Association of hysterectomy and invasive epithelial ovarian and tubal cancer: a cohort study within UKCTOCS

J A Taylor; M Burnell; A Ryan; C Karpinskyj; J K Kalsi; H Taylor; S Apostolidou; A Sharma; R Manchanda; R Woolas; S Campbell; M Parmar; N Singh; I J Jacobs; U Menon; A Gentry-Maharaj

doi:10.1111/1471-0528.16943

Association of hysterectomy and invasive epithelial ovarian and tubal cancer: a cohort study within UKCTOCS

BJOG. 2022 Jan;129(1):110-118. doi: 10.1111/1471-0528.16943. Epub 2021 Oct 17.

Authors

J A Taylor¹, M Burnell¹, A Ryan¹, C Karpinskyj¹, J K Kalsi^{2

3}, H Taylor⁴, S Apostolidou¹, A Sharma⁵, R Manchanda⁶, R Woolas⁷, S Campbell⁸, M Parmar¹, N Singh⁹, I J Jacobs^{2

10}, U Menon¹, A Gentry-Maharaj¹

Affiliations

¹ MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, University College London, London, UK.
² Department of Women's Cancer, Institute for Women's Health, University College London, London, UK.
³ Department Epidemiology and Public Health, Institute of Epidemiology and Health Care, UCL, London, UK.
⁴ Department of Surgery and Cancer, Imperial College Healthcare NHS Trust, London, UK.
⁵ Department of Obstetrics and Gynaecology, University Hospital of Wales, Cardiff, UK.
⁶ Barts Health NHS Trust and Wolfson Institute of Preventive Medicine, CRUK Barts Cancer Centre, Queen Mary University of London, London, UK.
⁷ Department of Gynaecological Oncology, Queen Alexandra Hospital, Portsmouth, UK.
⁸ Create Fertility, London, UK.
⁹ Department of Cellular Pathology, Barts Health NHS Trust, London, UK.
¹⁰ University of New South Wales, Sydney, NSW, Australia.

Abstract

Objective: To investigate the association between hysterectomy with conservation of one or both adnexa and ovarian and tubal cancer.

Design: Prospective cohort study.

Setting: Thirteen NHS Trusts in England, Wales and Northern Ireland.

Population: A total of 202 506 postmenopausal women recruited between 2001 and 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 11.1 years (interquartile range 9.96-12.04), totalling >2.17 million woman-years. Among women who had undergone hysterectomy, 0.55% (231/41 912) were diagnosed with ovarian/tubal cancer, compared with 0.59% (945/160 594) of those with intact uterus. Multivariable analysis showed no evidence of an association between hysterectomy and invasive epithelial ovarian/tubal cancer (hazard ratio 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. These data are important both for clinical counselling and for refining risk prediction models.

Tweetable abstract: Hysterectomy does not alter risk of invasive epithelial ovarian and tubal cancer.

Keywords: Hysterectomy; UKCTOCS; ovarian cancer; ovarian neoplasm; risk; type.

Publication types

Randomized Controlled Trial

MeSH terms

Aged
Carcinoma, Ovarian Epithelial / mortality*
Carcinoma, Ovarian Epithelial / surgery
Cohort Studies
England
Fallopian Tube Neoplasms / mortality*
Fallopian Tube Neoplasms / surgery
Female
Humans
Hysterectomy / statistics & numerical data*
Middle Aged
Northern Ireland
Ovarian Neoplasms / mortality*
Ovarian Neoplasms / surgery
Prospective Studies
Risk Factors
State Medicine
Surveys and Questionnaires
Wales

Abstract

Publication types

MeSH terms

Grants and funding