Background

Hysterectomy is one of the most frequent gynecologic surgeries in the United States. Women undergoing hysterectomy are commonly offered bilateral oophorectomy for ovarian and breast cancer prevention. Although bilateral oophorectomy may dramatically reduce the risk of gynecologic cancers, some studies suggested that bilateral oophorectomy may be associated with an increased risk of other types of cancer, such as lung cancer and colorectal cancer. However, the results are conflicting.

Objective

To study the association between bilateral oophorectomy and the risk of subsequent cancer of any type.

Study Design

This population-based cohort study included all premenopausal women who underwent bilateral oophorectomy for a nonmalignant indication before the age of 50, between January 1, 1988 and December 31, 2007 in Olmsted County, Minnesota, and a random sample of age-matched (±1 year) referent women who did not undergo bilateral oophorectomy. Women with cancer before oophorectomy (or index date) or within 6 months after the index date were excluded. Time-to-event analyses were performed to assess the risk of de novo cancer. Cancer diagnosis and type were confirmed using medical record review.

Results

Over a median follow-up of 18 years, the risk of any cancer did not significantly differ between the 1562 women who underwent bilateral oophorectomy before natural menopause and the 1610 referent women (adjusted hazard ratio, 0.82; 95% confidence interval, 0.66–1.03). However, women who underwent bilateral oophorectomy had a decreased risk of gynecologic cancers (adjusted hazard ratio, 0.15; 95% confidence interval, 0.06–0.34) but not of nongynecologic cancers (adjusted hazard ratio, 0.99; 95% confidence interval, 0.78–1.26). In particular, the risk of breast cancer, gastrointestinal cancer, and lung cancer did not differ between these 2 cohorts. Use of estrogen therapy through the age of 50 years in women who underwent bilateral oophorectomy did not modify the results.

Conclusion

Women who underwent bilateral oophorectomy before menopause have a reduced risk of gynecologic cancer but not of other types of cancer including breast cancer. Women at average risk of ovarian cancer should not consider bilateral oophorectomy for the prevention of breast cancer or other nongynecologic cancers.

中文翻译：

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绝经前双侧卵巢切除术后新发癌症的风险

背景

子宫切除术是美国最常见的妇科手术之一。接受子宫切除术的妇女通常会接受双侧卵巢切除术以预防卵巢癌和乳腺癌。尽管双侧卵巢切除术可以显着降低妇科癌症的风险，但一些研究表明，双侧卵巢切除术可能与其他类型癌症的风险增加有关，例如肺癌和结直肠癌。然而，结果是矛盾的。

客观的

研究双侧卵巢切除术与随后发生任何类型癌症的风险之间的关系。

学习规划

这项基于人群的队列研究包括所有在 1988 年 1 月 1 日至 2007 年 12 月 31 日期间在明尼苏达州奥姆斯特德县因非恶性适应症在 50 岁之前接受双侧卵巢切除术的绝经前妇女，以及年龄匹配的随机样本（± 1 年）未接受双侧卵巢切除术的参照女性。卵巢切除术前（或索引日期）或索引日期后 6 个月内患有癌症的女性被排除在外。进行事件发生时间分析以评估新发癌症的风险。使用病历审查确认癌症诊断和类型。

结果

在 18 年的中位随访期间，1562 名在自然绝经前接受双侧卵巢切除术的女性和 1610 名参照女性之间的任何癌症风险没有显着差异（调整后的风险比，0.82；95% 置信区间，0.66-1.03 ）。然而，接受双侧卵巢切除术的女性患妇科癌症的风险降低（调整后的风险比，0.15；95% 置信区间，0.06-0.34），但非妇科癌症的风险降低（调整后的风险比，0.99；95% 置信区间，0.78-1.26） ）。特别是，这两个队列之间患乳腺癌、胃肠道癌和肺癌的风险没有差异。接受双侧卵巢切除术的女性在 50 岁之前使用雌激素治疗并没有改变结果。

结论

在绝经前接受双侧卵巢切除术的女性患妇科癌症的风险降低，但其他类型的癌症（包括乳腺癌）的风险却没有。处于卵巢癌平均风险的女性不应考虑双侧卵巢切除术来预防乳腺癌或其他非妇科癌症。