Cancer Causes & Control

, Volume 20, Issue 5, pp 539–547

Breast cancer risk and hysterectomy status: the Multiethnic Cohort study

  • Christy G. Woolcott
  • Gertraud Maskarinec
  • Malcolm C. Pike
  • Brian E. Henderson
  • Lynne R. Wilkens
  • Laurence N. Kolonel
Original Paper

Abstract

Objective

The main objective was to examine the association between simple hysterectomy (without bilateral oophorectomy) and breast cancer risk. Because hysterectomy prevalence varies by ethnicity, the secondary objective was to examine whether inclusion of women with hysterectomies affects the estimates of breast cancer risk by ethnicity.

Methods

The Multiethnic Cohort study was assembled between 1993 and 1996 and included 68,065 women from Hawaii and Los Angeles, aged 45–75 years, without any missing information or bilateral oophorectomy. Hysterectomy status was self-reported. After 7.7 years median follow-up, 1,862 cases of invasive breast cancer were identified. Proportional hazards models were used to estimate relative risks (RR) while controlling for known risk factors.

Results

Prevalence of simple hysterectomy varied from 12% to 29% among the ethnic groups (White, African American, Native Hawaiian, Japanese American, and Latina). Overall, hysterectomy was not associated with breast cancer risk (RR = 0.98). Although the RRs were nonsignificantly elevated by 15% in White women and nonsignificantly reduced by 15% in Latinas of non-US origin, the variation by ethnicity was not significant (pinteraction = 0.48). The breast cancer risk associated with ethnicity was very similar when estimated with and without women with hysterectomies.

Conclusions

This study suggests that simple hysterectomy status does not alter breast cancer risk. Therefore, inclusion of women with simple hysterectomies does not substantially change estimated risk of breast cancer by ethnicity.

Keywords

Breast cancer Hysterectomy Ethnicity Cohort 

References

  1. 1.
    Schairer C, Persson I, Falkeborn M et al (1997) Breast cancer risk associated with gynecologic surgery and indications for such surgery. Int J Cancer 2:150–154. doi:10.1002/(SICI)1097-0215(19970117)70:2<150::AID-IJC2>3.0.CO;2-WCrossRefGoogle Scholar
  2. 2.
    Kreiger N, Sloan M, Cotterchio M, Kirsh V (1999) The risk of breast cancer following reproductive surgery. Eur J Cancer 1:97–101. doi:10.1016/S0959-8049(98)00343-8 CrossRefGoogle Scholar
  3. 3.
    Irwin KL, Lee NC, Peterson HB et al (1988) Hysterectomy, tubal sterilization, and the risk of breast cancer. Am J Epidemiol 6:1192–1201Google Scholar
  4. 4.
    Parazzini F, Braga C, La VC et al (1997) Hysterectomy, oophorectomy in premenopause, and risk of breast cancer. Obstet Gynecol 3:453–456. doi:10.1016/S0029-7844(97)00295-0 CrossRefGoogle Scholar
  5. 5.
    Collaborative Group on Hormonal Factors in Breast Cancer (1997) Breast cancer and hormone replacement therapy: collaborative reanalysis of data from 51 epidemiological studies of 52, 705 women with breast cancer and 108, 411 women without breast cancer. Collaborative Group on Hormonal Factors in Breast Cancer. Lancet 9084:1047–1059Google Scholar
  6. 6.
    Pike MC, Kolonel LN, Henderson BE et al (2002) Breast cancer in a multiethnic cohort in Hawaii and Los Angeles: risk factor-adjusted incidence in Japanese equals and in Hawaiians exceeds that in whites. Cancer Epidemiol Biomarkers Prev 9:795–800Google Scholar
  7. 7.
    Pike MC, Ross RK, Spicer DV (1998) Problems involved in including women with simple hysterectomy in epidemiologic studies measuring the effects of hormone replacement therapy on breast cancer risk. Am J Epidemiol 8:718–721Google Scholar
  8. 8.
    Rockhill B, Colditz GA, Rosner B (2000) Bias in breast cancer analyses due to error in age at menopause. Am J Epidemiol 4:404–408Google Scholar
  9. 9.
    Powell LH, Meyer P, Weiss G et al (2005) Ethnic differences in past hysterectomy for benign conditions. Womens Health Issues 4:179–186. doi:10.1016/j.whi.2005.05.002 CrossRefGoogle Scholar
  10. 10.
    Marshall LM, Spiegelman D, Goldman MB et al (1998) A prospective study of reproductive factors and oral contraceptive use in relation to the risk of uterine leiomyomata. Fertil Steril 3:432–439. doi:10.1016/S0015-0282(98)00208-8 CrossRefGoogle Scholar
  11. 11.
    Brett KM, Marsh JV, Madans JH (1997) Epidemiology of hysterectomy in the United States: demographic and reproductive factors in a nationally representative sample. J Womens Health 3:309–316Google Scholar
  12. 12.
    Meilahn EN, Matthews KA, Egeland G, Kelsey SF (1989) Characteristics of women with hysterectomy. Maturitas 4:319–329. doi:10.1016/0378-5122(89)90028-5 CrossRefGoogle Scholar
  13. 13.
    Sherman ME, Carreon JD, Lacey JV Jr, Devesa SS (2005) Impact of hysterectomy on endometrial carcinoma rates in the United States. J Natl Cancer Inst 22:1700–1702Google Scholar
  14. 14.
    Chlebowski RT, Chen Z, Anderson GL et al (2005) Ethnicity and breast cancer: factors influencing differences in incidence and outcome. J Natl Cancer Inst 6:439–448Google Scholar
  15. 15.
    Kolonel LN, Henderson BE, Hankin JH et al (2000) A Multiethnic Cohort in Hawaii and Los Angeles: baseline characteristics. Am J Epidemiol 151:346–357PubMedGoogle Scholar
  16. 16.
    Nothlings U, Wilkens LR, Murphy SP et al (2005) Meat and fat intake as risk factors for pancreatic cancer: the Multiethnic Cohort study. J Natl Cancer Inst 19:1458–1465Google Scholar
  17. 17.
    Therneau T, Grambsch P (2000) Modeling survival data: extending the Cox model. Springer-Verlag, New YorkGoogle Scholar
  18. 18.
    Rothman KJ, Greenland S (1998) Modern epidemiology, 2nd edn. Lippincott-Raven, Philadelphia, PA, p 256Google Scholar
  19. 19.
    Farquhar CM, Steiner CA (2002) Hysterectomy rates in the United States 1990–1997. Obstet Gynecol 2:229–234. doi:10.1016/S0029-7844(01)01723-9 CrossRefGoogle Scholar
  20. 20.
    Jacobson GF, Shaber RE, Armstrong MA, Hung YY (2006) Hysterectomy rates for benign indications. Obstet Gynecol 6:1278–1283Google Scholar
  21. 21.
    Keshavarz H, Hillis SD, Kieke BA, Marchbanks PA (2002) Hysterectomy surveillance – Unites States, 1994–1999. MMWR CDC Surveill Summ SS05:1–8Google Scholar
  22. 22.
    Parazzini F (2006) Risk factors for clinically diagnosed uterine fibroids in women around menopause. Maturitas 2:174–179. doi:10.1016/j.maturitas.2006.01.013 CrossRefGoogle Scholar
  23. 23.
    Settnes A, Andreasen AH, Jorgensen T (2005) Hypertension is associated with an increased risk for hysterectomy: a Danish cohort study. Eur J Obstet Gynecol Reprod Biol 2:218–224. doi:10.1016/j.ejogrb.2005.02.010 CrossRefGoogle Scholar
  24. 24.
    Terry KL, De Vivo I, Hankinson SE et al (2007) Anthropometric characteristics and risk of uterine leiomyoma. Epidemiology 6:758–763CrossRefGoogle Scholar
  25. 25.
    Wise LA, Palmer JR, Spiegelman D et al (2005) Influence of body size and body fat distribution on risk of uterine leiomyomata in U.S. black women. Epidemiology 3:346–354. doi:10.1097/01.ede.0000158742.11877.99 CrossRefGoogle Scholar
  26. 26.
    Wise LA, Palmer JR, Harlow BL et al (2004) Reproductive factors, hormonal contraception, and risk of uterine leiomyomata in African-American women: a prospective study. Am J Epidemiol 2:113–123. doi:10.1093/aje/kwh016 CrossRefGoogle Scholar
  27. 27.
    Farquhar C (2007) Endometriosis. BMJ 7587:249–253. doi:10.1136/bmj.39073.736829.BE CrossRefGoogle Scholar
  28. 28.
    Heilier JF, Donnez J, Nackers F et al (2007) Environmental and host-associated risk factors in endometriosis and deep endometriotic nodules: a matched case–control study. Environ Res 1:121–129. doi:10.1016/j.envres.2006.04.004 CrossRefGoogle Scholar
  29. 29.
    Missmer SA, Hankinson SE, Spiegelman D et al (2004) Reproductive history and endometriosis among premenopausal women. Obstet Gynecol 5(Pt 1):965–974Google Scholar
  30. 30.
    Missmer SA, Hankinson SE, Spiegelman D et al (2004) Incidence of laparoscopically confirmed endometriosis by demographic, anthropometric, and lifestyle factors. Am J Epidemiol 8:784–796. doi:10.1093/aje/kwh275 CrossRefGoogle Scholar
  31. 31.
    Parazzini F, Chiaffarino F, Surace M et al (2004) Selected food intake and risk of endometriosis. Hum Reprod 8:1755–1759. doi:10.1093/humrep/deh395 CrossRefGoogle Scholar
  32. 32.
    Vigano P, Parazzini F, Somigliana E, Vercellini P (2004) Endometriosis: epidemiology and aetiological factors. Best Pract Res Clin Obstet Gynaecol 2:177–200. doi:10.1016/j.bpobgyn.2004.01.007 CrossRefGoogle Scholar
  33. 33.
    Nygaard I, Bradley C, Brandt D (2004) Pelvic organ prolapse in older women: prevalence and risk factors. Obstet Gynecol 3:489–497Google Scholar
  34. 34.
    Rortveit G, Brown JS, Thom DH et al (2007) Symptomatic pelvic organ prolapse: prevalence and risk factors in a population-based, racially diverse cohort. Obstet Gynecol 6:1396–1403Google Scholar
  35. 35.
    Tegerstedt G, Miedel A, Maehle-Schmidt M, Nyren O, Hammarstrom M (2006) Obstetric risk factors for symptomatic prolapse: a population-based approach. Am J Obstet Gynecol 1:75–81. doi:10.1016/j.ajog.2005.06.086 CrossRefGoogle Scholar
  36. 36.
    Bertelsen L, Mellemkjaer L, Frederiksen K et al (2007) Risk for breast cancer among women with endometriosis. Int J Cancer 6:1372–1375. doi:10.1002/ijc.22490 CrossRefGoogle Scholar
  37. 37.
    Brinton LA, Westhoff CL, Scoccia B et al (2005) Causes of infertility as predictors of subsequent cancer risk. Epidemiology 4:500–507. doi:10.1097/01.ede.0000164812.02181.d5 CrossRefGoogle Scholar
  38. 38.
    Olson JE, Cerhan JR, Janney CA et al (2002) Postmenopausal cancer risk after self-reported endometriosis diagnosis in the Iowa Women’s Health Study. Cancer 5:1612–1618. doi:10.1002/cncr.10370 CrossRefGoogle Scholar
  39. 39.
    Melin A, Sparen P, Bergqvist A (2007) The risk of cancer and the role of parity among women with endometriosis. Hum Reprod 11:3021–3026. doi:10.1093/humrep/dem209 CrossRefGoogle Scholar
  40. 40.
    Brinton LA, Gridley G, Persson I, Baron J, Bergqvist A (1997) Cancer risk after a hospital discharge diagnosis of endometriosis. Am J Obstet Gynecol 3:572–579. doi:10.1016/S0002-9378(97)70550-7 CrossRefGoogle Scholar
  41. 41.
    Chan CC, Ng EH, Ho PC (2005) Ovarian changes after abdominal hysterectomy for benign conditions. J Soc Gynecol Investig 1:54–57. doi:10.1016/j.jsgi.2004.07.004 CrossRefGoogle Scholar
  42. 42.
    Souza AZ, Fonseca AM, Izzo VM, Clauzet RM, Salvatore CA (1986) Ovarian histology and function after total abdominal hysterectomy. Obstet Gynecol 6:847–849Google Scholar
  43. 43.
    Oldenhave A, Jaszmann LJ, Everaerd WT, Haspels AA (1993) Hysterectomized women with ovarian conservation report more severe climacteric complaints than do normal climacteric women of similar age. Am J Obstet Gynecol 3(Pt 1):765–771Google Scholar
  44. 44.
    Hartmann BW, Kirchengast S, Albrecht A, Metka M, Huber JC (1995) Hysterectomy increases the symptomatology of postmenopausal syndrome. Gynecol Endocrinol 3:247–252CrossRefGoogle Scholar
  45. 45.
    Stadberg E, Mattsson LA, Milsom I (2000) Factors associated with climacteric symptoms and the use of hormone replacement therapy. Acta Obstet Gynecol Scand 4:286–292. doi:10.1034/j.1600-0412.2000.079004286.x CrossRefGoogle Scholar
  46. 46.
    Cooper GS, Thorp JM Jr (1999) FSH levels in relation to hysterectomy and to unilateral oophorectomy. Obstet Gynecol 6:969–972. doi:10.1016/S0029-7844(99)00429-9 CrossRefGoogle Scholar
  47. 47.
    Farquhar CM, Sadler L, Harvey SA, Stewart AW (2005) The association of hysterectomy and menopause: a prospective cohort study. BJOG 7:956–962. doi:10.1111/j.1471-0528.2005.00696.x Google Scholar
  48. 48.
    Rosner B, Colditz GA (1996) Nurses’ health study: log-incidence mathematical model of breast cancer incidence. J Natl Cancer Inst 6:359–364. doi:10.1093/jnci/88.6.359 CrossRefGoogle Scholar
  49. 49.
    Setiawan VW, Haiman CA, Stanczyk FZ, Le ML, Henderson BE (2006) Racial/ethnic differences in postmenopausal endogenous hormones: the Multiethnic Cohort study. Cancer Epidemiol Biomarkers Prev 10:1849–1855. doi:10.1158/1055-9965.EPI-06-0307 CrossRefGoogle Scholar
  50. 50.
    Davis L, Kennedy SS, Moore J, Prentice A (2007) Modern combined oral contraceptives for pain associated with endometriosis. Cochrane Database Syst Rev 3:CD001019PubMedGoogle Scholar
  51. 51.
    Parker WH (2007) Uterine myomas: management. Fertil Steril 2:255–271. doi:10.1016/j.fertnstert.2007.06.044 CrossRefGoogle Scholar
  52. 52.
    Selak V, Farquhar C, Prentice A, Singla A (2007) Danazol for pelvic pain associated with endometriosis. Cochrane Database Syst Rev 4:CD000068PubMedGoogle Scholar
  53. 53.
    Colditz GA, Stampfer MJ, Willett WC et al (1987) Reproducibility and validity of self-reported menopausal status in a prospective cohort study. Am J Epidemiol 126:319–325PubMedGoogle Scholar
  54. 54.
    Treloar SA, Do KA, O’Connor VM et al (1999) Predictors of hysterectomy: an Australian study. Am J Obstet Gynecol 4:945–954. doi:10.1016/S0002-9378(99)70666-6 CrossRefGoogle Scholar
  55. 55.
    Brett KM, Madans JH (1994) Hysterectomy use: the correspondence between self-reports and hospital records. Am J Public Health 10:1653–1655CrossRefGoogle Scholar
  56. 56.
    Bosetti C, Tavani A, Negri E, Trichopoulos D, La VC (2001) Reliability of data on medical conditions, menstrual and reproductive history provided by hospital controls. J Clin Epidemiol 9:902–906. doi:10.1016/S0895-4356(01)00362-6 CrossRefGoogle Scholar
  57. 57.
    Horwitz RI, Yu EC (1985) Problems and proposals for interview data in epidemiological research. Int J Epidemiol 3:463–467. doi:10.1093/ije/14.3.463 CrossRefGoogle Scholar
  58. 58.
    Brizzolara S, Grandinetti A, Mor J (2002) Percentage of hysterectomy for pelvic organ prolapse in five ethnic groups. Int Urogynecol J Pelvic Floor Dysfunct 6:372–376. doi:10.1007/s001920200082 CrossRefGoogle Scholar
  59. 59.
    Brett KM, Higgins JA (2003) Hysterectomy prevalence by Hispanic ethnicity: evidence from a national survey. Am J Public Health 2:307–312CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media B.V. 2008

Authors and Affiliations

  • Christy G. Woolcott
    • 1
  • Gertraud Maskarinec
    • 1
  • Malcolm C. Pike
    • 2
  • Brian E. Henderson
    • 2
  • Lynne R. Wilkens
    • 1
  • Laurence N. Kolonel
    • 1
  1. 1.Cancer Research Center of HawaiiUniversity of HawaiiHonoluluUSA
  2. 2.Department of Preventive Medicine, Norris Comprehensive Cancer Center, Keck School of MedicineUniversity of Southern CaliforniaLos AngelesUSA

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