Tubal sterilisation, hysterectomy and decreased risk of ovarian cancer

Abstract

We have examined the effect of tubal sterilisation and hysterectomy on risk of ovarian cancer in a large case-control study in eastern Australia involving 824 women aged 18-79 years, diagnosed with epithelial ovarian cancer between 1990 and 1993, and 855 controls randomly selected from the electoral roll. Relative risks for ovarian cancer were estimated using multiple categorical regression to adjust for age, parity, oral contraceptive use and other risk factors. Tubal sterilisation was associated with a 39% reduction in risk of ovarian cancer (RR 0.61, 95% CI 0.46-0.85) and hysterectomy with a 36% reduction (RR 0.64, 95% CI 0.48-0.85). Risk remained low 25 years after surgery and was reduced irrespective of sterilisation technique, and estimates were similar among various types of epithelial ovarian cancer. The greatest reduction (74%) was observed among women with primary peritoneal tumours. Pelvic infection and use of vaginal sprays or contraceptive foams were not related to ovarian cancer, while use of talc in the perineal region slightly but significantly increased risk among women with patent fallopian tubes. Reportedly heavy or painful menses, perhaps associated with retrograde flow, were associated with ovarian cancer, and reduction in risk of disease after hysterectomy was greatest among women who had heavy periods. Although the factors that cause epithelial ovarian cancer are unknown, there are several discretionary factors that appear to protect against it. Oral contraception is associated with up to 70% reduction in risk after 10 or more years of use compared with never-use (Purdie et al., 1995), the protection presumably reflecting long-term suppression of ovulation. A 30-50% reduction in risk has been observed (Booth et al., 1989;Hankinson et al., 1993;Irwin et al., 1991;Whittemore et al., 1992), though not consistently (Chen et al., 1992;Risch et al., 1994;Shu et al., 1989), after tubal sterilisation, and this is independent of childbearing and oralcontraceptive use. A similar inverse association is found between hysterectomy with ovarian conservation and ovarian cancer (Hankinson et al., 1993;Hartge et al., 1989;Irwin et al., 1991;Risch et al., 1994;Weiss and Harlow, 1986).Explanations include blocking the ascent into the peritoneal cavity (Woodruff, 1971) of carcinogenic agents such as talc (Henderson et al., 1979), asbestos (Graham and Graham, 1967), viruses (Wahlberg, 1994) or contraceptive foams or gels (Silver, 1994) through surgical closure of the fallopian tubes or postsurgical compromise of ovarian circulation (Cattanach, 1985) associated with decreased ovarian function. Alternatively, the negative associations between pelvic surgery and ovarian cancer may be secondary to sub-fertility (Mori et al., 1992) or may be the result of surveillance bias since women whose ovaries have been screened for malignancy during surgery will have a reduced risk of cancer for several years compared with women not screened in this manner (Weiss and Harlow, 1986). Available data are largely inconclusive a...

Peritoneal carcinoma in women with genetic susceptibility: implications for Jewish populations

“…However, Narod's group found no risk reduction associated with tubal ligation in BRCA2 mutation carriers. Reductions in the risk of ovarian cancer similar to those observed with gynecologic surgery by Rutter et al and with tubal ligation by Narod et al in BRCA1 mutation carriers have been reported with tubal ligation and hysterectomy in general population studies [188][189][190][191].…”

“…Green et al found that while tubal ligation was associated with a 39% reduction in ovarian cancer risk, previous tubal ligation or hysterectomy was associated with an even greater 74% reduction of primary peritoneal cancer [190]. From these observations it can be concluded that although most profoundly bilateral oophorectomy and hysterectomy [129,130,153], but also tubal ligation [153,187], reduce the risk for ovarian cancer, and perhaps also peritoneal carcinoma, in women with and without genetic susceptibility, neither oophorectomy nor other gynecological operations are fully protective [116,129,130,153,187].…”

Current Understanding of Risk Factors for Ovarian Cancer

“…Although menses cease at menopause, there continues to be an ever diminishing secretion of hormones that may have a beneficial effect. • Almost all epidemiological studies that examined the association between tubal ligation and EOC risk support a protective effect with observed risk reductions from 10% to 80% [11,13,17,23,[64][65][66]. Prospective data from the Nurses Health Study on a cohort of 121,700 female nurses (30-55 years) showed a statistically significant 67% reduced risk of EOC among nurses who had tubal ligation compared to those without this procedure [66].…”

“…The reduced risks of EOC after tubal ligation also persisted across all levels of parity in this study. Furthermore, the protective effect after tubal ligation has been reported to persist up to 20 years after the surgery [64,65]. It appears that most common surgical sterilization methods are equally protective [65].…”

Benign Epithelial Ovarian Tumours—cancer Precursors or Markers for Ovarian Cancer Risk?

“…Consistent evidence suggests that an increased risk of invasive EOC is associated with a family history of ovarian cancer, while decreased risk is associated with increasing parity, oral contraceptive (OC) use, breast-feeding, tubal ligation and hysterectomy [13][14][15]. Risk factors for Fig.…”