Breast cancer risk and hysterectomy status: the Multiethnic Cohort study
- First Online:
- 80 Downloads
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.
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.
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.
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.
KeywordsBreast cancer Hysterectomy Ethnicity Cohort
- 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
- 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.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.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.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
- 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
- 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.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
- 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.Therneau T, Grambsch P (2000) Modeling survival data: extending the Cox model. Springer-Verlag, New YorkGoogle Scholar
- 18.Rothman KJ, Greenland S (1998) Modern epidemiology, 2nd edn. Lippincott-Raven, Philadelphia, PA, p 256Google Scholar
- 20.Jacobson GF, Shaber RE, Armstrong MA, Hung YY (2006) Hysterectomy rates for benign indications. Obstet Gynecol 6:1278–1283Google Scholar
- 21.Keshavarz H, Hillis SD, Kieke BA, Marchbanks PA (2002) Hysterectomy surveillance – Unites States, 1994–1999. MMWR CDC Surveill Summ SS05:1–8Google Scholar
- 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
- 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.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
- 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.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