Has the association between hysterectomy and ovarian cancer changed over time? A systematic review and meta-analysis

Jordan, Susan J., Nagle, Christina M., Coory, Michael D., Maresco, Diane, Protani, Melinda M., Pandeya, Neha A., Balasubramaniam, Kanchana D. and Webb, Penelope M. (2013) Has the association between hysterectomy and ovarian cancer changed over time? A systematic review and meta-analysis. European Journal of Cancer, 49 17: 3638-3647. doi:10.1016/j.ejca.2013.07.005


Author Jordan, Susan J.
Nagle, Christina M.
Coory, Michael D.
Maresco, Diane
Protani, Melinda M.
Pandeya, Neha A.
Balasubramaniam, Kanchana D.
Webb, Penelope M.
Title Has the association between hysterectomy and ovarian cancer changed over time? A systematic review and meta-analysis
Journal name European Journal of Cancer   Check publisher's open access policy
ISSN 0959-8049
1879-0852
Publication date 2013-11
Year available 2013
Sub-type Critical review of research, literature review, critical commentary
DOI 10.1016/j.ejca.2013.07.005
Volume 49
Issue 17
Start page 3638
End page 3647
Total pages 10
Place of publication Kidlington, Oxford, United Kingdom
Publisher Pergamon
Collection year 2014
Language eng
Formatted abstract
Until recently most studies suggested that hysterectomy with ovarian conservation was associated with a decreased risk of ovarian cancer. However, several recent studies have reported modestly increased risks of ovarian cancer following hysterectomy. Given that as many as 35% of women will have a hysterectomy, the nature of the association requires clarification. We conducted a systematic review and meta-analysis of the published literature on the relationship between hysterectomy and ovarian cancer to investigate whether there has been a temporal change in the association. Twenty observational studies that have reported a quantitative assessment of the association between hysterectomy and risk of histologically-confirmed ovarian cancer were included in the meta-analysis. The overall relative risk (RR) estimate was 0.81 (95% confidence interval (CI) 0.72-0.92) suggesting hysterectomy decreases the risk of ovarian cancer. However, there was significant heterogeneity in the results (I2 = 74%). Our exploration of sources of heterogeneity and metaregression showed that median year of cancer diagnosis of included cases explained most of the heterogeneity relative risk (RR = 0.70 (95% CI 0.65-0.76) for median year diagnosis pre 2000; RR = 1.18 (95% CI 1.06-1.31) for post 2000). This study shows that there has been a temporal shift in the association between hysterectomy and risk of ovarian cancer. One explanation may be the trend away from hysterectomy in younger women. Other speculative possibilities include the decline in oophorectomy rates and the use of oestrogen-only hormone replacement therapy in hysterectomised women. Until further evidence becomes available, clinicians should not advise women that a hysterectomy without salpingo-oophorectomy will favourably influence their future risk of ovarian cancer.
Keyword Hysterectomy
Meta-analysis
Ovarian cancer
Risk
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Critical review of research, literature review, critical commentary
Collections: Official 2014 Collection
School of Public Health Publications
 
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