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Article
December 15, 1993

Tubal Ligation, Hysterectomy, and Risk of Ovarian CancerA Prospective Study

JAMA. 1993;270(23):2813-2818. doi:10.1001/jama.1993.03510230051034
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)

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