Braem, Marieke G MOnland-Moret, N CharlotteSchouten, Leo JKruitwagen, Roy F P MLukanova, AnnekatrinAllen, Naomi EWark, Petra ATjønneland, AnneHansen, LouiseBraüner, Christina MarieOvervad, KimClavel-Chapelon, FrançoiseChabbert-Buffet, NathalieTeucher, BirgitFloegel, AnnaBoeing, HeinerTrichopoulou, AntoniaAdarakis, GeorgePlada, MariaRinaldi, SabinaFedirko, VeronikaRomieu, IsabellePala, ValeriaGalasso, RoccoSacerdote, CarlottaPalli, DomenicoTumino, RosarioBueno-de-Mesquita, H BasGram, Inger TorhildGavrilyuk, OxanaLund, EilivSanchez-Perez, Maria-JoseBonet, CatalinaChirlaque, Maria-DoloresLarrañaga, NereaGurrea, Aurelio BarricarteQuirós, Jose RIdahl, AnnikaOhlson, NinaLundin, EvaJirström, KarinButt, SalmaTsilidis, Konstantinos KKhaw, Kay-TeeWareham, NickRiboli, ElioKaaks, RudolfPeeters, Petra H M2013-10-022013-10-022012-05-18Braem MG, Onland-Moret NC, Schouten LJ, Kruitwagen RF, Lukanova A, Allen NE, et al. Multiple miscarriages are associated with the risk of ovarian cancer: results from the European Prospective Investigation into Cancer and Nutrition. PLoS ONE; 7(5):e37141http://hdl.handle.net/10668/1307While the risk of ovarian cancer clearly reduces with each full-term pregnancy, the effect of incomplete pregnancies is unclear. We investigated whether incomplete pregnancies (miscarriages and induced abortions) are associated with risk of epithelial ovarian cancer. This observational study was carried out in female participants of the European Prospective Investigation into Cancer and Nutrition (EPIC). A total of 274,442 women were followed from 1992 until 2010. The baseline questionnaire elicited information on miscarriages and induced abortions, reproductive history, and lifestyle-related factors. During a median follow-up of 11.5 years, 1,035 women were diagnosed with incident epithelial ovarian cancer. Despite the lack of an overall association (ever vs. never), risk of ovarian cancer was higher among women with multiple incomplete pregnancies (HR(≥4vs.0): 1.74, 95% CI: 1.20-2.70; number of cases in this category: n = 23). This association was particularly evident for multiple miscarriages (HR(≥4vs.0): 1.99, 95% CI: 1.06-3.73; number of cases in this category: n = 10), with no significant association for multiple induced abortions (HR(≥4vs.0): 1.46, 95% CI: 0.68-3.14; number of cases in this category: n = 7). Our findings suggest that multiple miscarriages are associated with an increased risk of epithelial ovarian cancer, possibly through a shared cluster of etiological factors or a common underlying pathology. These findings should be interpreted with caution as this is the first study to show this association and given the small number of cases in the highest exposure categories.enEstudios de CohortesEuropaFemeninoHumanosNeoplasias Glandulares y EpitelialesNeoplasias OváricasMedical Subject Headings::Analytical, Diagnostic and Therapeutic Techniques and Equipment::Investigative Techniques::Epidemiologic Methods::Epidemiologic Study Characteristics as Topic::Epidemiologic Studies::Cohort StudiesMedical Subject Headings::Geographicals::Geographic Locations::EuropeMedical Subject Headings::Check Tags::FemaleMedical Subject Headings::Organisms::Eukaryota::Animals::Chordata::Vertebrates::Mammals::Primates::Haplorhini::Catarrhini::Hominidae::HumansMedical Subject Headings::Diseases::Neoplasms::Neoplasms by Histologic Type::Neoplasms, Glandular and EpithelialMedical Subject Headings::Diseases::Neoplasms::Neoplasms by Site::Endocrine Gland Neoplasms::Ovarian NeoplasmsMedical Subject Headings::Phenomena and Processes::Reproductive and Urinary Physiological Phenomena::Reproductive Physiological Phenomena::Reproductive Physiological Processes::Reproduction::PregnancyMedical Subject Headings::Analytical, Diagnostic and Therapeutic Techniques and Equipment::Investigative Techniques::Epidemiologic Methods::Statistics as Topic::Models, Statistical::Proportional Hazards ModelsMedical Subject Headings::Analytical, Diagnostic and Therapeutic Techniques and Equipment::Investigative Techniques::Epidemiologic Methods::Epidemiologic Study Characteristics as Topic::Epidemiologic Studies::Cohort Studies::Longitudinal Studies::Prospective StudiesMedical Subject Headings::Analytical, Diagnostic and Therapeutic Techniques and Equipment::Investigative Techniques::Epidemiologic Methods::Data Collection::QuestionnairesMedical Subject Headings::Analytical, Diagnostic and Therapeutic Techniques and Equipment::Diagnosis::Diagnostic Techniques and Procedures::Medical History Taking::Reproductive HistoryMedical Subject Headings::Analytical, Diagnostic and Therapeutic Techniques and Equipment::Investigative Techniques::Epidemiologic Methods::Statistics as Topic::Probability::Risk::Risk AssessmentMedical Subject Headings::Diseases::Female Urogenital Diseases and Pregnancy Complications::Pregnancy Complications::Abortion, Spontaneous::Abortion, Habitualresearch article22623987open access10.1371/journal.pone.00371411932-6203PMC3356371