Table 3 Epidemiologic Studies of the Association Between Hysterectomy and Risk of Ovarian Cancer
From: Tubal ligation, hysterectomy and ovarian cancer: A meta-analysis
Author (Country) | Study Design | Case definition | Covariates | OR, RR, or SIR (95%CI) | Comments |
|---|---|---|---|---|---|
NECC 2012 (USA) [Personal communication with Dr. Daniel Cramer] | Case-control | Borderline and invasive ovarian cancer | age, study center, BMI , study phase, smoking, family history of ovarian and breast cancers, talc use, OC use , parity, breast feeding, age at menarche, post-menopausal status, use of post-menopausal hormones, tubal ligation | Hysterectomy only: 1.10 (0.83-1.46) | NECC 2012 (USA) [Personal communication with Dr. Daniel Cramer] |
N=2076 | Hysterectomy with unilateral oophorectomy: 0.68 (0.46-0.99) | ||||
Annegers et al. 1979 (USA) [38] | Case-control (Rochester Project) | Epithelial ovarian cancer N=116 cases | Controls matched on age and residence | Hysterectomy only: 0.36 (0.10-0.73) | |
Hysterectomy with unilateral oophorectomy: 0.06 (0.004-0.98) | |||||
Antoniou et al. 2009 (Europe and Canada) [13] | Retrospective Cohort | Ovarian cancer (only BRCA 1/2 carriers) | Age, duration of OC use, parity | Hysterectomy with or without unilateral oophorectomy: BRCA 1/2: 0.59 (0.22, 1.57) | Includes prevalent and incident cases. |
N=201 BRCA1 cases | Mean difference between age at diagnosis and interview: 6.7 years | ||||
N=52 BRCA2 cases | |||||
BRCA1:0.68 (0.22, 2.12) | |||||
BRCA2: 0.35 (0.08, 1.58) | |||||
Beard et al. 2000 (USA) [40] | Case-control (Rochester Project) | Invasive epithelial ovarian cancer | Controls matched on age and provider | Hysterectomy with or without unilateral oophorectomy: 0.5 (0.2–0.96) | |
N=103 cases | |||||
Booth et al 1989 (England) [32] | Case-control | Epithelial ovarian cancer | Age and social class | Hysterectomy only: 0.2 (0.1-0.4) | Cases less than 65 years old and diagnosed within 2 years. Age-matched hospital-based controls. |
N=235 cases | |||||
Hysterectomy with unilateral oophorectomy: 0.4 (0.1-1.1) | |||||
Braem et al. 2010 (Netherlands) [41] | Case-cohort study (Netherlands Cohort Study) | Invasive epithelial ovarian cancer | Age, OC use, parity | Hysterectomy with or without unilateral oophorectomy: 0.50 (0.34-0.72) | All women presumed to be postmenopausal |
N=375 | |||||
Chiaffarino et al. 2005 (Italy) [42] | Multi-center case-control study | Incident invasive epithelial ovarian cancer | Age, center, education, parity, OC use, family history of ovarian and breast cancer | Hysterectomy only: 0.6 (0.4-0.9) Hysterectomy and unilateral oophorectomy: 0.6 (0.3-1.1) | |
N=1031 cases | |||||
Green, Purdie, et al. 1997 (Australia) [26] | Case-control | Incident, primary epithelial ovarian cancer | Age, education, BMI, parity, OC duration, smoking, family history of ovarian cancer | Hysterectomy with or without unilateral oophorectomy: 0.64 (0.48-0.85) | 90% participation rate in cases, 73% in controls. |
N=824 cases | |||||
Hankinson et al. 1993 (USA) [43] | Cohort study (NHS) | Borderline and malignant epithelial ovarian cancer | Age, parity, duration of OC use, age at menarche, tubal ligation, smoking status, BMI | Hysterectomy only: 0.67 (0.45-1.00) | 90% follow-up rate |
N=260 cases | |||||
Jordan et al. 2008 (Australia) [10] | Case-control | Invasive epithelial serous ovarian cancer | Parity, hormonal contraceptive use, history of breast or ovarian cancer, age, education | Hysterectomy with or without unilateral oophorectomy: | |
N=627 cases | |||||
Serous (invasive): 1.27 (1.00, 1.60) | |||||
Jordan et al. 2007 (Australia) [16] | Case-control | Benign serous tumors (N=230) and benign mucinous tumors (N=133) | Age, state of residence, education, parity, hormonal contraceptive use, smoking status | Hysterectomy with or without unilateral oophorectomy: | 65% participation rate in cases, 47% in controls. |
For serous tumors by surgical indication: | |||||
Combined: 1.91 (1.38-2.66) | |||||
Mucinous: 0.95 (0.55-1.67) | Non-hormonal: 1.1 (0.5-2.7) | ||||
Serous: 2.75 (1.90-3.96) | Hormonal: 3.0 (2.1-4.5) | ||||
Kreiger et al. 1997 (Canada) [25] | Historical cohort study | Ovarian cancer N=169 observed cases in hysterectomy subcohort | Age, calendar year, length of follow-up | Hysterectomy only: 0.72 p<0.001 | Calculated observed over expected events. |
Sensitivity analysis excluding borderline malignancies similar. | |||||
Loft et al. 1997 (Denmark) [44] | Prospective historical cohort study | Ovarian cancer | Age | Hysterectomy with and without unilateral oophorectomy: 0.78 (0.60-0.96) | N=22,135 women w/ hysterectomy (3940 of whom had unilateral oophorectomy) |
N=71 | |||||
Follow-up=12.5 years | |||||
Luoto et al. 1997 (Finland) [39] | Historical cohort study | Ovarian cancer | Adjusted for education, parity, and follow-up. Non-hysterectomized women had similar distributions of age and municipality. | Partial hysterectomy: RR=0.94 (0.68-1.30) | Ovarian status not assessed. |
N=53 cases with partial hysterectomy | |||||
N=91 cases with total hysterectomy | |||||
Total hysterectomy: RR=0.62 (0.48-0.80) | |||||
Modugno et al. 2004 (USA) [9] | Pooled case-control | Epithelial ovarian cancer | Study site, age, family history, duration of oral contraceptive use, parity, endometriosis, tubal ligation | Hysterectomy with or without unilateral oophorectomy: 0.99 (0.83-1.18) | Pooled analysis from four studies. |
N=2098 cases | Analyzed by endometriosis status. | ||||
Moorman et al. 2009 (USA) [12] | Case-control North Carolina Ovarian Cancer Study | Invasive epithelial ovarian cancer | Age, parity, age at menarche, duration of OC use, family history of breast/ovarian cancer, BMI | Hysterectomy with or without unilateral oophorectomy: | |
N=746 White cases | |||||
N=111 African-Am cases | |||||
Whites: 1.22 (0.97, 1.54) African- | |||||
Americans: 1.07 (0.61, 1.87) | |||||
Nagle et al. 2008 (Australia) [15] | Case-control | Invasive epithelial endometrioid and clear cell ovarian cancer | Age, education, parity, and hormone contraceptive use | Hysterectomy with or without unilateral oophorectomy: | 47% participation rate in controls |
N=142 endometrioid cases | |||||
Endometrioid: 1.2 (0.8, 1.9) | |||||
Clear cell: 0.9 (0.5, 1.6) | |||||
N=90 clear cell cases | |||||
Parazzini et al. 1993 (Italy) [45] | Case-control study | Epithelial ovarian cancer | Age, education, parity, oral contraceptive use, menarche, menopause | Hysterectomy only: 0.6 (0.5-0.9) | |
N=953 cases | Hysterectomy with unilateral | ||||
oophorectomy: 0.6 (0.3-1.3) | |||||
Risch et al. 1994 (Canada) [46] | Case-control | Epithelial ovarian cancer | Age, duration of OC use, number of full-term pregnancies | Hysterectomy with or without unilateral oophorectomy: 0.51 (0.36-0.72) | |
N=450 cases | |||||
Rosenblatt et al. 1996 (Multi-national) [29] | Case-control (Multi-site/country) | Borderline or invasive epithelial ovarian cancer | Age, date of diagnosis, center, parity, OC use | Hysterectomy only: 0.41 (0.14-1.21) | |
N=385 cases | Hysterectomy with unilateral oophorectomy: 1.06 (0.34-3.29) | ||||
Combined: 0.58 (0.27-1.28) | |||||
Rutter et al. 2003 (Israel) [23] | Case-control | Epithelial ovarian cancer or primary peritoneal cancer | Age, ethnicity, parity, years of oral contraceptive use | Hysterectomy only: 0.69 (0.50-0.95) | Participation rate was 79% for case patients and 66% for controls. Includes BRCA-specific analysis. |
N=1124 cases | Hysterectomy with unilateral oophorectomy: 0.46 (0.25-0.86) | ||||
Whittemore et al 1992 (USA) [31] | Pooled case-control (12 studies included) | Invasive epithelial ovarian cancer | Age, study, parity, OC use | Hysterectomy with or without unilateral oophorectomy: Hospital-based studies: 0.66 (0.50-0.86) | Restricted to white women. 6 hospital based studies and 6 population-based studies. All hysterectomies performed at least 2 years prior to reference date. |
N=2197 cases | |||||
Population-based studies: 0.88 (0.72-1.1) | |||||
Wittenberg et al. 1999 (USA) [24] | Case-control | Mucinous and non-mucinous epithelial ovarian cancer | Age at diagnosis, parity, duration of OC use | Hysterectomy with or without unilateral oophorectomy: Mucinous: 0.2 (0.1, 1.0) | 64% participation rate in cases, 72% in controls. Included both borderline and invasive. |
N=43 mucinous cases | |||||
N=279 non-mucinous cases | Non-mucinous: 1.1 (0.7, 1.6) | ||||
Wynder et al. 1969 (USA) [47] | Case-control (Hospital based) | Epithelial ovarian cancer (N=150) plus miscellaneous ovarian tumors (N=8) | Age-matched controls | Hysterectomy with or without unilateral oophorectomy: 0.7 (0.04-1.0) |