Hysterectomy and risk of ovarian cancer: a systematic review and meta-analysis

Huo, Xiaqin; Yao, Liang; Han, Xue; Wen, Li; Liu, Junjuan; Zhou, Lei; Gou, Yuanfeng; Yang, Kehu; Liu, Huiling

doi:10.1007/s00404-018-5020-1

Cited by 8 publications

(16 citation statements)

References 40 publications

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“…In line with our results, one large metaanalysis including 24 studies on hysterectomy and risk reduction for EOC observed an overall hazard ratio of 0.74 20 and a recent population‐based cohort study in Sweden showed similar result with hazard ratio 0.79 11 . However, other studies have stated the contrary 21‐23 . Possibly, these diverse findings support the theory that EOC is a heterogeneous group with various associations according to the many different morphological subtypes.…”

Section: Discussionsupporting

confidence: 90%

Risk of epithelial ovarian cancer Type I and II after hysterectomy, salpingectomy and tubal ligation—A nationwide case‐control study

Darelius

Kristjánsdóttir

Dahm‐Kähler

et al. 2021

Intl Journal of Cancer

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The proposed different origins and pathways to of the dualistic model of epithelial ovarian cancer (EOC) may affect and alter the potential risk reduction related to hysterectomy, salpingectomy and tubal ligation. The aim of our study was to analyze associations between hysterectomy, salpingectomy or tubal ligation and risk reduction of EOC Type I and II. In this nationwide register‐based case‐control study, women diagnosed with EOC, Fallopian tube or primary peritoneal cancer between 2008 and 2014 were included. Cases were classified into Type I and II according to histology and predefined criteria. The exposure variables: hysterectomy, salpingectomy and tubal ligation were identified from national registries. Conditional logistic regression analyses were performed to evaluate associations between Type I and II EOC and the exposure variables. Among 4669 registered cases, 4040 were eligible and assessed for subtyping resulting in 1033 Type I and 3007 Type II. Ten controls were randomly assigned to each case from the register of population. In regression analyses, women with previous salpingectomy had a significantly lower risk of EOC Type II (odds ratio [OR] 0.62; 95% confidence interval [95%CI] 0.45‐0.85) but not Type I (OR 1.16; 95%CI 0.75‐1.78). Hysterectomy was associated with a reduced risk of both EOC Type I (OR 0.71; 95%CI 0.52‐0.99) and Type II (OR 0.81; 95%CI 0.68‐0.96). Similar estimates were obtained for tubal ligation, although without statistical significance. The association between salpingectomy and reduced risk of EOC Type II supports the proposed theory of high‐grade serous cancer originating from the tubal fimbriae.

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Section: Discussionsupporting

confidence: 90%

Risk of epithelial ovarian cancer Type I and II after hysterectomy, salpingectomy and tubal ligation—A nationwide case‐control study

Darelius

Kristjánsdóttir

Dahm‐Kähler

et al. 2021

Intl Journal of Cancer

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“…The OC3 consortium meta‐analysis of 19 prospective cohort studies (5584 cases) found a protective effect that was limited to clear‐cell cancer (relative risk 0.57, 95% CI 0.36–0.88) 6 . This was also noted in the 2019 systematic review (incorporating the OC3 data), which reported a null association with OC overall but a protective effect for endometrioid/clear cell‐cancers 11 . In our study the latter cancers were grouped as Type I together with low‐grade serous and mucinous cancers.…”

Section: Discussionmentioning

confidence: 69%

“…A follow‐up 2019 systematic review reported no association of hysterectomy and OC risk overall. A protective effect remained on subgroup analysis of invasive endometrioid/clear‐cell cancers 11 . More recently, an Australian study of 837 942 women has also reported no evidence of an association 12 .…”

Section: Introductionmentioning

confidence: 99%

Association of hysterectomy and invasive epithelial ovarian and tubal cancer: a cohort study within UKCTOCS

Taylor

Burnell

Ryan

et al. 2021

BJOG

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Objective To investigate the association between hysterectomy with conservation of one or both adnexa and ovarian and tubal cancer. Design Prospective cohort study. Setting Thirteen NHS Trusts in England, Wales and Northern Ireland. Population A total of 202 506 postmenopausal women recruited between 2001 and 2005 to the UK Collaborative Trial of Ovarian Cancer Screening (UKCTOCS) and followed up until 31 December 2014. Methods Multiple sources (questionnaires, hospital notes, Hospital Episodes Statistics, national cancer/death registries, ultrasound reports) were used to obtain accurate data on hysterectomy (with conservation of one or both adnexa) and outcomes censored at bilateral oophorectomy, death, ovarian/tubal cancer diagnosis, loss to follow up or 31 December 2014. Cox proportional hazards regression models were used to assess the association. Main outcome measures Invasive epithelial ovarian and tubal cancer (WHO 2014) on independent outcome review. Results Hysterectomy with conservation of one or both adnexa was reported in 41 912 (20.7%; 41 912/202 506) women. Median follow up was 11.1 years (interquartile range 9.96–12.04), totalling >2.17 million woman‐years. Among women who had undergone hysterectomy, 0.55% (231/41 912) were diagnosed with ovarian/tubal cancer, compared with 0.59% (945/160 594) of those with intact uterus. Multivariable analysis showed no evidence of an association between hysterectomy and invasive epithelial ovarian/tubal cancer (hazard ratio 0.98, 95% CI 0.85–1.13, P = 0.765). Conclusions This large cohort study provides further independent validation that hysterectomy is not associated with alteration of invasive epithelial ovarian and tubal cancer risk. These data are important both for clinical counselling and for refining risk prediction models. Tweetable abstract Hysterectomy does not alter risk of invasive epithelial ovarian and tubal cancer.

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“…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%

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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Hysterectomy and risk of ovarian cancer: a systematic review and meta-analysis

Cited by 8 publications

References 40 publications

Risk of epithelial ovarian cancer Type I and II after hysterectomy, salpingectomy and tubal ligation—A nationwide case‐control study

Risk of epithelial ovarian cancer Type I and II after hysterectomy, salpingectomy and tubal ligation—A nationwide case‐control study

Association of hysterectomy and invasive epithelial ovarian and tubal cancer: a cohort study within UKCTOCS

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

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