Tubal sterilization and risk of ovarian, endometrial and cervical cancer. A Danish population-based follow-up study of more than 65 000 sterilized women

Danish Cancer Society, Institute of Cancer Epidemiology, Copenhagen, Denmark.
International Journal of Epidemiology (Impact Factor: 9.2). 06/2004; 33(3):596-602. DOI: 10.1093/ije/dyh046
Source: PubMed

ABSTRACT On the basis of a population-based cohort, we assessed the cancer risk, focusing on gynaecological cancers and pre-malignant lesions, among women with a previous tubal sterilization.
Using the Danish Hospital Discharge Register we identified 65 232 women who had a tubal sterilization (1977-1993). The cohort was followed for cancer occurrence, and compared with the expected number based on the national cancer incidence rates.
The overall risk of ovarian cancer was decreased (standardized incidence ratio [SIR] = 0.82; 95% CI: 0.6, 1.0), and it was still decreased > or =10 years after the sterilization (SIR = 0.65; 95% CI: 0.4, 1.0). The rate of endometrial cancer was also decreased (SIR = 0.66; 95% CI: 0.5, 1.0), the risk continued being moderately reduced during follow-up, although it was not statistically significant.
In this nationwide, population-based study we find that women with tubal sterilization have a decreased risk of subsequent development of ovarian cancer. As the protective effect is not decreasing with years of follow-up, our data do not support that 'screening' bias can explain the protective effect, but indicate that the sterilization itself may convey a reduction in risk. The same pattern is found for endometrial cancer, the association being less strong.

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    • "Thus, simultaneous risk-reducing salpingectomies may become more widespread whenever a hysterectomy needs to be performed for benign indications and may be worth evaluating as isolated preventive procedures for women at a certain age group. It is well established that tubal ligation has a protective effect against the development of ovarian cancer [43] [44] [45]. Although the mechanisms remain unclear, with a tubal model of serous carcinogenesis, this protective risk may be explained in 3 ways: 1) For mid tubal ligation procedures, the mechanical barrier created by the ligation may prevent potentially mutagenic factors (inflammation, "
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    • "References from relevant articles were searched for additional relevant studies. A total of 32 casecontrol (Mori et al., 1984, 1988; Harlow et al., 1988; Hartge et al., 1988; Whittemore et al., 1988, 1992a, b; Booth et al., 1989; Shu et al., 1989; Irwin et al., 1991; Chen et al., 1992; Risch et al., 1994; Rosenberg et al., 1994; Cramer and Xu, 1995; Purdie et al., 1995; Risch et al., 1996; Rosenblatt and Thomas, 1996; Cornelison et al., 1997; Green et al., 1997; Modugno et al., 2001, 2004; Narod et al., 2001; Ness et al., 2001; Tung et al., 2003; McGuire et al., 2004; Mills et al., 2004; Pike et al., 2004; McLaughlin et al., 2007; Jordan et al., 2008; Moorman et al., 2008; Nagle et al., 2008), 5 prospective cohort (Hankinson et al., 1993; Miracle-McMahill et al., 1997; Tworoger et al., 2007; Antoniou et al., 2009; Dorjgochoo et al., 2009) and 3 historical cohort (Koch et al., 1984; Kreiger et al., 1997; Kjaer et al., 2004) studies were identified and included in the overview (Tables 1–3). The studies available were categorized into three groups for the main meta-analysis (Tables 1–3). "
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    ABSTRACT: The reduction of ovarian cancer (OC) risk in women with a history of tubal ligation (TL) has been reported repeatedly, mostly on small populations. We have aimed to provide a critical overview of the studies available to date and to conduct a meta-analysis. There were 40 relevant studies identified. The studies were divided into two groups for strict and extended meta-analysis, respectively. Subgroup analysis was performed for age, time dependency since TL, histological types of OC and BReast CAncer (BRCA) mutation. Meta-analysis of 13 strictly selected studies showed a reduced risk of epithelial OC by 34%. The protective effect of TL was confirmed even in a subgroup of women 10-14 years after the procedure. The risk reduction was confirmed for the endometrioid (RR = 0.40) and serous (RR = 0.73) cancers but not for mucinous. The review of relevant articles, as well as the meta-analysis of selected studies, yields consistent data on a significant reduction of OC risk in women who had undergone TL. The results of this meta-analysis should provide an impulse for further research on the etiology of ovarian epithelial cancers, focusing particularly on the importance of retrograde transport of endometrial cells.
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    • "We did not enquire about the poststerilisation use of the levonorgestrel-releasing IUS or uterine artery embolisation. Tubal sterilisation may offer some protection again ovarian, cervical , endometrial and breast cancers [31] [32], though if real the mechanisms are unknown. The numbers and duration of followup in our study do not permit useful conclusions regarding tumour development between sterilisation and questionnaire completion. "
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    ABSTRACT: To observe the incidence of menstrual symptoms and relevant surgery after sterilisation. 1101 women sterilised with Filshie clips between 1983 and 2002 were assessed prospectively comparing menstrual symptomatology documented immediately before surgery and 5-14 years later by questionnaire. Prevalence of menstrual dysfunction and subsequent surgery related to pre-operative menstrual symptoms and contraception. After excluding 232 (24%) of the 968 eligible women sent questionnaires whose address had changed, 573 of the remaining 735 women (78%) completed the questionnaire, 223 5-6 years after sterilisation, 175 after 7-9 years and 175 after 10-15 years; the respondents were demographically representative of the total population. Heavy periods increased from 9% before to 35% (P<0.0001) after sterilisation, painful periods from 2% to 21% (P<0.0001) and 6% had undergone hysterectomy or endometrial ablation. These findings were not influenced by the pre-sterilisation method of contraception but were inversely related to advancing age (P<0.0002). The lowest rates of menstrual symptoms were reported 10-15 years after sterilisation. Menstrual symptoms increased following Filshie clip sterilisation irrespective of pre-sterilisation symptoms and contraception. Whatever the causative mechanism, the progestogen-loaded intrauterine system (IUS), with similar efficacy but with improved menstrual symptoms, should be considered before sterilisation.
    Maturitas 04/2010; 65(4):372-7. DOI:10.1016/j.maturitas.2010.01.005 · 2.86 Impact Factor