Table 1.
Characteristics of the included studies for age at menopause with risk of the endometrial cancer among postmenopausal women.
| Author | Country (year) | Age range or mean age | Study design (years of follow up) | Age at menopause | Case (control or person-year) | Participants | RR(95%CI) | Adjustment for covariates | Menopausal type and definition of postmenopausal status | Source of case information |
|---|---|---|---|---|---|---|---|---|---|---|
| Kvale G [26] | Norway (1988) |
27-69 | Cohort (20) |
≤45 | 16 | 62079 | 1 | Age, residential type, parity | NA | Cases were identified by records from the Cancer Registry of Norway |
| 46-47 | 9 | NA | ||||||||
| 48-49 | 20 | |||||||||
| 50-51 | 21 | |||||||||
| 52-53 | 15 | |||||||||
| ≥54 | 15 | 2.55(1.25-5.20) | ||||||||
|
| ||||||||||
| Shu XO [27] | China (1991) |
18-74 56.0/56.4 |
Case-control | ≤45 | 29 (44) | 404 | 1 | Age, number of pregnancies, weight | ① | Cases were identified by records from the Cancer Registry of Shanghai (1988-1990) |
| 46-48 | 25 (50) | 1.00(0.50-2.00) | ||||||||
| 49-50 | 67 (56) | 2.30(1.20-4.40) | ||||||||
| ≥51 | 73 (60) | 1.90(1.00-3.60) | ||||||||
|
| ||||||||||
| Brinton LA [28] | America (1992) |
20-74 59.2/58.0 |
Case-control | <45 | 39 (28) | 504 | 1 | Age, education, parity, recent weight, OC use, menopausal estrogen use | ① | Cases were identified by medical records |
| 45-49 | 89 (69) | 0.88(0.50-1.70) | ||||||||
| 50-54 | 133 (83) | 0.99(0.50-1.80) | ||||||||
| ≥55 | 36 (27) | 0.77(0.40-1.70) | ||||||||
|
| ||||||||||
| Hirose K [29] | Japan (1999) |
30-80 56.6/48.5 |
Case-control | ≤47 | 12 (1408) | 7849 | 1 | Age, BMI | NA | Cases were identified by medical records |
| 48-52 | 36 (4738) | 0.88(0.45-1.69) | ||||||||
| ≥53 | 24 (1631) | 1.50(0.75-3.03) | ||||||||
|
| ||||||||||
| Olson JE [30] | America (1999) |
55-69 | Cohort (10) |
<45 | 41 (30853) | 24848 | 1 | Age | NA | Cases were identified by records from the State Health Registry of Iowa |
| 45-49 | 61 (56522) | 0.80(0.60-1.20) | ||||||||
| 50-54 | 148 (106394) | 1.10(0.80-1.50) | ||||||||
| >55 | 82 (30987) | 2.00(1.40-2.90) | ||||||||
|
| ||||||||||
| Salazar-Martinez E [31] | Mexico (1999) |
57.1/54.6 |
Case-control | ≤40 | 7 (32) | 356 | 1 | Age, anovulatory index, smoking, diabetes mellitus, hypertension, physical activity, BMI | ② | Cases were from the gynecological oncology service and identified by biopsy-positive result. |
| 41-45 | 13 (61) | 1.10(0.34-3.70) | ||||||||
| 46-50 | 16 (88) | 1.00(0.34-3.30) | ||||||||
| ≥51 | 22 (117) | 1.20(0.42-3.60) | ||||||||
|
| ||||||||||
| Xu WH [32] |
China (2004) |
30-69 55.2/55.1 |
Case-control | <45 | 31 (66) | 1025 | 1 | Age, education, OC use, alcohol drinking, any cancer history among first degree relatives, BMI, ever having had a live birth and ever having had an induce abortion, age at menarche | ① Women were considered postmenopausal when they reported not having had any menses over the past 12 months |
Cases were identified by records from the Cancer Registry of Shanghai (1997-2001) |
| 45-49 | 192 (247) | 1.67(1.03-2.70) | ||||||||
| 50-54 | 220 (204) | 2.38(1.46-3.87) | ||||||||
| ≥55 | 48 (17) | 5.15(2.48-10.69) | ||||||||
|
| ||||||||||
| Trentham-Dietz A [33] | America (2006) |
40-79 62.9/63.3 |
Case-control | <50 | 177 (716) | 2464 | 1 | Age | ② |
Cases were identified by records from Wisconsin Cancer Reporting System |
| 50-55 | 239 (866) | 1.20(0.96-1.50) | ||||||||
| >55 | 134 (332) | 1.69(1.30-2.21) | ||||||||
|
| ||||||||||
| Wernli KJ [34] | China (2006) |
NA | Cohort (9) |
<45 | 4 (62227) | 267400 | 1 | Age, parity | ② Women were considered postmenopausal when they reported not having had any menses over the past 6 months. |
Cases were identified by medical record |
| 45-49 | 36 (310089) | 2.09(0.56-7.75) | ||||||||
| 50-54 | 81 (394730) | 3.73(1.03-13.47) | ||||||||
| ≥55 | 19 (38686) | 9.09(2.78-29.69) | ||||||||
|
| ||||||||||
| Setiawan VW [35] | America (2007) |
45-75 61.6 |
Cohort (7.3) |
<45 | NA | 46933 | 1 | Age, BMI, age at menarche, parity, OC use, smoking, diabetes, hypertension, family History of endometrial cancer, race |
① |
Cases were identified by records from Hawaii Tumor Registry |
| 45-49 | 1.27(0.88-1.84) | |||||||||
| 50-54 | 1.67(1.16-2.41) | |||||||||
| ≥55 | 1.79(1.15-2.78) | |||||||||
|
| ||||||||||
| Zucchetto A [36] | Italy (2009) |
18-79 60/61 |
Case-control | <50 | 97 (252) | 1077 | 1 | Period of interview, BMI, age at menarche, parity, OC use | NA | Cases were identified by medical records. |
| 50-54 | 193 (358) | 1.57(1.13-2.18) | ||||||||
| ≥55 | 64 (113) | 1.76(1.14-2.72) | ||||||||
|
| ||||||||||
| Dossus L [4] | Denmark (2010) | NA | Cohort (8.7) |
≤50 | 221 (535097) | 302618 | 1 | Age, BMI, physical activity, alcohol, diabetes, smoking, education | Women were considered postmenopausal when they reported not having had any menses over the past 12 months, or when they were older than 55 years. | Cases were identified by record linkage, health insurance records, cancer and pathology registries and active follow-up of study subjects. |
| 51-52 | 106 (170078) | 1.32(1.04-1.68) | ||||||||
| 53-55 | 118 (156492) | 1.49(1.18-1.89) | ||||||||
| >55 | 53 (43212) | 2.20(1.61-3.01) | ||||||||
| Karageorgi S [37] | America (2010) |
30-50 41.8 |
Cohort (19.3) |
<45 | 41 (71578) | 121700 | 1 | Age, parity, age at first birth, age at last birth, OC use, PMH use, BMI, smoking, diabetes, family history of endometrial cancer, age at menarche | ① |
Cases were identified by medical records. |
| 45-49 | 141 (310321) | 0.82(0.57-1.18) | ||||||||
| 50-54 | 386 (521943) | 1.22(0.81-1.85) | ||||||||
| ≥55 | 68 (77867) | 1.25(0.78-2.01) | ||||||||
|
| ||||||||||
| Amankwah EK [38] | Canada (2013) |
40-79 62.1/62.6 |
Case-control | <50 | 127 (297) | 1103 | 1 | Age, residential type, smoking, BMI, hypertension | Postmenopausal status was defined as age ≥60 years, or self-identified as postmenopausal with the last menstrual period ≥12 months, or 50 to 59 years and using menopausal hormones for ≥2 years. | Cases were identified by records from Alberta Cancer Registry |
| 50-54 | 176 (348) | 1.23(0.92-1.64) | ||||||||
| ≥55 | 58 (97) | 1.55(1.03-2.33) | ||||||||
|
| ||||||||||
| Dashti SG [39] | America (2015) |
18-86 40 |
Cohort (15) |
<50 | 5 (3357) | 1128 | 1 | Country, education, ascertainment, age at menarche, parity, PMH use | ① Women were considered postmenopausal when they reported not having had any menses over the past 12 months |
Cases were identified by records from Colon Cancer Family Registry |
| ≥50 | 14 (4375) | 1.64(0.53-5.05) | ||||||||
|
| ||||||||||
| Jung KJ [40] | Korea (2016) |
55.6 | Cohort (12.1) |
≤45 | 5 | 66466 | 1 | Age, smoking, age at menarche, SBP, TC, HDL cholesterol, diabetes, exercise, exogenous hormone use, health insurance premium | Women were considered postmenopausal when they reported not having had any menses over the past 12 months | Cases were identified by records from National Health Insurance Service in Korea |
| 46-48 | 3 | 0.80(0.18-3.57) | ||||||||
| 49-51 | 12 | 2.68(0.82-8.78) | ||||||||
| ≥52 | 11 | 3.06(0.89-10.47) | ||||||||
|
| ||||||||||
| Yang HP [41] | Poland (2016) |
20-74 | Case-control | <45 | 33 (110) | 1 | Age, study site, age at menarche, oral contraceptive use, parity, LOC | ② |
Cases were identified by records from Polish Cancer Study | |
| 45-49 | 111 (355) | 1.44(0.83-2.48) | ||||||||
| 50-54 | 252 (579) | 2.71(1.38-5.35) | ||||||||
| ≥55 | 114 (179) | 3.59(1.62-7.96) | ||||||||
|
| ||||||||||
| Sponholtz TR [42] | America (2017) |
21-69 36.6 |
Cohort (18) |
<45 | 12 (22960) | 47555 | 1 | Age, study peroid, education, marital status, age at menarche, parity, menopausal status, OC use, estrogen-only female menopausal hormone use, estrogen plus progestin female menopausal hormone use, smoking status, BMI, physical activity | ② Women were considered postmenopausal when they reported not having had any menses over the past 12 months, bilateral oophorectomy, or when they were ≥57 years of age and whose menopausal status was obscured due to hormone use. |
Cases were identified by record linkage from state cancer registries |
| 45-49 | 38 (46155) | 1.45(0.73-2.89) | ||||||||
| 50-54 | 64 (64053) | 1.32(0.67-2.56) | ||||||||
| ≥55 | 28 (19161) | 1.45(0.70-3.02) | ||||||||
RR, relative risk; CI, confidence interval; NA, not available; BMI, body mass index; OC, oral contraceptive; PMH, postmenopausal hormone use; SBP, systolic blood pressure; TC, total cholesterol; HDL, high density lipoprotein; LOC, lifetime number of ovulatory cycles. ①, among women only with natural menopause; ②, among women with natural menopause and surgical menopause