Ovarian cancer risk in relation to medical visits, pelvic examinations and type of health care provider.

BACKGROUND Whether the current recommendations for ovarian cancer prevention and screening (annual history and physical examination) are effective has not been evaluated. We examined the relation between health care use and the risk of ovarian cancer. METHODS Using a case-control study design, we recorded the frequency of medical visits and pelvic examinations and the type of health care provider visited during a 5-year period from interviews with women with and without ovarian cancer between between July 1998 and July 2003. We used multivariable logistic regression analysis to calculate the adjusted odds ratio of ovarian cancer associated with the frequency of medical visits and pelvic examinations and the type of health care provider. In addition, we stratified cases and controls by menopausal status and cancer histologic subtype and grade. RESULTS A total of 668 cases and 721 age-matched controls agreed to participate in the study. We observed an increased risk of ovarian cancer among women who, during the 5-year study period, did not have a medical visit (odds ratio [OR] 2.8, 95% confidence interval [CI] 1.5-5.0) or pelvic examination (OR 3.9, 95% CI 2.2-6.9) or who had no regular health care provider (OR 2.7, 95% CI 1.3-5.7). This increase in risk was most pronounced among women who were postmenopausal (no medical visit, OR 7.7, 95% CI 2.6-23.0; no pelvic examination, OR 3.3, 95% CI 1.7-6.0; no health care provider, OR 12.5, 95% CI 2.7-57.5). INTERPRETATION Although the exact mechanism underlying the association between medical visits, pelvic examinations and type of health care provider and ovarian cancer is unknown, women should be encouraged to maintain regular medical care.