Journal
INTERNATIONAL JOURNAL OF EPIDEMIOLOGY
Volume 42, Issue 2, Pages 579-589Publisher
OXFORD UNIV PRESS
DOI: 10.1093/ije/dyt042
Keywords
Ovarian cancer; tubal ligation; tubal sterilization
Categories
Funding
- U.S. National Institutes of Health [R01CA074850, R01CA080742, R01CA112523, R01CA87538, R01CA58598, N01CN55424, N01PC67001, R01CA95023, R01CA61107, R01CA76016, R01CA54419, P50CA105009, K07CA095666, R01CA83918, K22CA138563, R01CA120429, U01CA71966, U01CA69417, R01CA16056, K07CA143047]
- U.S. Department of Defense [DAMD17-01-1-0729, W81X WH0610220, DAMD17-02-1-0669, DAMD17-02-1-0666, W81XWH-10-1-02802]
- California Cancer Research Program [00-01389V-20170, 2II0200]
- National Health and Medical Research Council of Australia [199600]
- Cancer Council of New South Wales
- Cancer Council of Victoria
- Cancer Council of Queensland
- Cancer Council of South Australia
- Cancer Council of Tasmania
- Cancer Foundation of Western Australia
- German Federal Ministry of Education and Research [01 GB 9401]
- German Cancer Research Center
- Danish Cancer Society [94 222 52]
- Mermaid I project
- Cancer Institute of New Jersey
- Radboud University Nijmegen Medical Centre
- National Health Research and Development Program of Health and Welfare Canada [6613-1415-53]
- U.S. National Institutes of Health. [R01CA136891, R01CA14089, R01CA17054, R01CA61132, R01CA 63464, N01PC67010, R03CA113148]
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Background Tubal ligation is a protective factor for ovarian cancer, but it is unknown whether this protection extends to all invasive histological subtypes or borderline tumors. We undertook an international collaborative study to examine the association between tubal ligation and ovarian cancer subtypes. Methods We pooled primary data from 13 population-based case-control studies, including 10 157 patients with ovarian cancer (7942 invasive; 2215 borderline) and 13 904 control women. Invasive cases were analysed by histological type, grade and stage, and borderline cases were analysed by histological type. Pooled odds ratios were estimated using conditional logistic regression to match on site, race/ethnicity and age categories, and to adjust for age, oral contraceptive use duration and number of full-term births. Results Tubal ligation was associated with significantly reduced risks of invasive serous (OR, 0.81; 95% CI, 0.74-0.89; P<0.001), endometrioid (OR, 0.48; 95% CI, 0.40-0.59; P<0.001), clear cell (OR, 0.52; 95% CI, 0.40-0.67; P<0.001) and mucinous (OR, 0.68; 95% CI, 0.52-0.89; P = 0.005) cancers. The magnitude of risk reduction was significantly greater for invasive endometrioid (P<0.0001) and clear cell (P = 0.0018) than for serous cancer. No significant associations were found with borderline serous or mucinous tumours. Conclusions We found that the protective effects of tubal ligation on ovarian cancer risk were subtype-specific. These findings provide insights into distinct aetiologies of ovarian cancer subtypes and mechanisms underlying the protective effects of tubal ligation.
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