The Association Between Hysterectomy and Ovarian Cancer Risk

A Population-Based Record-Linkage Study

Suzanne C. Dixon-Suen; Penelope M. Webb; Louise F. Wilson; Karen Tuesley; Louise M. Stewart; Susan J. Jordan

Disclosures

J Natl Cancer Inst. 2019;111(10):1097-1103. 

In This Article

Abstract and Introduction

Abstract

Background: Recent studies have called into question the long-held belief that hysterectomy without oophorectomy protects against ovarian cancer. This population-based longitudinal record-linkage study aimed to explore this relationship, overall and by age at hysterectomy, time period, surgery type, and indication for hysterectomy.

Methods: We followed the female adult Western Australian population (837 942 women) across a 27-year period using linked electoral, hospital, births, deaths, and cancer records. Surgery dates were determined from hospital records, and ovarian cancer diagnoses (n = 1640) were ascertained from cancer registry records. We used Cox regression to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for the association between hysterectomy and ovarian cancer incidence.

Results: Hysterectomy without oophorectomy (n = 78 594) was not associated with risk of invasive ovarian cancer overall (HR = 0.98, 95% CI = 0.85 to 1.11) or with the most common serous subtype (HR = 1.05, 95% CI = 0.89 to 1.23). Estimates did not vary statistically significantly by age at procedure, time period, or surgical approach. However, among women with endometriosis (5.8%) or with fibroids (5.7%), hysterectomy was associated with substantially decreased ovarian cancer risk overall (HR = 0.17, 95% CI = 0.12 to 0.24, and HR = 0.27, 95% CI = 0.20 to 0.36, respectively) and across all subtypes.

Conclusions: Our results suggest that for most women, having a hysterectomy with ovarian conservation is not likely to substantially alter their risk of developing ovarian cancer. However, our results, if confirmed, suggest that ovarian cancer risk reduction could be considered as a possible benefit of hysterectomy when making decisions about surgical management of endometriosis or fibroids.

Introduction

Hysterectomy without oophorectomy has been traditionally considered protective against ovarian cancer, supported by a considerable body of older research [summarized in[1–3]]. However, many studies including women diagnosed more recently have not seen a protective association; indeed, some reported modest increases in risk, as seen in a recent meta-analysis[4] and subsequent studies.[5,6] This apparent shift could arise from changes in surgical practices or patient characteristics, changes in menopausal hormone therapy (MHT) use, or perhaps improved reporting of oophorectomy status.

Hysterectomy is one of the most common major surgeries among women globally;[7,8] understanding the true relationship between hysterectomy alone and ovarian cancer risk is important to inform the current debate over the relative advantages of prophylactically removing ovaries at hysterectomy. Our aim was to explore the association between hysterectomy for benign indications and ovarian cancer risk, overall and by time period, age at surgery, hysterectomy type, and indication for hysterectomy. We examined this question using 45 years of administrative data from the Western Australian Data Linkage System (WADLS).[9]

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