Hysterectomy, oophorectomy and subsequent ovarian risk

ArticleinObstetrics and Gynecology 81(3):363-6 · April 1993with1 Read
Impact Factor: 5.18 · Source: PubMed
Abstract

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.

    • "The cause of endometriosis was hereby thought to be retrograde menstruation, i.e. the menstrual fluid flows backwards through the Fallopian tubes into the pelvic cavity. This is supported by the decreased risk of ovarian cancer in women who underwent tubal ligation or hysterectomy (Irwin et al., 1991; Sightler et al., 1991; Hankinson et al., 1993; Parazzini et al., 1993; Cornelison et al., 1997; Green et al., 1997; Loft et al., 1997; Miracle-McMahill et al., 1997; Rosenblatt and Thomas, 2004; Cibula et al., 2011; Rice et al., 2012). Furthermore, both endometriosis and ovarian cancers are associated with unopposed estrogens. "
    [Show abstract] [Hide abstract] ABSTRACT: Is ovarian or extra-ovarian endometriosis associated with an increased risk of ovarian cancer and borderline ovarian tumours (BOT)? We found a 3- to 8-fold increased risk of ovarian tumours associated with endometriosis: the magnitude of the risk increase depended on the definition of endometriosis. There is increasing evidence of an association between endometriosis and increased risk of ovarian cancer. However, most reports were based on self-reported diagnosis of endometriosis. We conducted a nationwide historic cohort study among women with subfertility problems between 1980 and 1995. For this analysis we selected all cohort members with endometriosis, and a comparison group of subfertile women (male factor or idiopathic) without endometriosis (total cohort of 8904 women). Median follow-up time was 15.2 for the entire study population. For this analysis we selected all cohort members with (n = 3657) and without (n = 5247) evidence of endometriosis. Seventy-eight per cent of diagnoses of endometriosis were confirmed by pathology report, and 22% was self-reported endometriosis (positive predictive value of 73%). We linked the cohort with the Dutch Pathology Database and the Netherlands Cancer Registry to assess the occurrence of ovarian cancer and BOT between January 1989 and June 2007. We observed a substantially increased risk of all ovarian malignancies combined in women with endometriosis when we based the definition of endometriosis on self-report, medical records information at subfertility treatment and/or the nationwide pathology database (hazard ratio (HR) 8.2; 95% confidence interval (CI) 3.1-21.6). The HR associated with endometriosis was 12.4 (95% CI 2.8-54.2) for ovarian cancer and 5.5 (95% CI 1.5-20.2) for BOT. When we excluded information from the pathology database, HRs were 3.0 (95% CI 1.5-6.1) for all ovarian tumours, 4.3 (95% CI 1.6-11.2) for ovarian cancer and 1.9 (95% CI 0.6-5.8) for BOT. Both ovarian and extra-ovarian endometriosis carried a significantly increased risk for ovarian cancer and BOT. We did not have information on oral contraceptive use and parity for 23.4 and 3.4%, of women in the analytic cohort, respectively. Furthermore, a limitation of our study, and also of other studies, is that the date of diagnosis of endometriosis is usually made long after the onset of the disease. Also, the number of cases in the cohort is small (n = 34), resulting in wide CIs. The fact that endometriosis was assessed before diagnosis of ovarian malignancy and the high degree of medical confirmation in our study likely contribute to the validity of our estimate of a 3- to 8-fold increased risk of ovarian tumours associated with endometriosis. The risk of ovarian malignancies associated with endometriosis was much higher in analyses including information on endometriosis from the nationwide pathology database, implying that risk estimates from studies using self-reported information on endometriosis may be too low due to non-differential misclassification bias. None. None.
    Preview · Article · Sep 2013 · Human Reproduction
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    • "Long-term oral contraceptive use and higher parity are consistently associated with a reduced ovarian cancer risk78910111213141516171819. Hysterectomy has been suggested to be protective, estimated to confer a 30%-50% risk reduction20212223. 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]. "
    [Show abstract] [Hide abstract] 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.
    Full-text · Article · Apr 2013 · Journal of Gynecologic Oncology
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    • "One potential explanation is a " screening effect " wherein surgeons areFigure 3 Forest plot for 24 studies of the association between hysterectomy and ovarian cancer risk. Forest plot summarizing individual effect estimates from 24 studies [9,10,12,13,15,16,23,26,29,31,32,38394041424344454647 contributing to summary effect estimates describing the association between hysterectomy and ovarian cancer risk. Black boxes mark the effect estimate for individual studies and the size of the black boxes represent the weight of individual studies in the summary estimate; horizontal gray lines demonstrate the width of the 95% CIs associated with each individual study; the black diamonds represent summary effect; stars indicate pooled studies. "
    [Show abstract] [Hide abstract] 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.
    Full-text · Article · May 2012 · Journal of Ovarian Research
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