To the Editor.
—Dr Hankinson and colleagues1 report a strong inverse association between tubal ligation and ovarian cancer in which tubal ligation reduced the risk of ovarian cancer to about one-third that of the control group; simple hysterectomy was almost as effective. How can one explain this? The authors speculate that blood supply to the ovaries might be affected. Also, they mention that oral contraceptives also have been shown to reduce the risk of ovarian cancer.2 Meanwhile, they report on the intriguing data implicating talc as a causative agent,3-5 but do not highlight this evidence of the flow of carcinogenic and other agents from perineum to ovaries.Is it possible that tubal ligation prevents ovarian cancer simply by limiting the upward flow of yet-to-be-identified toxins? Are contraceptive foams and gels to be implicated? Were these materials studied in the Nurses' Health Study? Tubal ligation, hysterectomy, and oral
Silver AS. Tubal Ligation, Hysterectomy, and Risk of Ovarian Cancer. JAMA. 1994;271(16):1235. doi:10.1001/jama.1994.03510400021011