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Cancer Risk After Midurethral Sling Surgery Using Polypropylene Mesh

Altman, Daniel, MD, PhD; Rogers, Rebecca, G., MD; Yin, Li, PhD; Tamussino, Karl, MD, PhD; Ye, Weimin, MD, PhD; Iglesia, Cheryl, B., MD

doi: 10.1097/AOG.0000000000002496
Contents: Female Pelvic Reconstruction: Original Research

OBJECTIVE: To assess whether there is any association between the implantation of synthetic polypropylene mesh slings for the treatment of stress urinary incontinence (SUI) and risk of cancer.

METHODS: We performed a nationwide cohort study based on the general female population in Sweden. All women entered the observational period as unexposed on January 1, 1997, and contributed person-time as unexposed unless they underwent a midurethral sling procedure for SUI, after which they contributed person-time as exposed until first occurrence of any cancer, death, emigration, or end of the observational period (December 31, 2009). Occurrence of primary cancer was ascertained from the Cancer Register. Hazard ratios (HRs) with 95% CIs were calculated by Cox proportional hazards regression.

RESULTS: The final study population included 5,385,186 women, including 20,905 exposed, encompassing a total of 44,012,936 person-years at risk. Other than an inverse association with rectal cancer (HR 0.5, 95% CI 0.3–0.8), there were no significant differences in risk between exposed and unexposed women for pelvic organ cancers including ovarian (HR 0.8, 95% CI 0.5–1.2), endometrial (HR 1.1, 95% CI 0.8–1.4), cervical (HR 0.4, 95% CI 0.2–1.0), bladder, and urethra (HR 0.7, 95% CI 0.4–1.2). No significant association was observed between exposed women and primary cancer in any organ system when compared with unexposed women. The relative risk for cancer after exposure showed little variation over time except for an inverse overall correlation within the first 4 years of surgery (HR 0.7, 95% CI 0.7–0.8). The incidence rates per 100,000 person-years (95% CIs) for exposed vs unexposed women were 20.5 (14.3–29.5) vs 21.0 (20.6–21.5) for rectal cancer, 25.5 (18.4–35.3) vs 19.8 (19.4–20.2) for ovarian cancer, 65.0 (53.0–79.8) vs 33.1 (32.6–33.7) for endometrial cancer, 5.7 (2.8–11.3) vs 11.9 (11.6–12.2) for cervical cancer, and 19.1 (13.1–27.8) vs 13.3 (13.0–13.7) for bladder and urethra cancer.

CONCLUSION: Our results suggest that midurethral polypropylene sling surgery for SUI is not associated with an increased cancer risk later in life.

Midurethral polypropylene sling surgery for stress urinary incontinence is not associated with an increased cancer risk later in life.

Stockholm Urogynecological Clinic and the Department of Clinical Sciences, Karolinska Institutet, Stockholm, Sweden; the Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy; the Department of Women's Health, University of Texas Austin Dell Medical School, Austin, Texas; the Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; the Department of Obstetrics and Gynecology, Medical University of Graz, Graz, Austria; and the Department of Obstetrics and Gynecology, MedStar Washington Hospital Center/Georgetown University School of Medicine, Washington, DC.

Corresponding author: Daniel Altman, MD, PhD, Department of Clinical Sciences, Karolinska Institutet Danderyd Hospital, 182 88 Stockholm, Sweden; email:

Supported by a grant from Karolinska Institutet research foundations (2-1734/2013).

Financial Disclosure Dr. Altman is the holder of an investigator-initiated study grant from Boston Scientific and has received speaker fees from Astellas Pharma. Dr. Rogers has received royalties from UptoDate and a stipend from the American Board of Obstetrics and Gynecology and the International Urogynecological Association; she was the Data and Safety Monitoring Board chair for the TRANSFORM trial for American Medical Systems. Dr. Iglesia has received royalties from UptoDate. The other authors did not report any potential conflicts of interest.

Presented at the Annual Pelvic Floor Disorders Week, October 3–7, 2017, Providence, Rhode Island.

Each author has indicated that he or she has met the journal's requirements for authorship.

© 2018 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.