Endometriosis and menopausal hormone therapy impact the hysterectomy-ovarian cancer association

Khoja, Lilah; Weber, Rachel Palmieri; Webb, Penelope M.; Jordan, Susan J.; Muthukumar, Aruna; Chang‐Claude, Jenny; Fortner, Renée T.; Jensen, Allan; Kjær, Susanne K.; Risch, Harvey A.; Doherty, Jennifer A.; Harris, Holly R.; Goodman, Marc T.; Modugno, Francesmary; Moysich, Kirsten B.; Berchuck, Andrew; Schildkraut, Joellen M.; Cramer, Daniel W.; Terry, Kathryn L.; Anton‐Culver, Hoda; Ziogas, Argyrios; Phung, Minh Tung; Hanley, Gillian E.; Wu, Anna H.; Mukherjee, Bhramar; McLean, Karen; Cho, Kathleen R.; Pike, Malcolm C.; Pearce, Celeste Leigh; Lee, Alice W.

doi:10.1016/j.ygyno.2021.10.088

Cited by 8 publications

(13 citation statements)

References 42 publications

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“…Our ndings in strati ed analysis showing reduced odds for ovarian cancer after hysterectomy in women with endometriosis is compatible with reports from previous studies [6, 10,14]. One study with pooled information from four US population-based case-control studies reported that hysterectomy was associated with statistically non-signi cantly decreased odds for ovarian cancer (OR = 0.69, 95% CI: 0.38-1.24) in women with endometriosis, whereas this was not found in women without endometriosis (OR = 1.02, 95% CI: 0.86-1.23) [14].…”

Section: Discussionsupporting

confidence: 93%

“…In line with our ndings, recent studies have found no association between hysterectomy and risk of ovarian cancer overall [6, 10,15], and a meta-analysis reported a pooled OR of 0.97 (95% CI: 0.83-1.12) based on data from 18 case-control studies published between 2000 and 2017 [5]. In contrast, data from two earlier meta-analyses published in 2012 [4], and 2013 [13], respectively, suggested that hysterectomy was associated with a lower risk of ovarian cancer.…”

Section: Discussionsupporting

confidence: 92%

“…and is associated with a moderately increased ovarian cancer risk [16,17]. In accordance, a recent study from the Ovarian Cancer Association Consortium (OCAC) found that adjustment for duration of MHT use affected the association between hysterectomy and ovarian cancer risk markedly [10]. A case-control study including 614 African-American women with ovarian cancer reported that hysterectomy decreased the risk of epithelial ovarian cancer (OR = 0.65, 95% CI: 0.46-0.92) in never users of estrogen-only MHT, whereas increased odds was observed among users [8].…”

Section: Discussionmentioning

confidence: 80%

“…It has been suggested that hysterectomy protects against ovarian cancer by blocking transfer of carcinogenic agents, and retrograde menstruation or endometriosis travelling through the female genital tract [3][4][5]. A number of studies have investigated the association between hysterectomy and risk of ovarian cancer with inconsistent ndings [4][5][6][7][8][9][10][11][12][13][14][15]. A meta-analysis observed a time-dependent trend in ndings and pointed out that one explanation could be changes over time in use of menopausal hormone therapy (MHT) [13].…”

Section: Introductionmentioning

confidence: 99%

“…MHT is known to increase the risk of ovarian cancer moderately [16,17], and is more commonly used among hysterectomized women [18], which might explain why a few recent observational studies have reported that the association between hysterectomy and ovarian cancer risk differs by use of . Other studies have reported that the association between hysterectomy and ovarian cancer varies by tumor histology [5,6,9,12], and history of endometriosis [6,10,14].…”

Section: Introductionmentioning

confidence: 99%

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Hysterectomy and risk of epithelial ovarian cancer by histologic type, endometriosis, and menopausal hormone therapy

Ring

Baandrup²,

Gottschau³

et al. 2022

Preprint

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Purpose This nationwide, register-based case-control study investigated the association between hysterectomy and risk of epithelial ovarian cancer according to histology and by history of endometriosis and MHT use. Methods From the Danish Cancer Registry, all women registered with epithelial ovarian cancer during 1998‒2016 were identified (n = 6,738). Each case was sex- and age-matched to 15 population controls using risk-set sampling. Information on previous hysterectomy on benign indication and potential confounders was retrieved from nationwide registers. Conditional logistic regression was used to calculate odds ratios (ORs) with 95% confidence intervals (CIs) for the association between hysterectomy and ovarian cancer according to histology, endometriosis, and use of MHT. Results Hysterectomy was not associated with risk of epithelial ovarian cancer overall (OR = 0.97; 95% CI 0.88‒1.06) but was associated with reduced risk of clear cell ovarian cancer (OR = 0.47; 95% CI 0.28‒0.78). In stratified analyses, decreased ORs associated with hysterectomy were seen in women with endometriosis (OR = 0.73; 95% CI 0.50‒1.09) and in non-users of MHT (OR = 0.87; 95% CI 0.76‒1.00). Conclusion Hysterectomy was not associated with epithelial ovarian cancer overall but with reduced risk of clear cell ovarian cancer. Our findings may suggest a reduced risk of ovarian cancer after hysterectomy in women with endometriosis and in MHT non-users, but the statistical precision of our results did not allow firm conclusions.

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Section: Discussionsupporting

confidence: 93%