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A Prospective Study

Susan E. Hankinson, ScD; David J. Hunter, MB, BS; Graham A. Colditz, MB, BS; Walter C. Willett, MD; Meir J. Stampfer, MD; Bernard Rosner, PhD; Charles H. Hennekens, MD; Frank E. Speizer, MD

JAMA. 1993;270(23):2813-2818.

Abstract
Objective.
—To assess whether tubal ligation and hysterectomy affect subsequent risk of ovarian cancer.

Design.
—Prospective cohort study with 12 years of follow-up.

Setting.
—United States, multistate.

Participants.
—A total of 121 700 female registered nurses who were 30 to 55 years of age in 1976; the follow-up rate was 90% as of 1988.

Main Outcome Measure.
—Ovarian cancer of epithelial origin confirmed by medical record review.

Results.
—We observed a strong inverse association between tubal ligation and ovarian cancer, which persisted after adjustment for age, oral contraceptive use, parity, and other ovarian cancer risk factors (multivariate relative risk [RR] 0.33; 95% confidence interval [CI], 0.16 to 0.64). The association was similar when we assessed tubal ligation status at the baseline questionnaire and excluded cases in the first 4 years to eliminate any possible short-term decrease in risk due to screening of the ovaries during ligation surgery. We noted a weaker inverse association between simple hysterectomy and ovarian cancer (RR, 0.67; 95% CI, 0.45 to 1.00). Neither vasectomy nor condom use by a partner was associated with risk of ovarian cancer.

Conclusions.
—These data indicate that tubal ligation, and perhaps hysterectomy, may substantially reduce risk of epithelial ovarian cancer.

(JAMA. 1993;270:2813-2818)

Author Affiliations
From the Channing Laboratory (Drs Hankinson, Hunter, Colditz, Willett, Stampfer, Rosner, and Speizer) and the Division of Preventive Medicine (Dr Hennekens), Department of Medicine, Brigham and Women's Hospital; the Department of Ambulatory Care and Prevention (Dr Hennekens), Harvard Medical School; and the Departments of Epidemiology (Drs Hankinson, Hunter, Colditz, Willett, and Stampfer) and Nutrition (Dr Willett), Harvard School of Public Health, Boston, Mass.

Footnotes
Reprint requests to Channing Laboratory, 180 Longwood Ave, Boston, MA 02115 (Dr Hankinson).

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