Prediagnostic serum calcium and albumin and ovarian cancer: A nested case-control study in the Norwegian Janus Serum Bank Cohort

- A nested case control study of ovarian cancer with 202 matched cases/controls.
- After 15 years of follow-up: high serum calcium was associated with increased risk.
- A markedly increased risk for high serum albumin is described for the first time.

BackgroundWomen with higher serum calcium may be more likely to be diagnosed and die of ovarian cancer. We evaluated that finding in a large, prospective cohort.MethodsWe conducted a nested case-control study using a population-based biobank from Norway. We compared 202 ovarian cancer cases and 202 controls, matched for age, date at blood draw, and county of residence, with respect to serum calcium and albumin, adjusted for anthropometric variables. We evaluated risks using the entire follow-up period as well as 2-15 years and 16-25 years (“early” and “late”, respectively).ResultsFor the entire follow-up, risk was significantly increased in the highest tertile of albumin and for high albumin and calcium jointly. Risks for ovarian cancer differed markedly by follow-up time. In early follow-up, women in the highest tertile of serum calcium had a 2.5-fold increased risk, adjusted for height and body mass index (OR = 2.47, 95% C.I. 1.12-5.45) with a significant dose-response (p = 0.024). Risk was not elevated in late follow-up (OR = 0.62, 95% C.I. 0.27-1.36). Similarly, in early follow-up, women in the highest tertile of serum albumin had an increased risk (OR = 2.55, 95% C.I.1.22-5.49) with a significant dose-response (p = 0.009). Conversely, risk was not increased in late follow-up (OR = 1.36, 95% C.I. 0.65-2.83).ConclusionsThese data confirm a prospective association between higher serum calcium and ovarian cancer. An association in early, but not late, follow-up suggests that the higher calcium reflects the presence of existing cancer. A positive association with serum albumin is novel and should be interpreted cautiously.