Association between pelvic inflammatory disease and subsequent salpingectomy on the risk for ovarian cancer

Henrik Falconer,Li Yin,Sahar Salehi,Daniel Altman

doi:10.1016/j.ejca.2020.11.046

Abstract

AimSalpingectomy is associated with a lower risk for ovarian cancer, suggesting that the fallopian tubes constitute the origin of the disease. It is unclear whether the observed effect is mediated by pelvic inflammatory disease (PID); a major indication for salpingectomy and implicated in the aetiology of ovarian cancer. MethodsIn this population-based cohort study, we used nationwide registry-based data on women exposed for PID with and without subsequent salpingectomy (n = 97,912) compared with the unexposed population (n = 5,429,174) between 1973 and 2010. The effect of hormone treatment was considered in a subanalysis. ResultsOf the exposed women, 9538 women underwent salpingectomy during the study period. There was a significant association between PID and ovarian cancer (hazard ratio [HR] 1.44, 95% confidence interval [CI] 1.31–1.59), whereas an inverse association was observed for exposed women with subsequent salpingectomy (HR 0.55, 95% CI 0.36–0.83). Salpingectomy performed on other indications (n = 24,895) was associated with a lower incidence of ovarian cancer (HR 0.72, 95% CI 0.56–0.93). No effect modification was observed for the use of oral contraceptives or hormonal replacement therapy. ConclusionSalpingectomy is associated with a lower incidence of ovarian cancer regardless of indication.

Highlights

Ovarian cancer is commonly diagnosed at an advanced stage and is associated with a dismal prognosis
A history of pelvic inflammatory disease (PID) without subsequent salpingectomy was associated with a higher risk for ovarian cancer (HR 1.44, 95% confidence intervals (CIs) 1.31e1.59), whereas PID followed by salpingectomy was inversely associated with ovarian cancer (HR 0.55, 95% CI 0.36e0.83)
Women with salpingectomy but without a previous history of PID had a lower incidence of ovarian cancer (HR 0.72, 95% CI 0.56e0.93)

Summary

Introduction

Ovarian cancer is commonly diagnosed at an advanced stage and is associated with a dismal prognosis. The role of PID on the risk of ovarian cancer is uncertain and pooled analyses of caseecontrol studies show conflicting results [10,11] Most of these studies were limited by the lack of serological data on PID agents but recent prospective data suggest that chlamydia trachomatis antibodies are associated with a two-fold ovarian cancer risk [12]. In this population-based cohort study, we hypothesized that salpingectomy on benign indications is associated with a reduction of ovarian cancer irrespective of the indication for the procedure. We studied a nationwide cohort of women in Sweden exposed to PID with, or without, subsequent salpingectomy

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Conclusion