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Association of hysterectomy and invasive epithelial ovarian and tubal cancer: A cohort study within UKCTOCS
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  • Julie Taylor,
  • Matthew Burnell,
  • Andy Ryan,
  • Chloe Karpinskyj,
  • Jatinderpal Kalsi,
  • Henry Taylor,
  • Sophia Apostolidou,
  • Aarti Sharma,
  • Ranjit Manchanda,
  • Robert Woolas,
  • Stuart Campbell,
  • Mahesh Parmar,
  • Naveena Singh,
  • Ian Jacobs,
  • Usha Menon,
  • Alexandra Gentry-Maharaj
Julie Taylor
University College London
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Matthew Burnell
University College London
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Andy Ryan
University College London
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Chloe Karpinskyj
University College London
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Jatinderpal Kalsi
University College London
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Henry Taylor
Imperial College Healthcare NHS Trust
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Sophia Apostolidou
University College London
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Aarti Sharma
University Hospital of Wales
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Ranjit Manchanda
Queen Mary University of London
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Robert Woolas
Queen Alexandra Hospital
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Stuart Campbell
Create Health Clinics
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Mahesh Parmar
University College London
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Naveena Singh
Barts Health NHS Trust
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Ian Jacobs
University of New South Wales
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Usha Menon
University College London
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Alexandra Gentry-Maharaj
University College London
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Abstract

Objective: To investigate the association between hysterectomy with conservation of one or both adnexa and ovarian and tubal cancer. Design: Prospective cohort study. Setting: 13 NHS Trusts in England, Wales and Northern Ireland. Population: 202,506 postmenopausal women recruited between 2001-2005 to the UK Collaborative Trial of Ovarian Cancer Screening (UKCTOCS) and followed up until 31 December 2014. Methods: Multiple sources (questionnaires, hospital notes, Hospital Episodes Statistics, national cancer/death registries, ultrasound reports) were used to obtain accurate data on hysterectomy (with conservation of one or both adnexa) and outcomes censored at bilateral oophorectomy, death, ovarian/tubal cancer diagnosis, loss to follow-up or 31 December 2014. Cox proportional hazards regression models were used to assess the association. Main outcome measures: Invasive epithelial ovarian and tubal cancer (WHO 2014) on independent outcome review. Results: Hysterectomy with conservation of one or both adnexa was reported in 41,912 (20.7%; 41,912/202,506) women. Median follow up was 11.1years (IQR 9.96-12.04), totalling >2.17million women-years. Among women who had undergone hysterectomy, 0.55% (231/41912) were diagnosed with ovarian/tubal cancer, compared with 0.59% (945/160594) of those with intact uterus. Multivariable analysis showed no evidence of an association between hysterectomy and invasive epithelial ovarian/tubal cancer (RR=0.98, 95%CI 0.85-1.13, p=0.765). Conclusions: This large cohort study provides further independent validation that hysterectomy is not associated with alteration of invasive epithelial ovarian and tubal cancer risk. This data is important both for clinical counselling and for refining risk prediction models.

Peer review status:ACCEPTED

22 Jun 2021Submitted to BJOG: An International Journal of Obstetrics and Gynaecology
24 Jun 2021Submission Checks Completed
24 Jun 2021Assigned to Editor
30 Jun 2021Reviewer(s) Assigned
25 Jul 2021Review(s) Completed, Editorial Evaluation Pending
04 Aug 2021Editorial Decision: Revise Minor
19 Aug 20211st Revision Received
20 Aug 2021Review(s) Completed, Editorial Evaluation Pending
20 Aug 2021Submission Checks Completed
20 Aug 2021Assigned to Editor
24 Aug 2021Editorial Decision: Accept