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Region Hovedstaden - en del af Københavns Universitetshospital
Udgivet

Endometriosis and menopausal hormone therapy impact the hysterectomy-ovarian cancer association

Publikation: Bidrag til tidsskriftTidsskriftartikelpeer review

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  • Lilah Khoja
  • Rachel Palmieri Weber
  • Penelope M Webb
  • Susan J Jordan
  • Aruna Muthukumar
  • Jenny Chang-Claude
  • Renée T Fortner
  • Allan Jensen
  • Susanne K Kjaer
  • Harvey Risch
  • Jennifer Anne Doherty
  • Holly R Harris
  • Marc T Goodman
  • Francesmary Modugno
  • Kirsten Moysich
  • Andrew Berchuck
  • Joellen M Schildkraut
  • Daniel Cramer
  • Kathryn L Terry
  • Hoda Anton-Culver
  • Argyrios Ziogas
  • Minh Tung Phung
  • Gillian E Hanley
  • Anna H Wu
  • Bhramar Mukherjee
  • Karen McLean
  • Kathleen Cho
  • Malcolm C Pike
  • Celeste Leigh Pearce
  • Alice W Lee
  • Australian Ovarian Cancer Study Group
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OBJECTIVE: To evaluate the association between hysterectomy and ovarian cancer, and to understand how hormone therapy (HT) use and endometriosis affect this association.

METHODS: We conducted a pooled analysis of self-reported data from 11 case-control studies in the Ovarian Cancer Association Consortium (OCAC). Women with (n = 5350) and without ovarian cancer (n = 7544) who never used HT or exclusively used either estrogen-only therapy (ET) or estrogen+progestin therapy (EPT) were included. Risk of invasive epithelial ovarian cancer adjusted for duration of ET and EPT use and stratified on history of endometriosis was determined using odds ratios (ORs) with 95% confidence intervals (CIs).

RESULTS: Overall and among women without endometriosis, there was a positive association between ovarian cancer risk and hysterectomy (OR = 1.19, 95% CI 1.09-1.31 and OR = 1.20, 95% CI 1.09-1.32, respectively), but no association upon adjusting for duration of ET and EPT use (OR = 1.04, 95% CI 0.94-1.16 and OR = 1.06, 95% CI 0.95-1.18, respectively). Among women with a history of endometriosis, there was a slight inverse association between hysterectomy and ovarian cancer risk (OR = 0.93, 95% CI 0.69-1.26), but this association became stronger and statistically significant after adjusting for duration of ET and EPT use (OR = 0.69, 95% CI 0.48-0.99).

CONCLUSIONS: The hysterectomy-ovarian cancer association is complex and cannot be understood without considering duration of ET and EPT use and history of endometriosis. Failure to take these exposures into account in prior studies casts doubt on their conclusions. Overall, hysterectomy is not risk-reducing for ovarian cancer, however the inverse association among women with endometriosis warrants further investigation.

OriginalsprogEngelsk
TidsskriftGynecologic Oncology
Vol/bind164
Udgave nummer1
Sider (fra-til)195-201
Antal sider7
ISSN0090-8258
DOI
StatusUdgivet - jan. 2022

Bibliografisk note

Copyright © 2021. Published by Elsevier Inc.

ID: 73989369