Hysterectomy, oophorectomy and subsequent ovarian risk
Istituto di Ricerche Farmacologiche Mario Negri, Milano, Italy. Obstetrics and Gynecology
(Impact Factor: 5.18).
To analyze the relation between hysterectomy with or without oophorectomy and the risk of subsequent ovarian cancer.
We have conducted a case-control study since 1983 in a network of general and university hospitals in the greater Milan area. The cases were 953 women aged less than 75 years with histologically confirmed epithelial ovarian cancer. Women younger than 75 years residing in the same geographic area and admitted for acute conditions to the same network of hospitals where the cases had been identified were eligible as controls. Potential controls were excluded if they had been admitted for gynecologic, hormonal, or neoplastic diseases or had previously undergone bilateral oophorectomy. A total of 2758 controls were interviewed.
Fifty-two cases (5.5%) and 215 controls (7.8%) reported a history of hysterectomy, including eight cases and 38 controls who also reported unilateral oophorectomy. In comparison with women with intact uterus and ovaries, the age-adjusted relative risk (RR) was 0.7 in both women who reported hysterectomy alone (95% confidence interval [CI] 0.5-0.9) and in those reporting hysterectomy plus unilateral oophorectomy, though the latter finding was not statistically significant (95% CI 0.3-1.4). The risk of ovarian cancer was inversely related with time from hysterectomy. Compared with women reporting no pelvic surgery, the RR was 0.9 (95% CI 0.4-1.7), 0.7 (0.3-1.6), 0.7 (0.3-1.4), and 0.5 (0.3-0.8), respectively, in women reporting hysterectomy within 4 years or less and 5-9, 10-14, and 15 years or more before interview.
Hysterectomy approximately halves the risk of ovarian cancer, possibly because of altered ovarian blood flow or the opportunity that hysterectomy provides for examining the ovaries.
Available from: Colin Binns
- "Long-term oral contraceptive use and higher parity are consistently associated with a reduced ovarian cancer risk [7-19]. Hysterectomy has been suggested to be protective, estimated to confer a 30%-50% risk reduction [20-23]. The evidence regarding use of hormone replacement therapy is somewhat conflicting, with some studies reporting a greater risk of ovarian cancer [19,24], and others revealing no association [9,12,25]. "
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ABSTRACT: To investigate the association between reproductive factors and the risk of ovarian cancer among southern Chinese women.
A hospital-based case-control study was undertaken in Guangzhou, Guangdong Province, between 2006 and 2008. A structured questionnaire was used to obtain information on parity, oral contraceptive use and other reproductive factors in a sample of 500 incident ovarian cancer patients and 500 controls (mean age, 59 years). Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated using unconditional logistic regression models.
High parity was inversely associated with ovarian cancer, with an adjusted OR 0.43 (95% CI, 0.30 to 0.62) for women who had given birth to 3 or more children compared to women who had given no more than one birth. Ever use of oral contraceptives was also protective against ovarian cancer; adjusted OR 0.56 (95% CI, 0.40 to 0.78). No association was found for hormone replacement therapy, menopausal status, hysterectomy and family history of ovarian and/or breast cancer.
High parity and oral contraceptive use are associated with a lower risk of ovarian cancer in southern Chinese women.
Available from: Shelley S Tworoger
- "For the examination of hysterectomy and ovarian cancer, we identified 24 studies to include in the meta-analysis (Figure 1) [9,10,12,13,15,16,23-26,29,31,32,38-47]. Nine of the studies reported effect estimates for simple hysterectomy, [23,25,29,32,38,42,43,45] seven provided estimates for hysterectomy with unilateral oophorectomy, [23,29,32,38,42,45] and 15 did not distinguish whether or not women with hysterectomy underwent a unilateral oophorectomy [9,10,12,13,15,16,24,26,31,39-41,44,46,47]. Two of the studies included in the primary meta-analysis for both tubal ligation and hysterectomy were pooled analyses [9,31], one was comprised of eight studies  and another was comprised of four studies . "
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ABSTRACT: The purpose of this meta-analysis was to determine the strength of the association between gynecologic surgeries, tubal ligation and hysterectomy, and ovarian cancer.
We searched the PubMed, Web of Science, and Embase databases for all English-language articles dated between 1969 through March 2011 using the keywords "ovarian cancer" and "tubal ligation" or "tubal sterilization" or "hysterectomy." We identified 30 studies on tubal ligation and 24 studies on hysterectomy that provided relative risks for ovarian cancer and a p-value or 95% confidence interval (CI) to include in the meta-analysis. Summary RRs and 95% CIs were calculated using a random-effects model.
The summary RR for women with vs. without tubal ligation was 0.70 (95%CI: 0.64, 0.75). Similarly, the summary RR for women with vs. without hysterectomy was 0.74 (95%CI: 0.65, 0.84). Simple hysterectomy and hysterectomy with unilateral oophorectomy were associated with a similar decrease in risk (summery RR = 0.62, 95%CI: 0.49-0.79 and 0.60, 95%CI: 0.47-0.78, respectively). In secondary analyses, the association between tubal ligation and ovarian cancer risk was stronger for endometrioid tumors (summary RR = 0.45, 95%CI: 0.33, 0.61) compared to serous tumors.
Observational epidemiologic evidence strongly supports that tubal ligation and hysterectomy are associated with a decrease in the risk of ovarian cancer, by approximately 26-30%. Additional research is needed to determine whether the association between tubal ligation and hysterectomy on ovarian cancer risk differs by individual, surgical, and tumor characteristics.
- "This was also demonstrated for hysterectomy. (Parazzini et al,1993;Tung et al,2003) "
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