title: Tubal ligation, hysterectomy and epithelial ovarian cancer in the New England Case-Control Study.
abstract: Previous studies have observed that tubal ligation and hysterectomy are associated with a decreased risk of ovarian cancer; however, little is known about whether these associations vary by surgical characteristics, individual characteristics or tumor histology. We used logistic regression to examine tubal ligation, simple hysterectomy and hysterectomy with unilateral oophorectomy in relation to risk of epithelial ovarian cancer in the New England Case-Control Study. Our primary analysis included 2,265 cases and 2,333 controls. Overall, tubal ligation was associated with a lower risk of epithelial ovarian cancer [odds ratio (OR) = 0.82, 95% confidence interval (CI): 0.68-0.97], especially for endometrioid tumors (OR = 0.45, 95% CI: 0.29-0.69). The inverse association between tubal ligation and ovarian cancer risk was stronger for women who had undergone the procedure at the time of last delivery (OR = 0.60, 95% CI: 0.42-0.84) rather than at a later time (OR = 0.93, 95% CI: 0.75-1.15). Overall, simple hysterectomy was not associated with ovarian cancer risk (OR: 1.09, 95% CI: 0.83-1.42), although it was associated with a nonsignificant decreased risk of ovarian cancer among women who underwent the procedure at age 45 or older (RR: 0.64, 95% CI: 0.40-1.02) or within the last 10 years (OR = 0.65, 95% CI: 0.38-1.13). Overall, women who had a hysterectomy with a unilateral oophorectomy had significantly lower risk of ovarian cancer (OR = 0.65, 95% CI: 0.45-0.94). In summary, tubal ligation and hysterectomy with unilateral oophorectomy were inversely associated with ovarian cancer risk in a large population-based case-control study. Additional research is necessary to understand the potential biologic mechanisms by which these procedures may reduce ovarian cancer risk.
authors: Department of Epidemiology, Harvard School of Public Health, Boston, MA; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA.
authors: Megan S
authors: MS
authors: Rice
authors: Megan A
authors: MA
authors: Murphy
authors: Allison F
authors: AF
authors: Vitonis
authors: Daniel W
authors: DW
authors: Cramer
authors: Linda J
authors: LJ
authors: Titus
authors: Shelley S
authors: SS
authors: Tworoger
authors: Kathryn L
authors: KL
authors: Terry
mesh_terms: D000328:Adult; D000077216:Carcinoma, Ovarian Epithelial; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000379:methods / Q000706:statistics & numerical data*; D016015:Logistic Models; D008875:Middle Aged; D009375:Neoplasms, Glandular and Epithelial / Q000453:epidemiology* / Q000473:pathology / Q000601:surgery; D009511:New England / Q000453:epidemiology; D016017:Odds Ratio; D010051:Ovarian Neoplasms / Q000453:epidemiology* / Q000473:pathology / Q000601:surgery; D012306:Risk; D012307:Risk Factors; D013246:Sterilization, Tubal / Q000379:methods / Q000706:statistics & numerical data*
keywords: epithelial ovarian cancer; hysterectomy; tubal ligation; tubal sterilization
references: Int J Cancer. 2013 Mar 1;132(5):1114-24
references: 22740148
references: Int J Epidemiol. 2004 Jun;33(3):596-602
references: 15163640
references: Obstet Gynecol Surv. 1992 Feb;47(2):71-9
references: 1538875
references: Am J Epidemiol. 2007 Oct 15;166(8):894-901
references: 17656616
references: Cancer Epidemiol Biomarkers Prev. 2009 Feb;18(2):601-10
references: 19190154
references: Int J Cancer. 1995 Nov 3;63(3):361-5
references: 7591232
references: Int J Gynecol Pathol. 2011 Nov;30(6):553-68
references: 21979592
references: Menopause. 2009 May-Jun;16(3):576-81
references: 19169161
references: Hum Reprod Update. 2011 Jan-Feb;17(1):55-67
references: 20634209
references: ISRN Obstet Gynecol. 2011;2011:140310
references: 21789283
references: Am J Epidemiol. 2009 Sep 1;170(5):598-606
references: 19605513
references: Int J Cancer. 2009 Mar 15;124(6):1409-15
references: 19065661
references: Obstet Gynecol. 1993 Mar;81(3):363-6
references: 8437787
references: Am J Epidemiol. 2004 Oct 1;160(7):613-8
references: 15383404
references: Am J Epidemiol. 1992 Nov 15;136(10):1184-203
references: 1476141
references: Br J Cancer. 1989 Oct;60(4):592-8
references: 2679848
references: Int J Cancer. 1997 Jun 11;71(6):948-51
references: 9185694
references: Am J Epidemiol. 1991 Aug 15;134(4):362-9
references: 1877597
references: Int J Biol Markers. 2001 Apr-Jun;16(2):112-20
references: 11471893
references: Cancer. 1979 Feb;43(2):723-9
references: 421190
references: Breast Cancer Res Treat. 2001 Sep;69(1):1-11
references: 11759823
references: Cancer Epidemiol Biomarkers Prev. 1996 Nov;5(11):933-5
references: 8922304
references: Obstet Gynecol. 2007 Nov;110(5):1091-5
references: 17978124
references: Gynecol Oncol. 2005 May;97(2):318-22
references: 15863124
references: Am J Epidemiol. 1997 Feb 15;145(4):349-57
references: 9054239
references: Natl Health Stat Report. 2008 Jul 30;(5):1-20
references: 18841653
references: Cancer Detect Prev. 1997;21(1):1-6
references: 9043756
references: J Natl Cancer Inst. 2003 Jul 16;95(14):1072-8
references: 12865453
references: Am J Epidemiol. 2005 Mar 1;161(5):442-51
references: 15718480
references: Eur J Cancer. 2008 Nov;44(16):2477-84
references: 18707869
references: Int J Cancer. 2012 Aug 15;131(4):E518-29
references: 21953625
references: J Ovarian Res. 2012 May 15;5(1):13
references: 22587442
references: Natl Health Stat Report. 2009 Jan 28;(11):1-25
references: 19294964
references: Ann Epidemiol. 2011 Mar;21(3):188-96
references: 21109450
references: Ann Epidemiol. 1995 Jul;5(4):310-4
references: 8520714
references: Ann Epidemiol. 2001 Nov;11(8):568-74
references: 11709277
references: Cancer Epidemiol Biomarkers Prev. 2010 Jun;19(6):1595-601
references: 20501761
references: JAMA. 1993 Dec 15;270(23):2813-8
references: 8133619
references: Lancet Oncol. 2007 Jan;8(1):26-34
references: 17196508
references: Int J Epidemiol. 1997 Aug;26(4):710-5
references: 9279601
references: Lancet Oncol. 2012 Apr;13(4):385-94
references: 22361336
references: J Reprod Med. 1981 Jun;26(6):289-94
references: 6454781