisbane, Queensland 4029, Australia

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Malcolm C Pike Queensland Institute of Medical Research, School of Public Health, Department of Preventive Medicine, Department of Epidemiology and Biostatistics, Program in Epidemiology, Obstetrics and Gynecology Epidemiology Center, Peter MacCallum Cancer Centre, Department of Epidemiology and Public Health, Cancer Epidemiology Program, Division of Cancer Epidemiology, Department of Obstetrics and Gynecology, Department of Biomedical Sciences, Department of Obstetrics and Gynecology, Roswell Park Cancer Center, Virus, Gynecologic Clinic, Department of Health Sciences Research, Department of Community and Family Medicine, Robert Wood Johnson Medical School, School of Public Health, National Cancer Institute, Division of Genetics and Epidemiology, Department of Cancer Epidemiology and Prevention, Department of Epidemiology, Department of Gynaecological Oncology, Royal Brisbane Hospital, Locked Bag 2000, Brisbane, Queensland 4029, Australia
Queensland Institute of Medical Research, School of Public Health, Department of Preventive Medicine, Department of Epidemiology and Biostatistics, Program in Epidemiology, Obstetrics and Gynecology Epidemiology Center, Peter MacCallum Cancer Centre, Department of Epidemiology and Public Health, Cancer Epidemiology Program, Division of Cancer Epidemiology, Department of Obstetrics and Gynecology, Department of Biomedical Sciences, Department of Obstetrics and Gynecology, Roswell Park Cancer Center, Virus, Gynecologic Clinic, Department of Health Sciences Research, Department of Community and Family Medicine, Robert Wood Johnson Medical School, School of Public Health, National Cancer Institute, Division of Genetics and Epidemiology, Department of Cancer Epidemiology and Prevention, Department of Epidemiology, Department of Gynaecological Oncology, Royal Brisbane Hospital, Locked Bag 2000, Brisbane, Queensland 4029, Australia

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Mary Anne Rossing Queensland Institute of Medical Research, School of Public Health, Department of Preventive Medicine, Department of Epidemiology and Biostatistics, Program in Epidemiology, Obstetrics and Gynecology Epidemiology Center, Peter MacCallum Cancer Centre, Department of Epidemiology and Public Health, Cancer Epidemiology Program, Division of Cancer Epidemiology, Department of Obstetrics and Gynecology, Department of Biomedical Sciences, Department of Obstetrics and Gynecology, Roswell Park Cancer Center, Virus, Gynecologic Clinic, Department of Health Sciences Research, Department of Community and Family Medicine, Robert Wood Johnson Medical School, School of Public Health, National Cancer Institute, Division of Genetics and Epidemiology, Department of Cancer Epidemiology and Prevention, Department of Epidemiology, Department of Gynaecological Oncology, Royal Brisbane Hospital, Locked Bag 2000, Brisbane, Queensland 4029, Australia

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Kathryn L Terry Queensland Institute of Medical Research, School of Public Health, Department of Preventive Medicine, Department of Epidemiology and Biostatistics, Program in Epidemiology, Obstetrics and Gynecology Epidemiology Center, Peter MacCallum Cancer Centre, Department of Epidemiology and Public Health, Cancer Epidemiology Program, Division of Cancer Epidemiology, Department of Obstetrics and Gynecology, Department of Biomedical Sciences, Department of Obstetrics and Gynecology, Roswell Park Cancer Center, Virus, Gynecologic Clinic, Department of Health Sciences Research, Department of Community and Family Medicine, Robert Wood Johnson Medical School, School of Public Health, National Cancer Institute, Division of Genetics and Epidemiology, Department of Cancer Epidemiology and Prevention, Department of Epidemiology, Department of Gynaecological Oncology, Royal Brisbane Hospital, Locked Bag 2000, Brisbane, Queensland 4029, Australia

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Anna H Wu Queensland Institute of Medical Research, School of Public Health, Department of Preventive Medicine, Department of Epidemiology and Biostatistics, Program in Epidemiology, Obstetrics and Gynecology Epidemiology Center, Peter MacCallum Cancer Centre, Department of Epidemiology and Public Health, Cancer Epidemiology Program, Division of Cancer Epidemiology, Department of Obstetrics and Gynecology, Department of Biomedical Sciences, Department of Obstetrics and Gynecology, Roswell Park Cancer Center, Virus, Gynecologic Clinic, Department of Health Sciences Research, Department of Community and Family Medicine, Robert Wood Johnson Medical School, School of Public Health, National Cancer Institute, Division of Genetics and Epidemiology, Department of Cancer Epidemiology and Prevention, Department of Epidemiology, Department of Gynaecological Oncology, Royal Brisbane Hospital, Locked Bag 2000, Brisbane, Queensland 4029, Australia

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The Australian Cancer Study (Ovarian Cancer) Queensland Institute of Medical Research, School of Public Health, Department of Preventive Medicine, Department of Epidemiology and Biostatistics, Program in Epidemiology, Obstetrics and Gynecology Epidemiology Center, Peter MacCallum Cancer Centre, Department of Epidemiology and Public Health, Cancer Epidemiology Program, Division of Cancer Epidemiology, Department of Obstetrics and Gynecology, Department of Biomedical Sciences, Department of Obstetrics and Gynecology, Roswell Park Cancer Center, Virus, Gynecologic Clinic, Department of Health Sciences Research, Department of Community and Family Medicine, Robert Wood Johnson Medical School, School of Public Health, National Cancer Institute, Division of Genetics and Epidemiology, Department of Cancer Epidemiology and Prevention, Department of Epidemiology, Department of Gynaecological Oncology, Royal Brisbane Hospital, Locked Bag 2000, Brisbane, Queensland 4029, Australia

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Australian Ovarian Cancer Study Group Queensland Institute of Medical Research, School of Public Health, Department of Preventive Medicine, Department of Epidemiology and Biostatistics, Program in Epidemiology, Obstetrics and Gynecology Epidemiology Center, Peter MacCallum Cancer Centre, Department of Epidemiology and Public Health, Cancer Epidemiology Program, Division of Cancer Epidemiology, Department of Obstetrics and Gynecology, Department of Biomedical Sciences, Department of Obstetrics and Gynecology, Roswell Park Cancer Center, Virus, Gynecologic Clinic, Department of Health Sciences Research, Department of Community and Family Medicine, Robert Wood Johnson Medical School, School of Public Health, National Cancer Institute, Division of Genetics and Epidemiology, Department of Cancer Epidemiology and Prevention, Department of Epidemiology, Department of Gynaecological Oncology, Royal Brisbane Hospital, Locked Bag 2000, Brisbane, Queensland 4029, Australia
Queensland Institute of Medical Research, School of Public Health, Department of Preventive Medicine, Department of Epidemiology and Biostatistics, Program in Epidemiology, Obstetrics and Gynecology Epidemiology Center, Peter MacCallum Cancer Centre, Department of Epidemiology and Public Health, Cancer Epidemiology Program, Division of Cancer Epidemiology, Department of Obstetrics and Gynecology, Department of Biomedical Sciences, Department of Obstetrics and Gynecology, Roswell Park Cancer Center, Virus, Gynecologic Clinic, Department of Health Sciences Research, Department of Community and Family Medicine, Robert Wood Johnson Medical School, School of Public Health, National Cancer Institute, Division of Genetics and Epidemiology, Department of Cancer Epidemiology and Prevention, Department of Epidemiology, Department of Gynaecological Oncology, Royal Brisbane Hospital, Locked Bag 2000, Brisbane, Queensland 4029, Australia

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Harvey A Risch Queensland Institute of Medical Research, School of Public Health, Department of Preventive Medicine, Department of Epidemiology and Biostatistics, Program in Epidemiology, Obstetrics and Gynecology Epidemiology Center, Peter MacCallum Cancer Centre, Department of Epidemiology and Public Health, Cancer Epidemiology Program, Division of Cancer Epidemiology, Department of Obstetrics and Gynecology, Department of Biomedical Sciences, Department of Obstetrics and Gynecology, Roswell Park Cancer Center, Virus, Gynecologic Clinic, Department of Health Sciences Research, Department of Community and Family Medicine, Robert Wood Johnson Medical School, School of Public Health, National Cancer Institute, Division of Genetics and Epidemiology, Department of Cancer Epidemiology and Prevention, Department of Epidemiology, Department of Gynaecological Oncology, Royal Brisbane Hospital, Locked Bag 2000, Brisbane, Queensland 4029, Australia

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Herbert Yu Queensland Institute of Medical Research, School of Public Health, Department of Preventive Medicine, Department of Epidemiology and Biostatistics, Program in Epidemiology, Obstetrics and Gynecology Epidemiology Center, Peter MacCallum Cancer Centre, Department of Epidemiology and Public Health, Cancer Epidemiology Program, Division of Cancer Epidemiology, Department of Obstetrics and Gynecology, Department of Biomedical Sciences, Department of Obstetrics and Gynecology, Roswell Park Cancer Center, Virus, Gynecologic Clinic, Department of Health Sciences Research, Department of Community and Family Medicine, Robert Wood Johnson Medical School, School of Public Health, National Cancer Institute, Division of Genetics and Epidemiology, Department of Cancer Epidemiology and Prevention, Department of Epidemiology, Department of Gynaecological Oncology, Royal Brisbane Hospital, Locked Bag 2000, Brisbane, Queensland 4029, Australia

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Jennifer A Doherty Queensland Institute of Medical Research, School of Public Health, Department of Preventive Medicine, Department of Epidemiology and Biostatistics, Program in Epidemiology, Obstetrics and Gynecology Epidemiology Center, Peter MacCallum Cancer Centre, Department of Epidemiology and Public Health, Cancer Epidemiology Program, Division of Cancer Epidemiology, Department of Obstetrics and Gynecology, Department of Biomedical Sciences, Department of Obstetrics and Gynecology, Roswell Park Cancer Center, Virus, Gynecologic Clinic, Department of Health Sciences Research, Department of Community and Family Medicine, Robert Wood Johnson Medical School, School of Public Health, National Cancer Institute, Division of Genetics and Epidemiology, Department of Cancer Epidemiology and Prevention, Department of Epidemiology, Department of Gynaecological Oncology, Royal Brisbane Hospital, Locked Bag 2000, Brisbane, Queensland 4029, Australia

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Jenny Chang-Claude Queensland Institute of Medical Research, School of Public Health, Department of Preventive Medicine, Department of Epidemiology and Biostatistics, Program in Epidemiology, Obstetrics and Gynecology Epidemiology Center, Peter MacCallum Cancer Centre, Department of Epidemiology and Public Health, Cancer Epidemiology Program, Division of Cancer Epidemiology, Department of Obstetrics and Gynecology, Department of Biomedical Sciences, Department of Obstetrics and Gynecology, Roswell Park Cancer Center, Virus, Gynecologic Clinic, Department of Health Sciences Research, Department of Community and Family Medicine, Robert Wood Johnson Medical School, School of Public Health, National Cancer Institute, Division of Genetics and Epidemiology, Department of Cancer Epidemiology and Prevention, Department of Epidemiology, Department of Gynaecological Oncology, Royal Brisbane Hospital, Locked Bag 2000, Brisbane, Queensland 4029, Australia

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Rebecca Hein Queensland Institute of Medical Research, School of Public Health, Department of Preventive Medicine, Department of Epidemiology and Biostatistics, Program in Epidemiology, Obstetrics and Gynecology Epidemiology Center, Peter MacCallum Cancer Centre, Department of Epidemiology and Public Health, Cancer Epidemiology Program, Division of Cancer Epidemiology, Department of Obstetrics and Gynecology, Department of Biomedical Sciences, Department of Obstetrics and Gynecology, Roswell Park Cancer Center, Virus, Gynecologic Clinic, Department of Health Sciences Research, Department of Community and Family Medicine, Robert Wood Johnson Medical School, School of Public Health, National Cancer Institute, Division of Genetics and Epidemiology, Department of Cancer Epidemiology and Prevention, Department of Epidemiology, Department of Gynaecological Oncology, Royal Brisbane Hospital, Locked Bag 2000, Brisbane, Queensland 4029, Australia

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Stefan Nickels Queensland Institute of Medical Research, School of Public Health, Department of Preventive Medicine, Department of Epidemiology and Biostatistics, Program in Epidemiology, Obstetrics and Gynecology Epidemiology Center, Peter MacCallum Cancer Centre, Department of Epidemiology and Public Health, Cancer Epidemiology Program, Division of Cancer Epidemiology, Department of Obstetrics and Gynecology, Department of Biomedical Sciences, Department of Obstetrics and Gynecology, Roswell Park Cancer Center, Virus, Gynecologic Clinic, Department of Health Sciences Research, Department of Community and Family Medicine, Robert Wood Johnson Medical School, School of Public Health, National Cancer Institute, Division of Genetics and Epidemiology, Department of Cancer Epidemiology and Prevention, Department of Epidemiology, Department of Gynaecological Oncology, Royal Brisbane Hospital, Locked Bag 2000, Brisbane, Queensland 4029, Australia

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Shan Wang-Gohrke Queensland Institute of Medical Research, School of Public Health, Department of Preventive Medicine, Department of Epidemiology and Biostatistics, Program in Epidemiology, Obstetrics and Gynecology Epidemiology Center, Peter MacCallum Cancer Centre, Department of Epidemiology and Public Health, Cancer Epidemiology Program, Division of Cancer Epidemiology, Department of Obstetrics and Gynecology, Department of Biomedical Sciences, Department of Obstetrics and Gynecology, Roswell Park Cancer Center, Virus, Gynecologic Clinic, Department of Health Sciences Research, Department of Community and Family Medicine, Robert Wood Johnson Medical School, School of Public Health, National Cancer Institute, Division of Genetics and Epidemiology, Department of Cancer Epidemiology and Prevention, Department of Epidemiology, Department of Gynaecological Oncology, Royal Brisbane Hospital, Locked Bag 2000, Brisbane, Queensland 4029, Australia

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Marc T Goodman Queensland Institute of Medical Research, School of Public Health, Department of Preventive Medicine, Department of Epidemiology and Biostatistics, Program in Epidemiology, Obstetrics and Gynecology Epidemiology Center, Peter MacCallum Cancer Centre, Department of Epidemiology and Public Health, Cancer Epidemiology Program, Division of Cancer Epidemiology, Department of Obstetrics and Gynecology, Department of Biomedical Sciences, Department of Obstetrics and Gynecology, Roswell Park Cancer Center, Virus, Gynecologic Clinic, Department of Health Sciences Research, Department of Community and Family Medicine, Robert Wood Johnson Medical School, School of Public Health, National Cancer Institute, Division of Genetics and Epidemiology, Department of Cancer Epidemiology and Prevention, Department of Epidemiology, Department of Gynaecological Oncology, Royal Brisbane Hospital, Locked Bag 2000, Brisbane, Queensland 4029, Australia

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Michael E Carney Queensland Institute of Medical Research, School of Public Health, Department of Preventive Medicine, Department of Epidemiology and Biostatistics, Program in Epidemiology, Obstetrics and Gynecology Epidemiology Center, Peter MacCallum Cancer Centre, Department of Epidemiology and Public Health, Cancer Epidemiology Program, Division of Cancer Epidemiology, Department of Obstetrics and Gynecology, Department of Biomedical Sciences, Department of Obstetrics and Gynecology, Roswell Park Cancer Center, Virus, Gynecologic Clinic, Department of Health Sciences Research, Department of Community and Family Medicine, Robert Wood Johnson Medical School, School of Public Health, National Cancer Institute, Division of Genetics and Epidemiology, Department of Cancer Epidemiology and Prevention, Department of Epidemiology, Department of Gynaecological Oncology, Royal Brisbane Hospital, Locked Bag 2000, Brisbane, Queensland 4029, Australia

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Rayna K Matsuno Queensland Institute of Medical Research, School of Public Health, Department of Preventive Medicine, Department of Epidemiology and Biostatistics, Program in Epidemiology, Obstetrics and Gynecology Epidemiology Center, Peter MacCallum Cancer Centre, Department of Epidemiology and Public Health, Cancer Epidemiology Program, Division of Cancer Epidemiology, Department of Obstetrics and Gynecology, Department of Biomedical Sciences, Department of Obstetrics and Gynecology, Roswell Park Cancer Center, Virus, Gynecologic Clinic, Department of Health Sciences Research, Department of Community and Family Medicine, Robert Wood Johnson Medical School, School of Public Health, National Cancer Institute, Division of Genetics and Epidemiology, Department of Cancer Epidemiology and Prevention, Department of Epidemiology, Department of Gynaecological Oncology, Royal Brisbane Hospital, Locked Bag 2000, Brisbane, Queensland 4029, Australia

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Galina Lurie Queensland Institute of Medical Research, School of Public Health, Department of Preventive Medicine, Department of Epidemiology and Biostatistics, Program in Epidemiology, Obstetrics and Gynecology Epidemiology Center, Peter MacCallum Cancer Centre, Department of Epidemiology and Public Health, Cancer Epidemiology Program, Division of Cancer Epidemiology, Department of Obstetrics and Gynecology, Department of Biomedical Sciences, Department of Obstetrics and Gynecology, Roswell Park Cancer Center, Virus, Gynecologic Clinic, Department of Health Sciences Research, Department of Community and Family Medicine, Robert Wood Johnson Medical School, School of Public Health, National Cancer Institute, Division of Genetics and Epidemiology, Department of Cancer Epidemiology and Prevention, Department of Epidemiology, Department of Gynaecological Oncology, Royal Brisbane Hospital, Locked Bag 2000, Brisbane, Queensland 4029, Australia

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Kirsten Moysich Queensland Institute of Medical Research, School of Public Health, Department of Preventive Medicine, Department of Epidemiology and Biostatistics, Program in Epidemiology, Obstetrics and Gynecology Epidemiology Center, Peter MacCallum Cancer Centre, Department of Epidemiology and Public Health, Cancer Epidemiology Program, Division of Cancer Epidemiology, Department of Obstetrics and Gynecology, Department of Biomedical Sciences, Department of Obstetrics and Gynecology, Roswell Park Cancer Center, Virus, Gynecologic Clinic, Department of Health Sciences Research, Department of Community and Family Medicine, Robert Wood Johnson Medical School, School of Public Health, National Cancer Institute, Division of Genetics and Epidemiology, Department of Cancer Epidemiology and Prevention, Department of Epidemiology, Department of Gynaecological Oncology, Royal Brisbane Hospital, Locked Bag 2000, Brisbane, Queensland 4029, Australia

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Susanne K Kjaer Queensland Institute of Medical Research, School of Public Health, Department of Preventive Medicine, Department of Epidemiology and Biostatistics, Program in Epidemiology, Obstetrics and Gynecology Epidemiology Center, Peter MacCallum Cancer Centre, Department of Epidemiology and Public Health, Cancer Epidemiology Program, Division of Cancer Epidemiology, Department of Obstetrics and Gynecology, Department of Biomedical Sciences, Department of Obstetrics and Gynecology, Roswell Park Cancer Center, Virus, Gynecologic Clinic, Department of Health Sciences Research, Department of Community and Family Medicine, Robert Wood Johnson Medical School, School of Public Health, National Cancer Institute, Division of Genetics and Epidemiology, Department of Cancer Epidemiology and Prevention, Department of Epidemiology, Department of Gynaecological Oncology, Royal Brisbane Hospital, Locked Bag 2000, Brisbane, Queensland 4029, Australia
Queensland Institute of Medical Research, School of Public Health, Department of Preventive Medicine, Department of Epidemiology and Biostatistics, Program in Epidemiology, Obstetrics and Gynecology Epidemiology Center, Peter MacCallum Cancer Centre, Department of Epidemiology and Public Health, Cancer Epidemiology Program, Division of Cancer Epidemiology, Department of Obstetrics and Gynecology, Department of Biomedical Sciences, Department of Obstetrics and Gynecology, Roswell Park Cancer Center, Virus, Gynecologic Clinic, Department of Health Sciences Research, Department of Community and Family Medicine, Robert Wood Johnson Medical School, School of Public Health, National Cancer Institute, Division of Genetics and Epidemiology, Department of Cancer Epidemiology and Prevention, Department of Epidemiology, Department of Gynaecological Oncology, Royal Brisbane Hospital, Locked Bag 2000, Brisbane, Queensland 4029, Australia

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Allan Jensen Queensland Institute of Medical Research, School of Public Health, Department of Preventive Medicine, Department of Epidemiology and Biostatistics, Program in Epidemiology, Obstetrics and Gynecology Epidemiology Center, Peter MacCallum Cancer Centre, Department of Epidemiology and Public Health, Cancer Epidemiology Program, Division of Cancer Epidemiology, Department of Obstetrics and Gynecology, Department of Biomedical Sciences, Department of Obstetrics and Gynecology, Roswell Park Cancer Center, Virus, Gynecologic Clinic, Department of Health Sciences Research, Department of Community and Family Medicine, Robert Wood Johnson Medical School, School of Public Health, National Cancer Institute, Division of Genetics and Epidemiology, Department of Cancer Epidemiology and Prevention, Department of Epidemiology, Department of Gynaecological Oncology, Royal Brisbane Hospital, Locked Bag 2000, Brisbane, Queensland 4029, Australia

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Estrid Hogdall Queensland Institute of Medical Research, School of Public Health, Department of Preventive Medicine, Department of Epidemiology and Biostatistics, Program in Epidemiology, Obstetrics and Gynecology Epidemiology Center, Peter MacCallum Cancer Centre, Department of Epidemiology and Public Health, Cancer Epidemiology Program, Division of Cancer Epidemiology, Department of Obstetrics and Gynecology, Department of Biomedical Sciences, Department of Obstetrics and Gynecology, Roswell Park Cancer Center, Virus, Gynecologic Clinic, Department of Health Sciences Research, Department of Community and Family Medicine, Robert Wood Johnson Medical School, School of Public Health, National Cancer Institute, Division of Genetics and Epidemiology, Department of Cancer Epidemiology and Prevention, Department of Epidemiology, Department of Gynaecological Oncology, Royal Brisbane Hospital, Locked Bag 2000, Brisbane, Queensland 4029, Australia

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Ellen L Goode Queensland Institute of Medical Research, School of Public Health, Department of Preventive Medicine, Department of Epidemiology and Biostatistics, Program in Epidemiology, Obstetrics and Gynecology Epidemiology Center, Peter MacCallum Cancer Centre, Department of Epidemiology and Public Health, Cancer Epidemiology Program, Division of Cancer Epidemiology, Department of Obstetrics and Gynecology, Department of Biomedical Sciences, Department of Obstetrics and Gynecology, Roswell Park Cancer Center, Virus, Gynecologic Clinic, Department of Health Sciences Research, Department of Community and Family Medicine, Robert Wood Johnson Medical School, School of Public Health, National Cancer Institute, Division of Genetics and Epidemiology, Department of Cancer Epidemiology and Prevention, Department of Epidemiology, Department of Gynaecological Oncology, Royal Brisbane Hospital, Locked Bag 2000, Brisbane, Queensland 4029, Australia

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Brooke L Fridley Queensland Institute of Medical Research, School of Public Health, Department of Preventive Medicine, Department of Epidemiology and Biostatistics, Program in Epidemiology, Obstetrics and Gynecology Epidemiology Center, Peter MacCallum Cancer Centre, Department of Epidemiology and Public Health, Cancer Epidemiology Program, Division of Cancer Epidemiology, Department of Obstetrics and Gynecology, Department of Biomedical Sciences, Department of Obstetrics and Gynecology, Roswell Park Cancer Center, Virus, Gynecologic Clinic, Department of Health Sciences Research, Department of Community and Family Medicine, Robert Wood Johnson Medical School, School of Public Health, National Cancer Institute, Division of Genetics and Epidemiology, Department of Cancer Epidemiology and Prevention, Department of Epidemiology, Department of Gynaecological Oncology, Royal Brisbane Hospital, Locked Bag 2000, Brisbane, Queensland 4029, Australia

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Robert A Vierkant Queensland Institute of Medical Research, School of Public Health, Department of Preventive Medicine, Department of Epidemiology and Biostatistics, Program in Epidemiology, Obstetrics and Gynecology Epidemiology Center, Peter MacCallum Cancer Centre, Department of Epidemiology and Public Health, Cancer Epidemiology Program, Division of Cancer Epidemiology, Department of Obstetrics and Gynecology, Department of Biomedical Sciences, Department of Obstetrics and Gynecology, Roswell Park Cancer Center, Virus, Gynecologic Clinic, Department of Health Sciences Research, Department of Community and Family Medicine, Robert Wood Johnson Medical School, School of Public Health, National Cancer Institute, Division of Genetics and Epidemiology, Department of Cancer Epidemiology and Prevention, Department of Epidemiology, Department of Gynaecological Oncology, Royal Brisbane Hospital, Locked Bag 2000, Brisbane, Queensland 4029, Australia

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Melissa C Larson Queensland Institute of Medical Research, School of Public Health, Department of Preventive Medicine, Department of Epidemiology and Biostatistics, Program in Epidemiology, Obstetrics and Gynecology Epidemiology Center, Peter MacCallum Cancer Centre, Department of Epidemiology and Public Health, Cancer Epidemiology Program, Division of Cancer Epidemiology, Department of Obstetrics and Gynecology, Department of Biomedical Sciences, Department of Obstetrics and Gynecology, Roswell Park Cancer Center, Virus, Gynecologic Clinic, Department of Health Sciences Research, Department of Community and Family Medicine, Robert Wood Johnson Medical School, School of Public Health, National Cancer Institute, Division of Genetics and Epidemiology, Department of Cancer Epidemiology and Prevention, Department of Epidemiology, Department of Gynaecological Oncology, Royal Brisbane Hospital, Locked Bag 2000, Brisbane, Queensland 4029, Australia

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Joellen Schildkraut Queensland Institute of Medical Research, School of Public Health, Department of Preventive Medicine, Department of Epidemiology and Biostatistics, Program in Epidemiology, Obstetrics and Gynecology Epidemiology Center, Peter MacCallum Cancer Centre, Department of Epidemiology and Public Health, Cancer Epidemiology Program, Division of Cancer Epidemiology, Department of Obstetrics and Gynecology, Department of Biomedical Sciences, Department of Obstetrics and Gynecology, Roswell Park Cancer Center, Virus, Gynecologic Clinic, Department of Health Sciences Research, Department of Community and Family Medicine, Robert Wood Johnson Medical School, School of Public Health, National Cancer Institute, Division of Genetics and Epidemiology, Department of Cancer Epidemiology and Prevention, Department of Epidemiology, Department of Gynaecological Oncology, Royal Brisbane Hospital, Locked Bag 2000, Brisbane, Queensland 4029, Australia

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Cathrine Hoyo Queensland Institute of Medical Research, School of Public Health, Department of Preventive Medicine, Department of Epidemiology and Biostatistics, Program in Epidemiology, Obstetrics and Gynecology Epidemiology Center, Peter MacCallum Cancer Centre, Department of Epidemiology and Public Health, Cancer Epidemiology Program, Division of Cancer Epidemiology, Department of Obstetrics and Gynecology, Department of Biomedical Sciences, Department of Obstetrics and Gynecology, Roswell Park Cancer Center, Virus, Gynecologic Clinic, Department of Health Sciences Research, Department of Community and Family Medicine, Robert Wood Johnson Medical School, School of Public Health, National Cancer Institute, Division of Genetics and Epidemiology, Department of Cancer Epidemiology and Prevention, Department of Epidemiology, Department of Gynaecological Oncology, Royal Brisbane Hospital, Locked Bag 2000, Brisbane, Queensland 4029, Australia

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Patricia Moorman Queensland Institute of Medical Research, School of Public Health, Department of Preventive Medicine, Department of Epidemiology and Biostatistics, Program in Epidemiology, Obstetrics and Gynecology Epidemiology Center, Peter MacCallum Cancer Centre, Department of Epidemiology and Public Health, Cancer Epidemiology Program, Division of Cancer Epidemiology, Department of Obstetrics and Gynecology, Department of Biomedical Sciences, Department of Obstetrics and Gynecology, Roswell Park Cancer Center, Virus, Gynecologic Clinic, Department of Health Sciences Research, Department of Community and Family Medicine, Robert Wood Johnson Medical School, School of Public Health, National Cancer Institute, Division of Genetics and Epidemiology, Department of Cancer Epidemiology and Prevention, Department of Epidemiology, Department of Gynaecological Oncology, Royal Brisbane Hospital, Locked Bag 2000, Brisbane, Queensland 4029, Australia

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Rachel P Weber Queensland Institute of Medical Research, School of Public Health, Department of Preventive Medicine, Department of Epidemiology and Biostatistics, Program in Epidemiology, Obstetrics and Gynecology Epidemiology Center, Peter MacCallum Cancer Centre, Department of Epidemiology and Public Health, Cancer Epidemiology Program, Division of Cancer Epidemiology, Department of Obstetrics and Gynecology, Department of Biomedical Sciences, Department of Obstetrics and Gynecology, Roswell Park Cancer Center, Virus, Gynecologic Clinic, Department of Health Sciences Research, Department of Community and Family Medicine, Robert Wood Johnson Medical School, School of Public Health, National Cancer Institute, Division of Genetics and Epidemiology, Department of Cancer Epidemiology and Prevention, Department of Epidemiology, Department of Gynaecological Oncology, Royal Brisbane Hospital, Locked Bag 2000, Brisbane, Queensland 4029, Australia

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Daniel W Cramer Queensland Institute of Medical Research, School of Public Health, Department of Preventive Medicine, Department of Epidemiology and Biostatistics, Program in Epidemiology, Obstetrics and Gynecology Epidemiology Center, Peter MacCallum Cancer Centre, Department of Epidemiology and Public Health, Cancer Epidemiology Program, Division of Cancer Epidemiology, Department of Obstetrics and Gynecology, Department of Biomedical Sciences, Department of Obstetrics and Gynecology, Roswell Park Cancer Center, Virus, Gynecologic Clinic, Department of Health Sciences Research, Department of Community and Family Medicine, Robert Wood Johnson Medical School, School of Public Health, National Cancer Institute, Division of Genetics and Epidemiology, Department of Cancer Epidemiology and Prevention, Department of Epidemiology, Department of Gynaecological Oncology, Royal Brisbane Hospital, Locked Bag 2000, Brisbane, Queensland 4029, Australia

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Allison F Vitonis Queensland Institute of Medical Research, School of Public Health, Department of Preventive Medicine, Department of Epidemiology and Biostatistics, Program in Epidemiology, Obstetrics and Gynecology Epidemiology Center, Peter MacCallum Cancer Centre, Department of Epidemiology and Public Health, Cancer Epidemiology Program, Division of Cancer Epidemiology, Department of Obstetrics and Gynecology, Department of Biomedical Sciences, Department of Obstetrics and Gynecology, Roswell Park Cancer Center, Virus, Gynecologic Clinic, Department of Health Sciences Research, Department of Community and Family Medicine, Robert Wood Johnson Medical School, School of Public Health, National Cancer Institute, Division of Genetics and Epidemiology, Department of Cancer Epidemiology and Prevention, Department of Epidemiology, Department of Gynaecological Oncology, Royal Brisbane Hospital, Locked Bag 2000, Brisbane, Queensland 4029, Australia

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Elisa V Bandera Queensland Institute of Medical Research, School of Public Health, Department of Preventive Medicine, Department of Epidemiology and Biostatistics, Program in Epidemiology, Obstetrics and Gynecology Epidemiology Center, Peter MacCallum Cancer Centre, Department of Epidemiology and Public Health, Cancer Epidemiology Program, Division of Cancer Epidemiology, Department of Obstetrics and Gynecology, Department of Biomedical Sciences, Department of Obstetrics and Gynecology, Roswell Park Cancer Center, Virus, Gynecologic Clinic, Department of Health Sciences Research, Department of Community and Family Medicine, Robert Wood Johnson Medical School, School of Public Health, National Cancer Institute, Division of Genetics and Epidemiology, Department of Cancer Epidemiology and Prevention, Department of Epidemiology, Department of Gynaecological Oncology, Royal Brisbane Hospital, Locked Bag 2000, Brisbane, Queensland 4029, Australia

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Sara H Olson Queensland Institute of Medical Research, School of Public Health, Department of Preventive Medicine, Department of Epidemiology and Biostatistics, Program in Epidemiology, Obstetrics and Gynecology Epidemiology Center, Peter MacCallum Cancer Centre, Department of Epidemiology and Public Health, Cancer Epidemiology Program, Division of Cancer Epidemiology, Department of Obstetrics and Gynecology, Department of Biomedical Sciences, Department of Obstetrics and Gynecology, Roswell Park Cancer Center, Virus, Gynecologic Clinic, Department of Health Sciences Research, Department of Community and Family Medicine, Robert Wood Johnson Medical School, School of Public Health, National Cancer Institute, Division of Genetics and Epidemiology, Department of Cancer Epidemiology and Prevention, Department of Epidemiology, Department of Gynaecological Oncology, Royal Brisbane Hospital, Locked Bag 2000, Brisbane, Queensland 4029, Australia

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Lorna Rodriguez-Rodriguez Queensland Institute of Medical Research, School of Public Health, Department of Preventive Medicine, Department of Epidemiology and Biostatistics, Program in Epidemiology, Obstetrics and Gynecology Epidemiology Center, Peter MacCallum Cancer Centre, Department of Epidemiology and Public Health, Cancer Epidemiology Program, Division of Cancer Epidemiology, Department of Obstetrics and Gynecology, Department of Biomedical Sciences, Department of Obstetrics and Gynecology, Roswell Park Cancer Center, Virus, Gynecologic Clinic, Department of Health Sciences Research, Department of Community and Family Medicine, Robert Wood Johnson Medical School, School of Public Health, National Cancer Institute, Division of Genetics and Epidemiology, Department of Cancer Epidemiology and Prevention, Department of Epidemiology, Department of Gynaecological Oncology, Royal Brisbane Hospital, Locked Bag 2000, Brisbane, Queensland 4029, Australia

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Melony King Queensland Institute of Medical Research, School of Public Health, Department of Preventive Medicine, Department of Epidemiology and Biostatistics, Program in Epidemiology, Obstetrics and Gynecology Epidemiology Center, Peter MacCallum Cancer Centre, Department of Epidemiology and Public Health, Cancer Epidemiology Program, Division of Cancer Epidemiology, Department of Obstetrics and Gynecology, Department of Biomedical Sciences, Department of Obstetrics and Gynecology, Roswell Park Cancer Center, Virus, Gynecologic Clinic, Department of Health Sciences Research, Department of Community and Family Medicine, Robert Wood Johnson Medical School, School of Public Health, National Cancer Institute, Division of Genetics and Epidemiology, Department of Cancer Epidemiology and Prevention, Department of Epidemiology, Department of Gynaecological Oncology, Royal Brisbane Hospital, Locked Bag 2000, Brisbane, Queensland 4029, Australia

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Louise A Brinton Queensland Institute of Medical Research, School of Public Health, Department of Preventive Medicine, Department of Epidemiology and Biostatistics, Program in Epidemiology, Obstetrics and Gynecology Epidemiology Center, Peter MacCallum Cancer Centre, Department of Epidemiology and Public Health, Cancer Epidemiology Program, Division of Cancer Epidemiology, Department of Obstetrics and Gynecology, Department of Biomedical Sciences, Department of Obstetrics and Gynecology, Roswell Park Cancer Center, Virus, Gynecologic Clinic, Department of Health Sciences Research, Department of Community and Family Medicine, Robert Wood Johnson Medical School, School of Public Health, National Cancer Institute, Division of Genetics and Epidemiology, Department of Cancer Epidemiology and Prevention, Department of Epidemiology, Department of Gynaecological Oncology, Royal Brisbane Hospital, Locked Bag 2000, Brisbane, Queensland 4029, Australia

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Hannah Yang Queensland Institute of Medical Research, School of Public Health, Department of Preventive Medicine, Department of Epidemiology and Biostatistics, Program in Epidemiology, Obstetrics and Gynecology Epidemiology Center, Peter MacCallum Cancer Centre, Department of Epidemiology and Public Health, Cancer Epidemiology Program, Division of Cancer Epidemiology, Department of Obstetrics and Gynecology, Department of Biomedical Sciences, Department of Obstetrics and Gynecology, Roswell Park Cancer Center, Virus, Gynecologic Clinic, Department of Health Sciences Research, Department of Community and Family Medicine, Robert Wood Johnson Medical School, School of Public Health, National Cancer Institute, Division of Genetics and Epidemiology, Department of Cancer Epidemiology and Prevention, Department of Epidemiology, Department of Gynaecological Oncology, Royal Brisbane Hospital, Locked Bag 2000, Brisbane, Queensland 4029, Australia

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Montserrat Garcia-Closas Queensland Institute of Medical Research, School of Public Health, Department of Preventive Medicine, Department of Epidemiology and Biostatistics, Program in Epidemiology, Obstetrics and Gynecology Epidemiology Center, Peter MacCallum Cancer Centre, Department of Epidemiology and Public Health, Cancer Epidemiology Program, Division of Cancer Epidemiology, Department of Obstetrics and Gynecology, Department of Biomedical Sciences, Department of Obstetrics and Gynecology, Roswell Park Cancer Center, Virus, Gynecologic Clinic, Department of Health Sciences Research, Department of Community and Family Medicine, Robert Wood Johnson Medical School, School of Public Health, National Cancer Institute, Division of Genetics and Epidemiology, Department of Cancer Epidemiology and Prevention, Department of Epidemiology, Department of Gynaecological Oncology, Royal Brisbane Hospital, Locked Bag 2000, Brisbane, Queensland 4029, Australia

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Jolanta Lissowska Queensland Institute of Medical Research, School of Public Health, Department of Preventive Medicine, Department of Epidemiology and Biostatistics, Program in Epidemiology, Obstetrics and Gynecology Epidemiology Center, Peter MacCallum Cancer Centre, Department of Epidemiology and Public Health, Cancer Epidemiology Program, Division of Cancer Epidemiology, Department of Obstetrics and Gynecology, Department of Biomedical Sciences, Department of Obstetrics and Gynecology, Roswell Park Cancer Center, Virus, Gynecologic Clinic, Department of Health Sciences Research, Department of Community and Family Medicine, Robert Wood Johnson Medical School, School of Public Health, National Cancer Institute, Division of Genetics and Epidemiology, Department of Cancer Epidemiology and Prevention, Department of Epidemiology, Department of Gynaecological Oncology, Royal Brisbane Hospital, Locked Bag 2000, Brisbane, Queensland 4029, Australia

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Hoda Anton-Culver Queensland Institute of Medical Research, School of Public Health, Department of Preventive Medicine, Department of Epidemiology and Biostatistics, Program in Epidemiology, Obstetrics and Gynecology Epidemiology Center, Peter MacCallum Cancer Centre, Department of Epidemiology and Public Health, Cancer Epidemiology Program, Division of Cancer Epidemiology, Department of Obstetrics and Gynecology, Department of Biomedical Sciences, Department of Obstetrics and Gynecology, Roswell Park Cancer Center, Virus, Gynecologic Clinic, Department of Health Sciences Research, Department of Community and Family Medicine, Robert Wood Johnson Medical School, School of Public Health, National Cancer Institute, Division of Genetics and Epidemiology, Department of Cancer Epidemiology and Prevention, Department of Epidemiology, Department of Gynaecological Oncology, Royal Brisbane Hospital, Locked Bag 2000, Brisbane, Queensland 4029, Australia

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Argyrios Ziogas Queensland Institute of Medical Research, School of Public Health, Department of Preventive Medicine, Department of Epidemiology and Biostatistics, Program in Epidemiology, Obstetrics and Gynecology Epidemiology Center, Peter MacCallum Cancer Centre, Department of Epidemiology and Public Health, Cancer Epidemiology Program, Division of Cancer Epidemiology, Department of Obstetrics and Gynecology, Department of Biomedical Sciences, Department of Obstetrics and Gynecology, Roswell Park Cancer Center, Virus, Gynecologic Clinic, Department of Health Sciences Research, Department of Community and Family Medicine, Robert Wood Johnson Medical School, School of Public Health, National Cancer Institute, Division of Genetics and Epidemiology, Department of Cancer Epidemiology and Prevention, Department of Epidemiology, Department of Gynaecological Oncology, Royal Brisbane Hospital, Locked Bag 2000, Brisbane, Queensland 4029, Australia

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Simon A Gayther Queensland Institute of Medical Research, School of Public Health, Department of Preventive Medicine, Department of Epidemiology and Biostatistics, Program in Epidemiology, Obstetrics and Gynecology Epidemiology Center, Peter MacCallum Cancer Centre, Department of Epidemiology and Public Health, Cancer Epidemiology Program, Division of Cancer Epidemiology, Department of Obstetrics and Gynecology, Department of Biomedical Sciences, Department of Obstetrics and Gynecology, Roswell Park Cancer Center, Virus, Gynecologic Clinic, Department of Health Sciences Research, Department of Community and Family Medicine, Robert Wood Johnson Medical School, School of Public Health, National Cancer Institute, Division of Genetics and Epidemiology, Department of Cancer Epidemiology and Prevention, Department of Epidemiology, Department of Gynaecological Oncology, Royal Brisbane Hospital, Locked Bag 2000, Brisbane, Queensland 4029, Australia

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Susan J Ramus Queensland Institute of Medical Research, School of Public Health, Department of Preventive Medicine, Department of Epidemiology and Biostatistics, Program in Epidemiology, Obstetrics and Gynecology Epidemiology Center, Peter MacCallum Cancer Centre, Department of Epidemiology and Public Health, Cancer Epidemiology Program, Division of Cancer Epidemiology, Department of Obstetrics and Gynecology, Department of Biomedical Sciences, Department of Obstetrics and Gynecology, Roswell Park Cancer Center, Virus, Gynecologic Clinic, Department of Health Sciences Research, Department of Community and Family Medicine, Robert Wood Johnson Medical School, School of Public Health, National Cancer Institute, Division of Genetics and Epidemiology, Department of Cancer Epidemiology and Prevention, Department of Epidemiology, Department of Gynaecological Oncology, Royal Brisbane Hospital, Locked Bag 2000, Brisbane, Queensland 4029, Australia

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Usha Menon Queensland Institute of Medical Research, School of Public Health, Department of Preventive Medicine, Department of Epidemiology and Biostatistics, Program in Epidemiology, Obstetrics and Gynecology Epidemiology Center, Peter MacCallum Cancer Centre, Department of Epidemiology and Public Health, Cancer Epidemiology Program, Division of Cancer Epidemiology, Department of Obstetrics and Gynecology, Department of Biomedical Sciences, Department of Obstetrics and Gynecology, Roswell Park Cancer Center, Virus, Gynecologic Clinic, Department of Health Sciences Research, Department of Community and Family Medicine, Robert Wood Johnson Medical School, School of Public Health, National Cancer Institute, Division of Genetics and Epidemiology, Department of Cancer Epidemiology and Prevention, Department of Epidemiology, Department of Gynaecological Oncology, Royal Brisbane Hospital, Locked Bag 2000, Brisbane, Queensland 4029, Australia

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Aleksandra Gentry-Maharaj Queensland Institute of Medical Research, School of Public Health, Department of Preventive Medicine, Department of Epidemiology and Biostatistics, Program in Epidemiology, Obstetrics and Gynecology Epidemiology Center, Peter MacCallum Cancer Centre, Department of Epidemiology and Public Health, Cancer Epidemiology Program, Division of Cancer Epidemiology, Department of Obstetrics and Gynecology, Department of Biomedical Sciences, Department of Obstetrics and Gynecology, Roswell Park Cancer Center, Virus, Gynecologic Clinic, Department of Health Sciences Research, Department of Community and Family Medicine, Robert Wood Johnson Medical School, School of Public Health, National Cancer Institute, Division of Genetics and Epidemiology, Department of Cancer Epidemiology and Prevention, Department of Epidemiology, Department of Gynaecological Oncology, Royal Brisbane Hospital, Locked Bag 2000, Brisbane, Queensland 4029, Australia

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Penelope M Webb Queensland Institute of Medical Research, School of Public Health, Department of Preventive Medicine, Department of Epidemiology and Biostatistics, Program in Epidemiology, Obstetrics and Gynecology Epidemiology Center, Peter MacCallum Cancer Centre, Department of Epidemiology and Public Health, Cancer Epidemiology Program, Division of Cancer Epidemiology, Department of Obstetrics and Gynecology, Department of Biomedical Sciences, Department of Obstetrics and Gynecology, Roswell Park Cancer Center, Virus, Gynecologic Clinic, Department of Health Sciences Research, Department of Community and Family Medicine, Robert Wood Johnson Medical School, School of Public Health, National Cancer Institute, Division of Genetics and Epidemiology, Department of Cancer Epidemiology and Prevention, Department of Epidemiology, Department of Gynaecological Oncology, Royal Brisbane Hospital, Locked Bag 2000, Brisbane, Queensland 4029, Australia

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Whilst previous studies have reported that higher BMI increases a woman's risk of developing ovarian cancer, associations for the different histological subtypes have not been well defined. As the prevalence of obesity has increased dramatically, and classification of ovarian histology has improved in the last decade, we sought to examine the association in a pooled analysis of recent studies participating in the Ovarian Cancer Association Consortium. We evaluated the association between BMI (recent, maximum and in young adulthood) and ovarian cancer risk using original data from 15 case–control studies (13 548 cases and 17 913 controls). We combined study-specific adjusted odds ratios (ORs) using a random-effects model. We further examined the associations by histological subtype, menopausal status and post-menopausal hormone use. High BMI (all time-points) was associated with increased risk. This was most pronounced for borderline serous (recent BMI: pooled OR=1.24 per 5 kg/m2; 95% CI 1.18–1.30), invasive endometrioid (1.17; 1.11–1.23) and invasive mucinous (1.19; 1.06–1.32) tumours. There was no association with serous invasive cancer overall (0.98; 0.94–1.02), but increased risks for low-grade serous invasive tumours (1.13, 1.03–1.25) and in pre-menopausal women (1.11; 1.04–1.18). Among post-menopausal women, the associations did not differ between hormone replacement therapy users and non-users. Whilst obesity appears to increase risk of the less common histological subtypes of ovarian cancer, it does not increase risk of high-grade invasive serous cancers, and reducing BMI is therefore unlikely to prevent the majority of ovarian cancer deaths. Other modifiable factors must be identified to control this disease.

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