Tubal ligation and ovarian cancer risk in a large cohort: Substantial variation by histological type
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TLDR
There was substantial heterogeneity in tumour risk associated with tubal ligation for the four main histotypes, serous, endometrioid, mucinous and clear cell, which is consistent with hypotheses that high‐grade and low‐grade serous tumours have different origins, and that some endometioid and clearcell tumours might arise from cells and/or carcinogens travelling through the fallopian tubes.Abstract:
Histopathological and molecular studies suggest that different histological subtypes (histotypes) of ovarian cancer have different aetiologies. Few studies have been large enough to explore reliably the effect of tubal ligation (sterilization), which has been associated with a reduced overall risk of ovarian cancer, on different tumour histotypes. In a prospective study of 1.1 million UK women without prior cancer or bilateral oophorectomy, 8,035 ovarian cancers occurred during mean follow-up of 13.8 years. Using a Cox proportional hazards model, we estimated adjusted relative risks of ovarian cancer associated with tubal ligation. Overall, there was substantial heterogeneity in tumour risk associated with tubal ligation for the four main histotypes, serous, endometrioid, mucinous and clear cell (heterogeneity: p < 0.0001). For serous tumours, the most common histotype (n = 3,515), risks differed significantly between high-grade (RR: 0.77, 95% CI: 0.67–0.89) and low-grade tumours (RR: 1.13, 95% CI: 0.89–1.42); heterogeneity: p = 0.007. Relative risks were almost halved for endometrioid (n = 690, RR: 0.54, 95% CI: 0.43–0.69) and clear cell tumours (n = 401, RR: 0.55, 95% CI: 0.39–0.77), but there was no association between tubal ligation and mucinous tumours (n = 836, RR: 0.99, 95% CI: 0.84–1.18). For the main tumour histotypes we found little variation of risk by timing of tubal ligation. The significant differences by tumour histotype are unlikely to be due to confounding and are consistent with hypotheses that high-grade and low-grade serous tumours have different origins, and that some endometrioid and clear cell tumours might arise from cells and/or carcinogens travelling through the fallopian tubes.read more
Citations
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Epidemiology of ovarian cancer: a review.
TL;DR: The epidemiology provides clues on etiology, primary prevention, early detection, and possibly even therapeutic strategies for OC, including parity, oral contraceptive use, and lactation.
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Ovarian cancer in the world: epidemiology and risk factors.
TL;DR: Examining the epidemiology and risk factors of ovarian cancer in the world provides significant evidence that preventive measures as well as health education and early detection in high risk groups of women are highly recommended.
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Endometriosis and endometriosis-associated cancers: new insights into the molecular mechanisms of ovarian cancer development.
Amy Dawson,Marta Llaurado Fernandez,Michael S. Anglesio,Paul J. Yong,Mark S. Carey,Mark S. Carey +5 more
TL;DR: It is suggested that deep infiltrating endometriosis may represent a benign neoplasm that invades locally but rarely metastasises, and a combination of molecular, pathological, and inheritance markers may define a high-risk group that might benefit from risk-reducing strategies.
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Challenges and Opportunities in Studying the Epidemiology of Ovarian Cancer Subtypes
Jennifer A. Doherty,Lauren C. Peres,Chen Wang,Gregory P. Way,Casey S. Greene,Joellen M. Schildkraut +5 more
TL;DR: The need for multidisciplinary studies with pathology review using the current guidelines, further molecular characterization of the histotypes and subtypes, inclusion of women of diverse racial/ethnic and socioeconomic backgrounds, and updated epidemiologic and clinical data relevant to current generations of women at risk of EOC are highlighted.
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The Association between Endometriosis, Tubal Ligation, Hysterectomy and Epithelial Ovarian Cancer: Meta-Analyses.
TL;DR: The result indicated that endometriosis was a risk factors of epithelial ovarian cancer whereas tubal ligation was a protective risk factor of epithelian ovarian cancer, hysterectomy may have no relationship with epithel ovarian cancer.
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