International Journal of Epidemiology, Vol 26, 710-715, Copyright © 1997 by International Epidemiological Association
N Kreiger, M Sloan, M Cotterchio and P Parsons
BACKGROUND: This historical cohort study was conducted to examine the
relationship between gynaecological surgery and ovarian cancer risk.
METHODS: Women were included if they had had tubal ligation, hysterectomy,
or unilateral ovariectomy in Ontario between March 1979 and April 1993. The
cohort was linked to the Ontario Cancer Registry and the Ontario mortality
file. Person-years in the cohort were accumulated until death, the removal
of both ovaries, a diagnosis of ovarian cancer, or the end of the study
period 31 December 1993. Observed cancers were compared to expected based
on Ontario age- and calendar period-specific incidence rates. RESULTS: For
tubal ligation and hysterectomy, fewer ovarian cancers were observed than
were expected by age, calendar year of procedure, and length of follow-up;
the observed/expected ratios were generally statistically significant. In
contrast, no protective effect was evident for unilateral ovariectomy; in
fact statistically significant excess cancers were seen in early follow-up
periods. Observed/expected ratios were nearly identical and somewhat
protective for the two strata defined by whether or not the ovaries were
visualized. Disruption of the ovarian pathway conferred a protective
effect, while no disruption significantly increased risk. CONCLUSIONS: The
data do not support screening bias although short-term follow-up data
indicate the possibility of detection bias. The long-term follow-up data,
as well as the data on pathway disruption, are consistent with the
hypothesis that the surgical procedures themselves may produce a protective
effect against ovarian cancer, through alteration of the hormonal
environment and/or by physical destruction of a carcinogen's route to the
ovary.
ARTICLES
Surgical procedures associated with risk of ovarian cancer
Division of Preventive Oncology, Ontario Cancer Treatment and Research Foundation, Toronto, Canada.
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