Article

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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    • "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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