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Background Few studies have evaluated the association between early life adiposity and ovarian cancer risk. Adiposity during different periods of life may be differentially associated with the risk. Patients and methods We prospectively followed 133 526 women in the Nurses' Health Study (NHS; 1980–2012) and NHSII (1989–2013). Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for incident ovarian cancer (N  = 788) according to validated measures for early life adiposity [body mass index (BMI) at age 10 imputed from somatotype and recalled BMI at age 18) as well as BMI change between age 10 and 18 and after age 18 (current weight assessed on every biennial questionnaire since baseline). Results After mutual adjustment for BMI at age 10, BMI at age 18 and current BMI, the HR (95% CI) for ovarian cancer risk per 5 kg/m2 was 0.84 (0.74–0.96) for BMI at age 10 (P -trend = 0.01), 1.17 (1.03–1.33) for BMI at age 18 (P -trend = 0.02), and 1.06 (0.99–1.14) for current BMI (P -trend = 0.08). However, the inverse association with BMI at age 10 was attenuated after adjusting for BMI change between age 10 and 18 and BMI change after age 18 (HR per 5 kg/m2: 1.04; 95% CI 0.91–1.20; P -trend = 0.55). By contrast, BMI change between age 10 and 18 was strongly positively associated with ovarian cancer risk (HR per 5 kg/m2 increase: 1.24; 95% CI 1.11–1.39; P -trend = 0.0002), whereas BMI change since age 18 was only slightly associated with risk (HR per 5 kg/m2 increase: 1.06; 95% CI 0.99–1.14; P -trend = 0.10). These associations were in general stronger for premenopausal cases or non-serous tumors. Conclusion Early life changes in adiposity were more strongly associated with ovarian cancer risk than adulthood changes. The specific mechanisms underlying the associations with adiposity changes during early life warrant further investigation. [ABSTRACT FROM AUTHOR]

This study evaluated approaches for recruiting patients at a cancer center to an electronic survey about their experience with the COVID-19 pandemic. Eight groups (n = 2,750 patients total) were contacted via email to complete a 15-minute survey. Groups consisted of: 1) a detailed email only, 2) a brief email only, 3) a mailed letter and brief email, 4) a mailed letter, small prize in the envelope, and brief email, 5) a mailed postcard and brief email, 6) a brief email and $10 gift card, 7) a mailed letter, brief email and $10 gift card, and 8) a mailed postcard, brief email, and $10 gift card. Patients were considered eligible if they had a valid email address, were seen at the cancer center since January 1, 2015, had English as a preferred language, a last known vital status of alive, an address inside the cancer center's catchment area, and were between 40 and 89 years old. Patients were over sampled for Hispanic ethnicity and African American race, then randomly sampled. Response rates were evaluated overall, by race/ethnicity, gender, time since visit to the cancer center and age. Multiple logistic regression was used to assess the odds of completing the survey. 259 patients (9.4%) completed the survey across all pilot groups. Response rates varied by pilot group, ranging from 2.6% response for a detailed email only, to 18.4% response for a brief email, postcard and gift card. The latter group was also among the highest for response rates among Hispanics (25.6%) and Non-Hispanic/Non-White patients (15.9%). In a multivariate model adjusting for race, ethnicity, age, and gender, we found those who received a gift card had 1.86 times (95% CI: 1.40-2.48) higher odds of completing the survey than those who did not. Additionally, those who received a postcard or letter compared to those who only received an email had 1.46 times (95% CI: 1.05-2.04) higher odds of completing the survey. In our study of cancer patients seen at a major cancer center, prompting potential study participants with a letter or postcard before an email improved response rates. Further including a gift card increased response rates, particularly for underrepresented minorities. Future analyses include evaluating response rates by insurance status and cancer type. [ABSTRACT FROM AUTHOR]

Adult body mass index (BMI) has been associated with ovarian cancer risk, but few studies have examined body size earlier in life. We prospectively examined associations of body fatness at ages 5 and 10, BMI at age 18, height, and birthweight with risk of epithelial ovarian cancer in the Nurses' Health Study (NHS: 110 311 women, 735 cases) and Nurses' Health Study II (NHSII: 113 059 women, 137 cases). Cox proportional hazards regression was used to estimate relative risks (RRs) and 95% confidence intervals (CIs). There was a weak inverse association between average body fatness at ages 5 and 10 and risk in the NHS (RR for heaviest vs most lean=0.81, 95% CI: 0.53-1.24, P for trend=0.04) and a nonsignificant positive association in the NHSII (RR=2.09, 95% CI: 0.98-4.48, P for trend=0.10), possibly due to differences in age and menopausal status. Height was positively associated with risk in both cohorts (RR for >or=1.75 vs <1.6 m=1.43, 95% CI: 1.05-1.96, P for trend=0.001). Body mass index at the age of 18 years and birthweight were not associated with risk. Further research should examine the biological mechanisms underlying the observed associations. [ABSTRACT FROM AUTHOR]

The relationship between postmenopausal hormone use (PMH) and ovarian cancer risk is unclear, particularly for specific hormone formulations, but recent studies suggest that there is a positive association. We conducted a prospective observational study with 82,905 postmenopausal women, including 389 ovarian cancers, in the Nurses' Health Study from 1976 to 2002. Compared with never users of PMH, both current and past users of > or =5 years had a significantly elevated risk of ovarian cancer (RR=1.41, 95% confidence interval (CI) 1.07-1.86 and relative risk (RR)=1.52, 95% CI 1.01-2.27, respectively). Examined by hormone type in continuous years, use of unopposed estrogen was associated with a significant increase in the risk of epithelial ovarian cancer (P for trend <0.001; RR for 5-year increment of use=1.25, 95% CI 1.12-1.38). Use of estrogen plus progestin (RR for 5-year increment of use=1.04, 95% CI 0.82-1.32) was not significantly associated with ovarian cancer risk. Generally, results were similar for serous tumours (RR for 5-year increment of unopposed estrogen use=1.23, 95% CI 1.07-1.40) and slightly stronger for endometrioid tumours (RR for 5-year increment of unopposed estrogen use=1.53, 95% CI 1.20-1.94). Recency of use was not significantly associated with ovarian cancer risk, but statistical power was limited here. [ABSTRACT FROM AUTHOR]

Purpose: The COVID-19 pandemic has substantially changed social practices, economic stability, and access to medical care that may significantly affect cancer patients, especially those undergoing active treatment. We characterized the pandemic's influence on healthcare delivery, behavioral health, and financial stress in cancer patients. Methods: We included data from N = 1,253 adult cancer patients, who visited HCI in the last 4 years, consented to the Total Cancer Care study, and completed a COVID-19 survey as part of the COPES consortium. The survey was administered between Aug and Sept 2020 and included questions on change/cancellation of medical visits, change in exercise and alcohol consumption, daily life, social interactions, and financial stress since March 2020. Results: The cohort's mean age was 60.4 (19-92) years, with 54% female, 68% non-Hispanic White, 41% retired, 43% employed full or part-time, and 24% living in rural counties. Among the 27% of patients who reported receiving current treatment at HCI, 30% had to change or cancel a medical visit due to the pandemic, with 2% reported a change/cancellation in a biopsy, surgery, radiotherapy, and chemotherapy; 5% reported a change/cancellation in imaging; and 3% and 23% reported a change/cancellation in cancer screening and doctor's visit, respectively. 18% rescheduled an appointment to a telehealth visit. Changes in exercise habits due to the pandemic were common (47%), with 10% no longer exercising regularly, 21% exercising less, and 11% exercising more than before. 5% reported increased alcohol consumption, while 6% reported a decrease. Most patients (84%) experienced a change in their daily lives (ranging from somewhat to a lot of change). 69% had fewer social interactions, and 49% reported financial stress due to the pandemic, with 11% reporting being quite a bit/very much financially stressed. Conclusions: These findings suggest that within approximately the first 6 months, the COVID-19 pandemic had a substantial impact on cancer patients' lives, with adverse effects on health behaviors and financial stress. Healthcare delivery continued for essential cancer care but was disrupted for other services, such as cancer screening. Further analyses are underway. Funding: U01CA206110 and R01CA211705. [ABSTRACT FROM AUTHOR]

Background: Ovarian cancer risk in adulthood may be affected by early life exposure to tobacco smoke. We investigated this relationship in two large prospective cohorts, the Nurses' Health Study (NHS) and NHSII. Methods: In total, analyses included 110,305 NHS participants (1976-2016) and 112,859 NHSII participants (1989-2017). Self-reported early life smoking exposures were queried at baseline or follow-up questionnaires. Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for risk of ovarian cancer overall and by tumor histotype. Results: Compared with women who never smoked, ovarian cancer risk was similar for women who started to smoke at age <18 (HR = 0.98, 95%CI: 0.86-1.11) or =18 (HR = 1.02, 95%CI: 0.93-1.12). Overall, ovarian cancer risk was not different among participants whose mother did versus did not smoke during pregnancy (HR = 1.05, 95%CI: 0.87-1.27); however, an increased risk was observed among women who themselves were never smokers (HR = 1.38, 95%CI: 1.05-1.81) but not ever smokers (HR = 0.86, 95%CI: 0.66-1.14; Pheterogeneity = 0.02). These associations did not differ by histotype (Pheterogeneity=0.35). Parental smoking in the home during childhood/adolescence was related to a 15% increased risk of ovarian cancer in adulthood (HR = 1.15, 95%CI: 1.04-1.27) and this association was notably stronger among women with non-serous/low-grade serous tumors (HR = 1.28, 95%CI: 1.02-1.61) versus high-grade serous/poorly differentiated tumors (HR = 1.09, 95%CI: 0.93-1.28, Pheterogeneity = 0.25). Conclusions: Exposure to parental tobacco smoke, but not early initiation of smoking, was associated with a modest elevated risk of ovarian cancer. Further investigations are required to confirm these findings and elucidate underlying mechanisms. [ABSTRACT FROM AUTHOR]