Importance The relationship between use of powder in the genital area and ovarian cancer is not established. Positive associations reported in case-control studies have not been confirmed in cohort studies. Objective To estimate the association between use of powder in the genital area and ovarian cancer using prospective observational data. Design, Setting, and Participants Data were pooled from 4 large, US-based cohorts: Nurses' Health Study (enrollment 1976; follow-up 1982-2016; n = 81 869), Nurses' Health Study II (enrollment 1989; follow-up 2013-2017; n = 61 261), Sister Study (enrollment 2003-2009; follow-up 2003-2017; n = 40 647), and Women's Health Initiative Observational Study (enrollment 1993-1998; follow-up 1993-2017; n = 73 267). Exposures Ever, long-term (≥20 years), and frequent (≥1/week) use of powder in the genital area. Main Outcomes and Measures The primary analysis examined the association between ever use of powder in the genital area and self-reported incident ovarian cancer. Covariate-adjusted hazard ratios (HRs) and 95% CIs were estimated using Cox proportional hazards models. Results The pooled sample included 252 745 women (median age at baseline, 57 years) with 38% self-reporting use of powder in the genital area. Ten percent reported long-term use, and 22% reported frequent use. During a median of 11.2 years of follow-up (3.8 million person-years at risk), 2168 women developed ovarian cancer (58 cases/100 000 person-years). Ovarian cancer incidence was 61 cases/100 000 person-years among ever users and 55 cases/100 000 person-years among never users (estimated risk difference at age 70 years, 0.09% [95% CI, -0.02% to 0.19%]; estimated HR, 1.08 [95% CI, 0.99 to 1.17]). The estimated HR for frequent vs never use was 1.09 (95% CI, 0.97 to 1.23) and for long-term vs never use, the HR was 1.01 (95% CI, 0.82 to 1.25). Subgroup analyses were conducted for 10 variables; the tests for heterogeneity were not statistically significant for any of these comparisons. While the estimated HR for the association between ever use of powder in the genital area and ovarian cancer risk among women with a patent reproductive tract was 1.13 (95% CI, 1.01 to 1.26), the P value for interaction comparing women with vs without patent reproductive tracts was .15. Conclusions and Relevance In this analysis of pooled data from women in 4 US cohorts, there was not a statistically significant association between use of powder in the genital area and incident ovarian cancer. However, the study may have been underpowered to identify a small increase in risk.

中文翻译：

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生殖器部位使用粉末与卵巢癌风险的关联

重要性 生殖器部位使用粉末与卵巢癌之间的关系尚未确定。病例对照研究中报告的正相关尚未在队列研究中得到证实。目的使用前瞻性观察数据估计在生殖器区域使用粉末与卵巢癌之间的关联。设计、设置和参与者 数据来自 4 个基于美国的大型队列：护士健康研究（1976 年注册；1982-2016 年随访；n = 81 869）、护士健康研究 II（1989 年注册；后续- 2013-2017 年；n = 61 261）、姐妹研究（2003-2009 年招募；2003-2017 年随访；n = 40 647）和妇女健康倡议观察性研究（1993-1998 年招募；2009 年随访 2017 年） ；n = 73 267）。接触过，长期（≥20 年），和频繁（≥1/周）在生殖器区域使用粉末。主要结果和措施主要分析检查了在生殖器区域使用粉末与自我报告的卵巢癌事件之间的关联。使用 Cox 比例风险模型估计协变量调整的风险比 (HR) 和 95% CI。结果 合并样本包括 252 745 名女性（基线时的中位年龄为 57 岁），其中 38% 的女性自我报告在生殖器区域使用粉末。10% 报告长期使用，22% 报告频繁使用。在中位 11.2 年的随访期间（380 万人年有风险），2168 名女性患上了卵巢癌（58 例/10 万人年）。曾经使用过的卵巢癌发病率为 61 例/100 000 人年，未使用过的为 55 例/100 000 人年（估计 70 岁时的风险差异，0. 09% [95% CI，-0.02% 至 0.19%]；估计 HR，1.08 [95% CI，0.99 至 1.17]）。频繁使用与从不使用的估计 HR 为 1.09（95% CI，0.97 至 1.23），长期使用与从未使用的 HR 为 1.01（95% CI，0.82 至 1.25）。对 10 个变量进行了亚组分析；对于这些比较中的任何一个，异质性检验都没有统计学意义。虽然生殖道未闭女性曾在生殖器部位使用粉末与卵巢癌风险之间的关联估计 HR 为 1.13（95% CI，1.01 至 1.26），但相互作用的 P 值比较女性与未闭女性生殖道是 0.15。结论和相关性 在对来自 4 个美国队列的女性的汇总数据的分析中，在生殖器部位使用粉末与卵巢癌发病率之间没有统计学上的显着关联。然而，该研究可能不足以确定风险的小幅增加。