Tubal ligation and ovarian cancer risk in African American women
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.
Multivariable logistic regression models were used to estimate odds ratios (OR) and 95% confidence intervals (CI) adjusted for potentially confounding factors.
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.
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.
KeywordsOvarian cancer Epidemiologic studies Tubal ligation African-American women
African American Cancer Epidemiology Study
Body mass index
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.
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.
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.
Compliance with ethical standards
Conflict of interest
The authors have no conflicts of interest to declare.
- 1.Cancer Facts & Figures (2016) A. C. Society, Ed., ed. AtlantaGoogle Scholar
- 4.Wu AH, Pearce CL, Tseng CC, Pike MC (2015) African Americans and Hispanics remain at lower risk of ovarian cancer than non-hispanic whites after considering nongenetic risk factors and oophorectomy rates, (in eng). Cancer Epidemiol Biomarkers Prev 24:1094–1100CrossRefPubMedPubMedCentralGoogle Scholar
- 20.Rosenblatt KA, Thomas DB (1996) Reduced risk of ovarian cancer in women with a tubal ligation or hysterectomy. The World Health Organization Collaborative Study of Neoplasia and Steroid Contraceptives, (in eng). Cancer Epidemiol Biomark Prev 5:933–935Google Scholar
- 25.Centers for Disease Control and Prevention (2006) Racial and socioeconomic disparities in breastfeeding–United States, 2004, (in eng). MMWR Morb Mortal Wkly Rep 55(12):335–339Google Scholar
- 30.Ogden CL, Carroll MD, Fryar CD, Flegal KM (2015) Prevalence of obesity among adults and youth: United States, 2011–2014, (in eng). NCHS Data Brief 219:1–8Google Scholar
- 37.John EM, Whittemore AS, Harris R, Itnyre J (1993) Characteristics relating to ovarian cancer risk: collaborative analysis of seven U.S. case–control studies. Epithelial ovarian cancer in black women. Collaborative Ovarian Cancer Group, (in eng). J Natl Cancer Inst 85:142–147CrossRefPubMedGoogle Scholar
- 45.Whittemore AS, Harris R, Itnyre J (1992) Characteristics relating to ovarian cancer risk: collaborative analysis of 12 US case–control studies. II. Invasive epithelial ovarian cancers in white women. Collaborative Ovarian Cancer Group, (in eng). Am J Epidemiol 136:1184–1203CrossRefPubMedGoogle Scholar