Mary Qiu1, Carol L Shields2. 1. Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland. 2. Ocular Oncology Service, Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania.
Abstract
IMPORTANCE: Choroidal nevus is a precursor for uveal melanoma and there are no known risk factors besides white race. Female sex hormones have been hypothesized to play a role in the pathogenesis of uveal melanoma. OBJECTIVE: To explore the association between female reproductive factors and choroidal nevus in the US adult female population. DESIGN, SETTING, AND PARTICIPANTS: Cross-sectional, population-based study of 2505 US women aged 40 years or older from the 2005-2008 National Health and Nutrition Examination Survey. The women completed the reproductive health questionnaire and underwent retinal imaging. The analysis was conducted in April 2015. EXPOSURES: Age at menarche, oral contraceptive use, pregnancy, parity, age at first and last births, age at menopause, hysterectomy, oophorectomy, hormone therapy use, and body mass index (calculated as weight in kilograms divided by height in meters squared). MAIN OUTCOMES AND MEASURES: Choroidal nevus on retinal imaging. RESULTS: The mean age of participants was 56.5 years, and the racial/ethnic distribution was 76.9% white, 10.1% African American, 8.4% Hispanic, and 4.8% other. The weighted prevalence of choroidal nevus was 4.5%. Premenopausal women who first gave birth before age 20 years had more than 4 times higher odds of choroidal nevus than those who first gave birth after age 35 years (odds ratio [OR], 4.16; 95% CI, 1.29-13.45; P = .02), and premenopausal women who gave birth to their last child before age 25 years had nearly 5 times higher odds of choroidal nevus than those who gave birth to their last child after age 35 years (OR, 4.89; 95% CI, 1.15-20.74; P = .03). These relationships were independent of total parity and years between the first and last births. The odds of choroidal nevus in postmenopausal women who were overweight and obese were 2 times higher than in postmenopausal women with normal body mass index (OR, 2.11; 95% CI, 1.19-3.76; P = .01 for overweight and OR, 1.92; 95% CI, 1.13-3.25; P = .02 for obese). CONCLUSIONS AND RELEVANCE: The association between choroidal nevus and earlier start and end to childbearing in premenopausal women and obesity in postmenopausal women suggests that this relationship could be partially mediated via increased total lifetime unopposed estrogen. Clinicians should have an increased index of suspicion for choroidal nevus and choroidal melanoma in this population.
IMPORTANCE: Choroidal nevus is a precursor for uveal melanoma and there are no known risk factors besides white race. Female sex hormones have been hypothesized to play a role in the pathogenesis of uveal melanoma. OBJECTIVE: To explore the association between female reproductive factors and choroidal nevus in the US adult female population. DESIGN, SETTING, AND PARTICIPANTS: Cross-sectional, population-based study of 2505 US women aged 40 years or older from the 2005-2008 National Health and Nutrition Examination Survey. The women completed the reproductive health questionnaire and underwent retinal imaging. The analysis was conducted in April 2015. EXPOSURES: Age at menarche, oral contraceptive use, pregnancy, parity, age at first and last births, age at menopause, hysterectomy, oophorectomy, hormone therapy use, and body mass index (calculated as weight in kilograms divided by height in meters squared). MAIN OUTCOMES AND MEASURES: Choroidal nevus on retinal imaging. RESULTS: The mean age of participants was 56.5 years, and the racial/ethnic distribution was 76.9% white, 10.1% African American, 8.4% Hispanic, and 4.8% other. The weighted prevalence of choroidal nevus was 4.5%. Premenopausal women who first gave birth before age 20 years had more than 4 times higher odds of choroidal nevus than those who first gave birth after age 35 years (odds ratio [OR], 4.16; 95% CI, 1.29-13.45; P = .02), and premenopausal women who gave birth to their last child before age 25 years had nearly 5 times higher odds of choroidal nevus than those who gave birth to their last child after age 35 years (OR, 4.89; 95% CI, 1.15-20.74; P = .03). These relationships were independent of total parity and years between the first and last births. The odds of choroidal nevus in postmenopausal women who were overweight and obese were 2 times higher than in postmenopausal women with normal body mass index (OR, 2.11; 95% CI, 1.19-3.76; P = .01 for overweight and OR, 1.92; 95% CI, 1.13-3.25; P = .02 for obese). CONCLUSIONS AND RELEVANCE: The association between choroidal nevus and earlier start and end to childbearing in premenopausal women and obesity in postmenopausal women suggests that this relationship could be partially mediated via increased total lifetime unopposed estrogen. Clinicians should have an increased index of suspicion for choroidal nevus and choroidal melanoma in this population.