The Association between hysterectomy and ovarian cancer risk: A population-based record-linkage study
Menée en Australie à partir de données portant sur 837 942 femmes (durée de suivi : 27 ans), cette étude évalue l'association entre une hystérectomie sans oophorectomie et le risque de cancer de l'ovaire
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 = 1,640) 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 = 0.85-1.11), or with the most common serous subtype (HR = 1.05, 95% CI = 0.89-1.23). 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 = 0.12-0.24 and HR = 0.27, 95% CI = 0.20-0.36, 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.
Journal of the National Cancer Institute , résumé, 2018