Tubal ligation, hysterectomy and ovarian cancer: A meta-analysis

Abstract

PurposeThe purpose of this meta-analysis was to determine the strength of the association between gynecologic surgeries, tubal ligation and hysterectomy, and ovarian cancer.MethodsWe 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.ResultsThe 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.ConclusionObservational 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.

Reproductive characteristics in relation to ovarian cancer risk by histologic pathways

“…The strong inverse association for tubal ligation with risk of endometrioid tumors is consistent with two meta-analyses (both included the NECC study) (Cibula et al, 2011;Rice et al, 2012). In contrast, we found no evidence that tubal ligation or hysterectomy were protective for type II/high-grade serous tumors, although this result is not supported by the finding of a 27% risk reduction with tubal ligation for serous invasive cancers (Cibula et al, 2011).…”

Scenario of ovarian mass lesions at a teaching hospital in Andhra Pradesh, India

“…Surgeries such as hysterectomy and tubal ligation are said to confer a weak protective effect against ovarian cancer from ascending carcinogens. 23. Women with ovarian preservation at hysterectomy are at risk for future oophorectomy, which ranges from 2.9% to 7.7%.…”

Costs and Benefits of Opportunistic Salpingectomy as an Ovarian Cancer Prevention Strategy

“…18 We assumed a 90% reduction in ovarian cancer risk with BSO 6 and a 20% reduction with hysterectomy alone. 19,20 Based on long-term follow-up data from the Nurses Health Study, women having concomitant BSO with hysterectomy before the age of 50 years without estrogen replacement therapy had higher risks of all-cause mortality from coronary heart disease, cardiovascular disease, and total cancers including lung and colorectal cancer. We assumed that premenopausal women who had BSO with hysterectomy were routinely prescribed estrogen replacement therapy after surgery, but that 20% discontinued this by 5 years.…”