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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    ABSTRACT: Routine dysplasia screening decreases the rates of cervical cancer. Since many women seek gynecological care to secure contraception, it was hypothesized that sterilized women will be less likely to undergo routine cervical cancer screening. Prior studies tried to evaluate this relationship, but results were conflicting. The study sought to further explore the sociodemographic and behavioral risk factors that might predispose sterilized women to be screening non-adherent and more likely to have cervical dysplasia.
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    ABSTRACT: Objective According to the recent theories on the ovarian cancer origin, any protective effect of tubal ligation may vary with histologic subtype of ovarian cancer. Furthermore, bilateral salpingectomy may represent an opportunity for surgical prevention of serous ovarian cancer.DesignNationwide register-based case-control study.SettingDenmark during 1982–2011.PopulationCases were all Danish women diagnosed with epithelial ovarian cancer (n=13 241) or borderline ovarian tumor (n=3605) in the study period. Age-matched female population controls were randomly selected by risk set sampling. We required that cases and controls had no previous cancer and that controls had no previous bilateral oophorectomy.Methods Conditional logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs), adjusting for potential confounders.Main outcome measuresEpithelial ovarian cancer and borderline ovarian tumors stratified according to histology. Results. Tubal ligation reduced overall epithelial ovarian cancer risk (OR=0.87; 95% CI: 0.78–0.98). We observed significant risk variation according to histology (p=0.003) with the strongest risk reductions associated with endometrioid cancer (OR=0.66; 95% CI: 0.47–0.93) and epithelial ovarian cancer of “other” histology (OR=0.60; 95% CI: 0.43–0.83). Tubal ligation was not associated with risk of borderline ovarian tumors. Finally, bilateral salpingectomy reduced epithelial ovarian cancer risk by 42% (OR=0.58; 95% CI: 0.36–0.95).Conclusions We confirmed that tubal ligation reduces the risk of epithelial ovarian cancer and particularly endometrioid cancer. To our knowledge, this is the first observational publication to report on salpingectomy and ovarian cancer risk and our promising findings warrant further investigation.This article is protected by copyright. All rights reserved.
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    ABSTRACT: Das Ovarialkarzinom wird zumeist in fortgeschrittenem Stadium mit entsprechend schlechter Prognose diagnostiziert. Prävention und Screening könnten diesen fatalen Verlauf beeinflussen. Charakterisierung und Identifikation der Risikogruppen, bereits verfügbare präventive Maßnahmen fördern und mögliche in Studien evaluieren, Verbesserung der Diagnostik und Evaluation möglicher Screeningmethoden – dies sind einige Aspekte des Problemfeldes. Betrachtet werden hormonelle Kontrazeption, weitere endokrine und chemopräventive Optionen sowie chirurgische Aspekte. Die Bedeutung von nichthereditären Risiken, welche die Inzidenz des Ovarialkarzinoms erhöhen, wird erörtert. Bereits heute bestehen Interventions- und Vermeidungsmöglichkeiten zur Prävention des Ovarialkarzinoms, die mit diagnostischen Maßnahmen verbunden werden können. Sekundär- und Tertiärprävention werden diskutiert.
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