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American Journal of Epidemiology Vol. 127, No. 6: 1192-1201
Copyright © 1988 by The Johns Hopkins University School of Hygiene and Public Health
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HYSTERECTOMY, TUBAL STERILIZATION, AND THE RISK OF BREAST CANCER
Reprint requests to Dr. Kathleen L. Irwin, Epide-miologic Studies Branch, Division of Reproductive Health, Center for Health Promotion and Education, Centers for Disease Control, Atlanta, GA 30333.
Studies suggest that hysterectomy and tubal sterilization may alter the function of the remaining ovaries. Conceivably, this effect could after breast cancer risk. To investigate whether these surgeries affect breast cancer risk, the authors analyzed data collected between December 1, 1980, and April 30, 1983, in a population-based, case-control study of women aged 20–54 years, the Cancer and Steroid Hormone Study. Compared with never-sterilized women, women with hysterectomy and no remaining ovaries had a decreased risk of breast cancer (relative risk (RR) = 0.7,95% confidence interval (Cl) = 0.6–0.8). Risk was lowest in women who had their surgery before age 40 years or 15 or more years in the past; surgery at an early age provided greater protection than surgery in the distant past Hysterectomy with one or two remaining ovaries was also inversely associated with breast cancer risk (RR = 0.8, 95= Cl = 0.7–0.9), but no relation was found with age at surgery or time since surgery. Women with tubal sterilization had a slightly increased risk of breast cancer, which was of borderline statistical significance (RR = 1.2, 95% Cl = 1.0–1.3). However, no relation was found with age at surgery or time since surgery. The data suggest that hysterectomy with bilateral oophorectomy decreases the breast cancer risk in women aged less than 55 years, possibly by curtailing ovarian function at a critical period. However, neither hysterectomy without bilateral oophorectomy nor tubal sterilization appears to substantially alter breast cancer risk in women of this age.
breast neoplasms; hysterectomy; sterilization, tubal; ovariectomy
1From the Division of Reproductive Health, Center for Health Promotion and Education, Centers for Disease Control. Principal Investigator: George L. Rubin. Project Director: Phyllis A. Wingo. Project Associates: Nancy C. Lee, Michele G. Mandei, Herbert B. Peterson. Data Collection Centers Principal Investigators: Atlanta—Raymond Greenberg; Connecticut—J. Wister Meigs, W. Douglas Thompson; Detroit—G. Marie Swanson; Iowa—Elaine Smith; New Mexico—Charles Key, Dorothy Pathak; San Francisco—Donald Austin; Seattle—David Thomas; Utah—Joseph Lyon, Dee West. Pathology Review Principal Investigators: Fred Goretein, Robert Mc-Divitt, Stanley J. Robboy. Project Consultants: Lonnie Burnett, Robert Hoover, Peter M. Layde, Howard W. Ory; James J. Schlesselman; David Schottenfeld, Bruce Stadel, Linda A. Webster, Colin White. Pathology Consultants: Walter Bauer, William Christopher son, Deborah GerselL Robert Kurman, Allen Paris, Frank Vellios.
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