The effects of twins, parity and age at first birth on cancer risk in Swedish women

The effect of reproductive history on the risk of cervical, colorectal and thyroid cancers and melanoma has been explored but the results to date are inconsistent. We aimed to examine in a record-linkage cohort study the risk of developing these cancers, as well as breast, ovarian and endometrial cancers, among mothers who had given birth to twins compared with those who had only singleton pregnancies. Women who delivered a baby in Sweden between 1961 and 1996 and who were 15 years or younger in 1961 were selected from the Swedish civil birth register and linked with the Swedish cancer registry. We used Poisson regression to assess associations between reproductive factors and cancer. Twinning was associated with reduced risks of breast, colorectal, ovarian and uterine cancers, although no relative risks were statistically significant. The delivery of twins did not increase the risk of any cancers studied. Increasing numbers of maternities were associated with significantly reduced risks of all tumors except thyroid cancer. We found positive associations between a later age at first birth and breast cancer and melanoma, while there were inverse associations with cervix, ovarian, uterine and colorectal cancers. These findings lend weight to the hypothesis that hormonal factors influence the etiology of colorectal cancer in women, but argue against any strong effect of hormones on the development of melanoma or tumors of the thyroid.