OBJECTIVE: To examine associations of simple hysterectomy and hysterectomy with bilateral salpingo-oophorectomy (BSO), relative to no surgery, with total and site-specific cancer risk in the Cancer Prevention Study-II Nutrition Cohort.
METHODS: We examined associations of hysterectomy with BSO and simple hysterectomy with total and site-specific cancer risk in 66,802 postmenopausal women from the Cancer Prevention Study-II Nutrition Cohort.
RESULTS: During a median follow-up of 13.9 years, 8,621 cancers were diagnosed. Hysterectomy with BSO performed at any age (1,892 cases), compared with no hysterectomy (n=5,586 cases), is associated with a 10% reduction in all cancers (relative risk [RR] 0.90, 95% confidence interval [CI] 0.85–0.96). This inverse association does not hold if the surgery occurred at ages 55 years or older (583 cases; RR 1.02, 95% CI 0.94–1.12). Hysterectomy with BSO (715 cases) was associated with a 20% reduction in breast cancer performed at any age (RR 0.80, 95% CI 0.73–0.88). Hysterectomy without BSO was associated with a deceased cancer risk only if performed at age 45 years or younger (541 cases; RR 0.88, 95% CI 0.80–0.97) and overall was associated with a decreased risk of breast cancer (419 cases; RR 0.86, 95% CI 0.76–0.96).
CONCLUSION: In a large prospective study, hysterectomy with BSO before age 55 years, relative to no surgery, is associated with a lower risk of total cancer. This information, particularly the lower risk in women younger than 45 years, should be considered in counseling women about ovarian management at the time of surgery.
LEVEL OF EVIDENCE: II
In a large prospective study, hysterectomy with bilateral salpingo-oophorectomy before age 55 years, relative to no surgery, is associated with a lower risk of total cancer.
Epidemiology Research Program, American Cancer Society, Atlanta, Georgia.
Corresponding author: Mia M. Gaudet, PhD, American Cancer Society, 250 Williams Street, NW, Atlanta, GA 30303; e-mail: firstname.lastname@example.org.
The American Cancer Society (ACS) funds the creation, maintenance, and updating of the Cancer Prevention Study-II (CPS-II) cohort.
The authors thank the Cancer Prevention Study-II Nutrition Cohort participants and Study Management Group for their invaluable contributions to this research. The authors also acknowledge the contribution to this study from central cancer registries supported through the Centers for Disease Control and Prevention National Program of Cancer Registries and cancer registries supported by the National Cancer Institute Surveillance Epidemiology and End Results program.
Presented at the12th Annual Frontiers in Cancer Prevention Research, American Association for Cancer Research, October 27–30, 2013, National Harbor, Maryland.
Financial Disclosure The authors did not report any potential conflicts of interest.