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

Publikation: Bidrag til tidsskrift › Tidsskriftartikel › Forskning › fagfællebedømt

  • The Australian Ovarian Cancer Study Group

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 - 2022

Bibliografisk note

Funding Information:
Penelope M. Webb reports grant funding from Astra Zeneca for an unrelated study of ovarian cancer. Joellen Schildkraut and Malcolm Pike report grant funding from the National Institutes of Health. Renee Fortner reports grant funding from the German Federal Ministry of Education and Research, Programme of Clinical Biomedical Research.

Funding Information:
AUS: The Australian Ovarian Cancer Study (AOCS) was supported by the U.S. Army Medical Research and Materiel Command ( DAMD17-01-1-0729 ), National Health and Medical Research Council of Australia ( 199600 , 400413 and 400281 ), Cancer Councils of New South Wales , Victoria, Queensland, South Australia and Tasmania and Cancer Foundation of Western Australia (Multi-State Applications 191, 211 and 182). AOCS gratefully acknowledges additional support from Ovarian Cancer Australia and the Peter MacCallum Foundation ; CON: This work was supported by the National Institutes of Health (grant numbers R01-CA063678 , R01-CA074850 , R01-CA80742 ); DOV: National Institutes of Health R01-CA112523 and R01-CA87538 ; GER: This work was supported by the German Federal Ministry of Education and Research, Programme of Clinical Biomedical Research (grant number 01GB 9401 ) and the German Cancer Research Center (DKFZ); HAW: U.S. National Institutes of Health ( R01-CA58598 , N01-CN-55424 and N01-PC-67001 ); HOP: University of Pittsburgh School of Medicine Dean's Faculty Advancement Award (F. Modugno), Department of Defense ( DAMD17-02-1-0669 ); MAL: This work was supported by the National Cancer Institute at the National Institutes for Health (grant number R01-CA61107 ), the Danish Cancer Society (grant number 94 222 52 ), and the Mermaid I and III projects; NCO: This work was supported by the National Institutes of Health (grant number 1-R01-CA76016 ) and Department of Defense (grant DAMD17-02-1-0666 ); NEC: This work was supported by the National Institutes of Health ( R01-CA54419 and P50-CA105009 ) and Department of Defense ( W81XWH-10-1-02802 ); UCI: This work was supported by the National Institutes of Health (grant number R01-CA058860 ) and the Lon V Smith Foundation (grant number LVS-39420 ); USC: This work was supported by the National Institutes of Health ( P01CA17054 , P30CA14089 , R01CA61132 , N01PC67010 , R03CA113148 , R03CA115195 , N01CN025403 , P30CA046592 ), California Cancer Research Program ( 00-01389 V-20170 , 2II0200 ). AWL was supported in part through a Scientific Scholar Award from the Rivkin Center for Ovarian Cancer . MCP was supported in part through the NIH/NCI Support Grant P30 CA008748 to Memorial Sloan Kettering Cancer Center .

Funding Information:
We would like to thank all of the women who participated in this research. We are grateful to the family and friends of Kathryn Sladek Smith for their generous support of the Ovarian Cancer Association Consortium through their donations to the Ovarian Cancer Research Fund. We thank the doctors, nurses, clinical and scientific collaborators, health care providers and health information sources who have contributed to the many studies contributing to this manuscript. We also wish to thank Marjorie Riggan for her great assistance with managing the OCAC database.

Publisher Copyright:
© 2021

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