Objective: To investigate the association between hysterectomy with
conservation of one or both adnexa and ovarian and tubal cancer. Design:
Prospective cohort study. Setting: 13 NHS Trusts in England, Wales and
Northern Ireland. Population: 202,506 postmenopausal women recruited
between 2001-2005 to the UK Collaborative Trial of Ovarian Cancer
Screening (UKCTOCS) and followed up until 31 December 2014. Methods:
Multiple sources (questionnaires, hospital notes, Hospital Episodes
Statistics, national cancer/death registries, ultrasound reports) were
used to obtain accurate data on hysterectomy (with conservation of one
or both adnexa) and outcomes censored at bilateral oophorectomy, death,
ovarian/tubal cancer diagnosis, loss to follow-up or 31 December 2014.
Cox proportional hazards regression models were used to assess the
association. Main outcome measures: Invasive epithelial ovarian and
tubal cancer (WHO 2014) on independent outcome review. Results:
Hysterectomy with conservation of one or both adnexa was reported in
41,912 (20.7%; 41,912/202,506) women. Median follow up was 11.1years
(IQR 9.96-12.04), totalling >2.17million women-years. Among
women who had undergone hysterectomy, 0.55% (231/41912) were diagnosed
with ovarian/tubal cancer, compared with 0.59% (945/160594) of those
with intact uterus. Multivariable analysis showed no evidence of an
association between hysterectomy and invasive epithelial ovarian/tubal
cancer (RR=0.98, 95%CI 0.85-1.13, p=0.765). Conclusions: This large
cohort study provides further independent validation that hysterectomy
is not associated with alteration of invasive epithelial ovarian and
tubal cancer risk. This data is important both for clinical counselling
and for refining risk prediction models.
Association of hysterectomy and invasive epithelial ovarian and tubal cancer: A cohort study within UKCTOCS
