title: Ovarian cancer risk after salpingectomy: a nationwide population-based study.
abstract: BACKGROUND
  Recent genetic and morphologic studies have challenged the traditional view on the pathogenesis of ovarian cancer; suggesting that ovarian cancer predominantly arises within the fallopian tubes or the uterus. We hypothesize that surgical removal of the fallopian tubes is associated with a reduced risk for ovarian cancer.
  
  
  METHODS
  In this population-based cohort study, we used data on women with previous surgery on benign indication (sterilization, salpingectomy, hysterectomy, and bilateral salpingo-oophorectomy [BSO], hysterectomy; n = 251465) compared with the unexposed population (n = 5449119) between 1973 and 2009 and analyzed with Cox regression models. The effects of one- and two-sided salpingectomy were considered in a subanalysis. All statistical tests were two-sided.
  
  
  RESULTS
  There was a statistically significantly lower risk for ovarian cancer among women with previous salpingectomy (HR = 0.65, 95% CI = 0.52 to 0.81) when compared with the unexposed population. In addition, statistically significant risk reductions were observed among women with previous hysterectomy (HR = 0.79, 95% CI = 0.70 to 0.88), sterilization (HR = 0.72, 95% CI = 0.64 to 0.81), and hysterectomy with BSO (HR = 0.06, 95% CI = 0.03 to 0.12). Bilateral salpingectomy was associated with a 50% decrease in risk of ovarian cancer compared with the unilateral procedure (HR = 0.35, 95% CI = 0.17 to 0.73, and 0.71, 95% CI = 0.56 to 0.91, respectively).
  
  
  CONCLUSIONS
  Salpingectomy on benign indication is associated with reduced risk of ovarian cancer. These data support the hypothesis that a substantial fraction of ovarian cancer arises in the fallopian tube. Our results suggest that removal of the fallopian tubes by itself, or concomitantly with other benign surgery, is an effective measure to reduce ovarian cancer risk in the general population.
authors: Department of Medical Epidemiology and Biostatistics (HF, LY, HG, DA) and Department of Women's and Children's Health (HF), Karolinska Institutet, Stockholm, Sweden; Department of Clinical Sciences, Karolinska Institutet Danderyd Hospital, Stockholm, Sweden (DA). henrik.falconer@karolinska.se.
authors: Henrik
authors: H
authors: Falconer
authors: Department of Medical Epidemiology and Biostatistics (HF, LY, HG, DA) and Department of Women's and Children's Health (HF), Karolinska Institutet, Stockholm, Sweden; Department of Clinical Sciences, Karolinska Institutet Danderyd Hospital, Stockholm, Sweden (DA).
authors: Li
authors: L
authors: Yin
authors: Department of Medical Epidemiology and Biostatistics (HF, LY, HG, DA) and Department of Women's and Children's Health (HF), Karolinska Institutet, Stockholm, Sweden; Department of Clinical Sciences, Karolinska Institutet Danderyd Hospital, Stockholm, Sweden (DA).
authors: Henrik
authors: H
authors: Grönberg
authors: Department of Medical Epidemiology and Biostatistics (HF, LY, HG, DA) and Department of Women's and Children's Health (HF), Karolinska Institutet, Stockholm, Sweden; Department of Clinical Sciences, Karolinska Institutet Danderyd Hospital, Stockholm, Sweden (DA).
authors: Daniel
authors: D
authors: Altman
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D005187:Fallopian Tubes / Q000473:pathology / Q000601:surgery; D005260:Female; D006801:Humans; D007044:Hysterectomy; D008875:Middle Aged; D010051:Ovarian Neoplasms / Q000453:epidemiology* / Q000517:prevention & control*; D010052:Ovariectomy; D016016:Proportional Hazards Models; D012042:Registries; D018570:Risk Assessment; D012307:Risk Factors; D058994:Salpingectomy; D013246:Sterilization, Tubal; D013548:Sweden / Q000453:epidemiology