To the Editor.
—Regarding the article by Dr Hankinson and colleagues1 on tubal ligation, hysterectomy, and risk of ovarian cancer, one possible mechanism not mentioned by the authors is that some infectious agent, probably a virus, is being prevented from reaching the ovaries by surgical closure of the route from the vagina to the ovaries. Also noted in their study was a somewhat lessened risk if the partner used condoms, again an argument for an infectious cause. Ascending bacterial infections commonly cause endometritis and salpingitis; surely viruses go where bacteria do not fear to tread. The association of Burkitt's lymphoma with the Epstein-Barr virus, cervical cancer with the human papillomavirus, and Kaposi's sarcoma with the human immunodeficiency virus lend at least some credence to the oncogenic virus theory. A virus inserting itself by mistake in the wrong sequence of DNA or RNA could plausibly cause the production of a
Wahlberg C. Tubal Ligation, Hysterectomy, and Risk of Ovarian Cancer. JAMA. 1994;271(16):1236. doi:10.1001/jama.1994.03510400021012