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Tubal ligation and ovarian cancer risk in African American women

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Abstract

Purpose

Tubal ligation has been associated with reduced risk of epithelial ovarian cancer (EOC) in studies of primarily white women, but less is known about the association in African American (AA) women. We sought to evaluate the associations among 597 invasive ovarian cancer cases and 742 controls of AA descent recruited from the African American Cancer Epidemiology Study, a population-based case–control study in 11 geographical areas in the US.

Methods

Multivariable logistic regression models were used to estimate odds ratios (OR) and 95% confidence intervals (CI) adjusted for potentially confounding factors.

Results

An inverse association between tubal ligation and EOC was observed that was not statistically significant (OR 0.88, 95% CI 0.68–1.14). However, an inverse association with EOC risk was observed among women who had a tubal ligation at age 35 years or older (OR 0.64; 95% CI 0.41–0.98), but not among those who had a tubal ligation before age 35 (OR 0.98; 95% CI 0.74–1.29) (p for interaction = 0.08). The association also varied considerably by tumor subtype. A strong inverse association was observed for endometrioid tumors (OR 0.31, 95% CI 0.14–0.70), whereas associations with mucinous (OR 0.87, 95% CI 0.36–2.12) and serous (OR 0.94, 95% CI 0.71–1.24) tumors were weaker and not statistically significant. A statistically non-significant positive association for clear cell tumors (OR 1.84, 95% CI 0.58–5.82) was based on a low number of cases.

Conclusions

Our findings show that tubal ligation may confer a reduced risk for EOC among AA women that is comparable to the associations that have been previously observed in primarily white populations.

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Abbreviations

AA:

African American

AACES:

African American Cancer Epidemiology Study

BMI:

Body mass index

CI:

Confidence intervals

OR:

Odds ratio

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Acknowledgments

We would like to acknowledge the AACES interviewers, Christine Bard, LaTonda Briggs, Whitney Franz (North Carolina) and Robin Gold (Detroit). We also acknowledge the individuals responsible for facilitating case ascertainment across the ten sites including: Jennifer Burczyk-Brown (Alabama); Rana Bayakly, Vicki Bennett and Judy Andrews (Georgia); the Louisiana Tumor Registry; Lisa Paddock and Manisha Narang (New Jersey); Diana Slone, Yingli Wolinsky, Steven Waggoner, Anne Heugel, Nancy Fusco, Kelly Ferguson, Peter Rose, Deb Strater, Taryn Ferber, Donna White, Lynn Borzi, Eric Jenison, Nairmeen Haller, Debbie Thomas, Vivian von Gruenigen, Michele McCarroll, Joyce Neading, John Geisler, Stephanie Smiddy, David Cohn, Michele Vaughan, Luis Vaccarello, Elayna Freese, James Pavelka, Pam Plummer, William Nahhas, Ellen Cato, John Moroney, Mark Wysong, Tonia Combs, Marci Bowling, Brandon Fletcher (Ohio); Susan Bolick, Donna Acosta, Catherine Flanagan (South Carolina); Martin Whiteside (Tennessee) and Georgina Armstrong and the Texas Registry, Cancer Epidemiology and Surveillance Branch, Department of State Health Services.

Funding

The current study was supported by the New Jersey Commission on Cancer Research. The AACES study was funded by NCI (R01CA142081). Additional support was provided by Metropolitan Detroit Cancer Surveillance System (MDCSS) with federal funds from the National Cancer Institute, National Institute of Health, Dept. of Health and Human Services, under Contract No. HHSN261201000028C and the Epidemiology Research Core, supported in part by NCI Center Grant (P30CA22453) to the Karmanos Cancer Institute, Wayne State University School of Medicine and NCI Center Grant (P30CA072720) to the Rutgers Cancer Institute of New Jersey. The New Jersey State Cancer Registry, Cancer Epidemiology Services, New Jersey Department of Health, is funded by the Surveillance, Epidemiology and End Results (SEER) Program of the National Cancer Institute under contract HHSN261201300021I, the National Program of Cancer Registries (NPCR), Centers for Disease Control and Prevention under grant 5U58DP003931-02 as well as the State of New Jersey and the Rutgers Cancer Institute of New Jersey. The funders had no role in the design, analysis or writing of this article.

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Authors and Affiliations

  1. Georgia Comprehensive Cancer Registry, Georgia Department of Public Health, Atlanta, GA, USA

    Chrissy McNamara

  2. Department of Public Health Sciences, University of Virginia, Charlottesville, VA, USA

    Sarah E. Abbott, Lauren C. Peres, Fabian Camacho & Joellen M. Schildkraut

  3. Department of Population Science, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA

    Elisa V. Bandera & Bo Qin

  4. Department of Community and Family Medicine, Duke Cancer Institute, Durham, NC, USA

    Patricia G. Moorman

  5. Hollings Cancer Center and Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA

    Anthony J. Alberg

  6. Case Comprehensive Cancer Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA

    Jill S. Barnholtz-Sloan

  7. Cancer Prevention and Population Sciences Program, Baylor College of Medicine, Houston, TX, USA

    Melissa Bondy

  8. Department of Oncology and the Karmanos Cancer Institute, Population Studies and Disparities Research Program, Wayne State University School of Medicine, Detroit, MI, USA

    Michele L. Cote & Ann G. Schwartz

  9. Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, AL, USA

    Ellen Funkhouser

  10. Epidemiology Program, Louisiana State University Health Sciences Center School of Public Health, New Orleans, LA, USA

    Edward S. Peters

  11. Department of Medicine, The University of Tennessee Graduate School of Medicine, 1924 Alcoa Highway Box U-114, Knoxville, TN, 37920, USA

    Paul Terry

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  1. Chrissy McNamara
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  2. Sarah E. Abbott
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  3. Elisa V. Bandera
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  4. Bo Qin
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  5. Lauren C. Peres
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  7. Patricia G. Moorman
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  8. Anthony J. Alberg
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  9. Jill S. Barnholtz-Sloan
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  10. Melissa Bondy
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  15. Joellen M. Schildkraut
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  16. Paul Terry
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Contributions

All authors participated in the design of the research; C.M., P.D.T., F.C., and S.E.A. performed analyses, and all authors wrote the paper. C.M. and P. D.T. had primary responsibility for final content. All authors read and approved the final manuscript.

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Correspondence to Paul Terry.

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McNamara, C., Abbott, S.E., Bandera, E.V. et al. Tubal ligation and ovarian cancer risk in African American women. Cancer Causes Control 28, 1033–1041 (2017). https://doi.org/10.1007/s10552-017-0943-6

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