The Association Between Hysterectomy and Ovarian Cancer Risk: A Population-Based Record-Linkage Study

Abstract

Background Recent studies have called into question the long-held belief that hysterectomy without oophorectomy protects against ovarian cancer. This population-based longitudinal record-linkage study aimed to explore this relationship, overall and by age at hysterectomy, time period, surgery type, and indication for hysterectomy. Methods We followed the female adult Western Australian population (837 942 women) across a 27-year period using linked electoral, hospital, births, deaths, and cancer records. Surgery dates were determined from hospital records, and ovarian cancer diagnoses (n = 1640) were ascertained from cancer registry records. We used Cox regression to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for the association between hysterectomy and ovarian cancer incidence. Results Hysterectomy without oophorectomy (n = 78 594) was not associated with risk of invasive ovarian cancer overall (HR = 0.98, 95% CI = 0.85 to 1.11) or with the most common serous subtype (HR = 1.05, 95% CI = 0.89 to 1.23). Estimates did not vary statistically significantly by age at procedure, time period, or surgical approach. However, among women with endometriosis (5.8%) or with fibroids (5.7%), hysterectomy was associated with substantially decreased ovarian cancer risk overall (HR = 0.17, 95% CI = 0.12 to 0.24, and HR = 0.27, 95% CI = 0.20 to 0.36, respectively) and across all subtypes. Conclusions Our results suggest that for most women, having a hysterectomy with ovarian conservation is not likely to substantially alter their risk of developing ovarian cancer. However, our results, if confirmed, suggest that ovarian cancer risk reduction could be considered as a possible benefit of hysterectomy when making decisions about surgical management of endometriosis or fibroids.

Hysterectomy with and without oophorectomy and all-cause and cause-specific mortality

“…The exposures of interest were hysterectomy and oophorectomy for benign indication, defined using procedure codes from the HMDC, as we had done in a previous publication (Supplemental Table 3). 17 Oophorectomy was categorized as none, unilateral, or bilateral. Women who had an oophorectomy more than 6 months before or after their hysterectomy were categorized as having a separate oophorectomy.…”

Endometriosis-Associated Ovarian Cancer: The Origin and Targeted Therapy

“…However, according to a report from Sweden, in women hospitalized for a diagnosis of endometriosis, the risk ratio of ovarian cancer was 1.54 without hysterectomy and 1.05 with hysterectomy, with hysterectomy eliminating the risk of ovarian cancer [ 20 ]. In addition, in a study reported in 2019 that followed 830,000 women for 27 years, hysterectomy without oophorectomy reduced the risk of ovarian cancer to HR 0.17 in women with endometriosis [ 41 ]. Thus, the risk of developing EAOC was reduced with hysterectomy rather than cystectomy of ECs.…”

Endometriosis and endometriosis associated ovarian cancer

“…Evidence suggests that performing a hysterectomy while preserving the ovaries may help to prevent the development of ovarian cancers in women. Report from Dixon-Suen et al on a study carried out on 837 942 women from Western Australia, demonstrated that in women diagnosed with endometriosis or fibroids, a hysterectomy significantly reduced their overall risks for developing ovarian cancers (HR = 0.17, 95% CI = 0.12-0.24, and HR = 0.27, 95% CI = 0.20-0.36, respectively) [42] . Furthermore, in some cases of endometriosis, cystectomies may also aid in preventing cancer development [43] .…”