Suzanne Dixon

The Marriage Alliance in the Roman Elite

Elite marriage in Rome in the late Republic and early Empire was con tracted between noble houses of equivalent status, often for immediate political gains. Contrary to views advanced by some scholars, spouses nonetheless enter tained strong expectations of conjugal loyalty and happiness but marriage was relatively fragile. Power was vested in the older generation rather than men as such. A separate matrimonial regime was usually maintained during marriage and dowry was essentially recoverable on divorce or widowhood. Upper class women were therefore relatively independent although they subordinated in dividual preference to corporate interests. Their primary loyalty was to their natal kin but they observed the obligation to redistribute their dowry and patrimony in the following generation to their children, who belonged to the fathers lineage.

‘As many options as there are, there are just not enough for me’: Contraceptive use and barriers to access among Australian women

Abstract Objective A comprehensive life course perspective of womens experiences in obtaining and using contraception in Australia is lacking. This paper explores free-text comments about contraception provided by women born between 1973 and 1978 who participated in the Australian Longitudinal Study on Womens Health (ALSWH). Methods The ALSWH is a national population-based cohort study involving over 40,000 women from three age groups, who are surveyed every three years. An initial search identified 1600 comments from 690 women across five surveys from 1996 (when they were aged 18–23 years) to 2009 (31–36 years). The analysis included 305 comments from 289 participants. Factors relating to experiences of barriers to access and optimal contraceptive use were identified and explored using thematic analysis. Results Five themes recurred across the five surveys as women aged: (i) side effects affecting physical and mental health; (ii) lack of information about contraception; (iii) negative experiences with health services; (iv) contraceptive failure; and (v) difficulty with accessing contraception. Conclusion Side effects of hormonal contraception and concerns about contraceptive failure influence womens mental and physical health. Many barriers to effective contraception persist throughout womens reproductive lives. Further research is needed into reducing barriers and minimising negative experiences, to ensure optimal contraceptive access for Australian women. Chinese Abstract 摘 要 目的 从一种全面的生命历程的角度来看，澳大利亚妇女缺乏获取和采用避孕方法方面的经验。本文探究了1973年至1978年间出生，参加澳大利亚妇女健康纵向研究（ALSWH）的女性所提供的关于避孕的自由评论。 方法 ALSWH是一项国家性的以人群为基础的群组研究项目，有来自各个年龄组的40,000多名女性参加，每三年对她们进行一次调查。最初搜索到的是在1996年（当时她们18-23岁）至2009年（当时她们31-36岁）参与五项研究的690名女性所做的1600条评论。本项分析包括289名参与者的305条评论。采用主题分析方法确定并探究了与所面临的障碍和采用理想避孕方法等方面的经验相关的因素。 结果 随着这些女性年龄的增长，五项研究的五个主题再次出现：（i）影响生理和心理健康的副作用；（ii）缺乏避孕相关的信息；（iii）卫生服务的负面经历；（iv）避孕失败；（V）成功避孕的困难。 结论 激素避孕和对担心避孕失败的副作用影响女性的生理和心理健康。许多有效避孕的障碍会始终贯穿女性的育龄期。下一步的研究应减少障碍并使负面的经历最小化，为澳大利亚妇女确保最佳的避孕方法。

Dietary folate and related micronutrients, folate-metabolising genes, and ovarian cancer survival.

OBJECTIVE Folate is essential for DNA synthesis and methylation and is implicated in tumour progression. Few studies have examined its role in ovarian cancer survival. Our objective was to determine relationships between intake of folate, related one-carbon nutrients, single nucleotide polymorphisms (SNPs) in folate-metabolising genes and survival following ovarian cancer diagnosis. METHODS This analysis included 1270 women with invasive epithelial ovarian cancer diagnosed in 2002-2006. Pre-diagnostic and some post-diagnostic lifestyle, dietary, and sociodemographic information was collected via self-administered questionnaires. DNA samples were genotyped for SNPs in methylenetetrahydrofolate reductase (MTHFR), methionine synthase (MTR) and methionine synthase reductase (MTRR) genes. Adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated using Cox regression. RESULTS Multivariate analyses did not identify associations between higher pre-diagnostic intake of folate, folic acid, vitamins B2, B6, and B12, methionine, betaine or choline and survival overall. In stratified analyses, higher folic acid and folate intake was associated with significantly worse survival among women with mucinous tumours (HRs per 100 μg 1.30 and 1.43, respectively) and smokers (HRs per 100 μg 1.23 and 1.16 respectively). There was also a suggestion that higher supplemental folic acid use post-diagnosis was associated with worse survival (HR per 100 μg 1.03, 95%CI 1.00-1.05). MTHFR SNP rs2066470 was significantly associated with survival (per allele HR 0.81, 95%CI 0.67-0.98). CONCLUSIONS Our data provide little evidence that folate intake affects ovarian cancer survival. However, combined effects with smoking, and findings within the mucinous subtype and for post-diagnosis folic acid, warrant further investigation.

Use of common analgesic medications and ovarian cancer survival: results from a pooled analysis in the Ovarian Cancer Association Consortium

Background:Nonsteroidal anti-inflammatory drugs (NSAIDs) have been associated with improved survival in some cancers, but evidence for ovarian cancer is limited.Methods:Pooling individual-level data from 12 Ovarian Cancer Association Consortium studies, we evaluated the association between self-reported, pre-diagnosis use of common analgesics and overall/progression-free/disease-specific survival among 7694 women with invasive epithelial ovarian cancer (4273 deaths).Results:Regular analgesic use (at least once per week) was not associated with overall survival (pooled hazard ratios, pHRs (95% confidence intervals): aspirin 0.96 (0.88–1.04); non-aspirin NSAIDs 0.97 (0.89–1.05); acetaminophen 1.01 (0.93–1.10)), nor with progression-free/disease-specific survival. There was however a survival advantage for users of any NSAIDs in studies clearly defining non-use as less than once per week (pHR=0.89 (0.82–0.98)).Conclusions:Although this study did not show a clear association between analgesic use and ovarian cancer survival, further investigation with clearer definitions of use and information about post-diagnosis use is warranted.

Lymphadenectomy in early-stage intermediate-/high-risk endometrioid endometrial cancer: Clinical characteristics and outcomes in an Australian cohort

Objective The role of lymphadenectomy (LND) in early-stage endometrial cancer (EC) remains controversial. Previous studies have included low-risk patients and nonendometrioid histologies for which LND may not be beneficial, whereas long-term morbidity after LND is unclear. In a large Australian cohort of women with clinical early-stage intermediate-/high-risk endometrioid EC, we analyzed the association of LND with clinicopathological characteristics, adjuvant treatment, survival, patterns of disease recurrence, and morbidity. Materials and Methods From a larger prospective study (Australian National Endometrial Cancer Study), we analyzed data from 328 women with stage IA grade 3 (n = 63), stage IB grade 1 to 3 (n = 160), stage II grade 1 to 3 (n = 71), and stage IIIC1/2 grade 1 to 3 (n = 31/3) endometrioid EC. Overall survival (OS) was estimated using Kaplan-Meier methods. The association of LND with OS was assessed using Cox regression analysis adjusted for age, stage, grade, and adjuvant treatment. The association with risk of recurrent disease was analyzed using logistic regression adjusted for age, stage, and grade. Morbidity data were analyzed using χ2 tests. Results Median follow-up was 45.8 months. Overall survival at 3 years was 93%. Lymphadenectomy was performed in 217 women (66%), 16% of this group having positive nodes. Median node count was 12. There were no significant differences in OS between LND and no LND groups, or by number of nodes removed. After excluding stage IB grade 1/2 tumors, there was no association between LND and OS among a “high-risk” group of 190 women with a positive node rate of 24%. However, a similar cohort (n = 71) of serous EC in the Australian National Endometrial Cancer Study had improved survival after LND. Women who underwent LND had significantly higher rates of critical events (5% vs 0%, P = 0.02) and lymphoedema (23% vs 4%, P < 0.0001). Conclusions In this cohort with early-stage intermediate-/high-risk endometrioid EC, LND did not improve survival but was associated with significantly increased morbidity.

The effect of height, BMI and serum lipid levels on ovarian cancer prognosis in over 12,000 women: a Mendelian randomization study

Introduction Previous observational studies investigating height, body mass index and serum lipid levels as prognostic factors in ovarian cancer have been inconclusive. In addition to possible influences of reverse causation, it is possible that factors such as diet, socio-economic status and other lifestyle factors are confounding true associations. Mendelian Randomization (MR) utilises genotype data for variants associated with phenotypes of interest to create genetic risk scores for these modifiable exposures. One advantage of using genetic markers as proxies is that they are determined from birth and are therefore unaffected by confounding variables. We aim to use MR to investigate the association between height, BMI and serum lipid levels (high-density lipoprotein (HDL), low-density lipoprotein (LDL) and triglycerides) and ovarian cancer prognosis in the absence of confounding variables. Methods We used data from 12,908 invasive ovarian cancer cases with 5,813 events from 26 studies in the Ovarian Cancer Association Consortium. All individuals were of European ancestry. We calculated genetic risk scores for each individual for height, BMI and serum lipids by taking the sum of the alleles associated with the trait, weighted by the size of their effect on the trait. The genetic risk scores were then included in a Cox proportional hazards model adjusted for study and two principal components to test for association with prognosis. For the analysis of height, we included 422 uncorrelated single nucleotide polymorphisms identified by the Genetic Investigation of Anthropometric Traits (GIANT) consortium as associated with height at genome-wide significance. In the analysis of BMI, we included 32 SNPs associated with BMI in analyses by the GIANT consortium. In order to account for the pleiotropy between the three lipid types we included the genetic risk scores for each of the three traits in a joint analysis. SNPs identified by the Global Lipids Genetics Consortium as associated with lipid levels were included: 95 with HDL, 82 with LDL and 64 with triglycerides. Results We found no evidence of association between the five genetic risk scores and ovarian cancer prognosis. The genetic risk score for height had an estimated hazard ratio of 1.01, 95% confidence interval 0.94 - 1.08, p-value = 0.82. The hazard ratio for BMI was 1.00, 95% CI 0.95 - 1.05, p-value = 0.99. The hazard ratios for HDL, LDL and triglycerides were 1.03(0.94-1.13), 1.02(0.94-1.12) and 1.08(0.96-1.21) respectively with p-values = 0.53, 0.58 and 0.19. Conclusion Our study does not provide any evidence of association between height, BMI and serum lipid levels and ovarian cancer prognosis. Citation Format: Ailith Pirie, Suzanne C. Dixon, Penelope M. Webb, Wei Zheng, Paul D. P. Pharoah, on behalf of the Ovarian Cancer Association Consortium. The effect of height, BMI and serum lipid levels on ovarian cancer prognosis in over 12,000 women: a Mendelian randomization study. [abstract]. In: Proceedings of the 106th Annual Meeting of the American Association for Cancer Research; 2015 Apr 18-22; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Res 2015;75(15 Suppl):Abstract nr 4637. doi:10.1158/1538-7445.AM2015-4637

Abstract 881: Association of adult body mass index and height with risk of ovarian cancer in 39,000 women: Results of a Mendelian randomization study

INTRODUCTION: Observational studies have reported positive associations between higher body mass index (BMI) and risks of borderline ovarian tumors and non-high grade serous ovarian cancer (non-HGSC), but the lack of association observed for HGSC may be due to bias arising from weight loss before diagnosis. Observational studies also suggest a positive association between greater height and ovarian cancer risk, but confounding factors may be obscuring the true relationship. The Mendelian randomization (MR) technique uses genetic markers as proxies for environmental risk factors, and can overcome the limitations of bias and confounding which affect observational studies. AIM / METHODS: This study used MR to elucidate the relationship between body size (BMI and height) and risk of ovarian cancer. We pooled data from 16,395 cases and 23,003 controls, all genetically European, from 39 studies in the Ovarian Cancer Association Consortium. We constructed a weighted genetic risk score (GRS) for each trait, summing trait-increasing alleles at 31 single nucleotide polymorphisms (SNPs) associated with BMI and 609 SNPs associated with height in genome-wide association studies, weighting alleles by published β-coefficients for their effect on the trait. Each GRS was a strong instrument for the trait (F-statistics 33.8 [BMI] and 516 [height]). In a two-stage predictor substitution MR approach, we used multivariate logistic regression to model case-control status on body size predicted by each GRS. Study-specific estimates per 5-unit increase in predicted BMI or height were pooled to generate pooled odds ratios (OR) and 95% confidence intervals (CI) using random-effects meta-analysis. Our primary hypotheses were that genetic BMI would be associated with increased risk of non-HGSC but not HGSC and genetic height would be associated with increased risk of ovarian cancer overall. RESULTS: Higher genetically-predicted BMI was associated with increased risk of non-HGSC cancer (OR 1.37, 95% CI 1.02-1.83 per 5-unit increase) but not HGSC (OR 1.05, 95% CI 0.83-1.33). In secondary analyses stratified by behavior/subtype, the strongest association was seen for low grade/borderline serous cancers (OR 2.02, 95% CI 1.24-3.30). Women with greater genetically-predicted height had a modestly increased risk of all (invasive and borderline) ovarian tumors (OR 1.06, 95% CI 1.01-1.11 per 5 cm). In secondary analyses stratified by histologic subtype, the strongest association was seen for clear cell cancers (OR 1.20, 95% CI 1.04-1.38). CONCLUSION: This study is the first to apply MR to investigate ovarian cancer risk factors. These data confirm results from epidemiologic studies, suggesting that obesity is causally associated with non-HGSC, but does not increase risk of the most common HGSC subtype. They also support an association between height and ovarian cancer. Citation Format: Suzanne C. Dixon, Christina M. Nagle, Aaron P. Thrift, Paul D.P Pharoah, Ailith Pirie, Celeste Leigh Pearce, Wei Zheng, Penelope M. Webb, for the Ovarian Cancer Association Consortium. Association of adult body mass index and height with risk of ovarian cancer in 39,000 women: Results of a Mendelian randomization study. [abstract]. In: Proceedings of the 106th Annual Meeting of the American Association for Cancer Research; 2015 Apr 18-22; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Res 2015;75(15 Suppl):Abstract nr 881. doi:10.1158/1538-7445.AM2015-881