Irwin K L, Lee N C, Peterson H B, Rubin G L, Wingo P A, Mandel M G
Division of Reproductive Health, Center for Health Promotion and Education, Centers for Disease Control, Atlanta, GA 30333.
Am J Epidemiol. 1988 Jun;127(6):1192-201. doi: 10.1093/oxfordjournals.aje.a114912.
Studies suggest that hysterectomy and tubal sterilization may alter the function of the remaining ovaries. Conceivably, this effect could alter breast cancer risk. To investigate whether these surgeries affect breast cancer risk, the authors analyzed data collected between December 1, 1980, and April 30, 1983, in a population-based, case-control study of women aged 20-54 years, the Cancer and Steroid Hormone Study. Compared with never-sterilized women, women with hysterectomy and no remaining ovaries had a decreased risk of breast cancer (relative risk (RR) = 0.7, 95% confidence interval (CI) = 0.6-0.8). Risk was lowest in women who had their surgery before age 40 years or 15 or more years in the past; surgery at an early age provided greater protection than surgery in the distant past. Hysterectomy with one or two remaining ovaries was also inversely associated with breast cancer risk (RR = 0.8, 95% CI = 0.7-0.9), but no relation was found with age at surgery or time since surgery. Women with tubal sterilization had a slightly increased risk of breast cancer, which was of borderline statistical significance (RR = 1.2, 95% CI = 1.0-1.3). However, no relation was found with age at surgery or time since surgery. The data suggest that hysterectomy with bilateral oophorectomy decreases the breast cancer risk in women aged less than 55 years, possibly by curtailing ovarian function at a critical period. However, neither hysterectomy without bilateral oophorectomy nor tubal sterilization appears to substantially alter breast cancer risk in women of this age.
研究表明，子宫切除术和输卵管绝育术可能会改变剩余卵巢的功能。可以想象，这种影响可能会改变患乳腺癌的风险。为了调查这些手术是否会影响患乳腺癌的风险，作者分析了在1980年12月1日至1983年4月30日期间收集的数据，这些数据来自一项基于人群的20 - 54岁女性病例对照研究——癌症与类固醇激素研究。与从未绝育的女性相比，接受子宫切除术且没有剩余卵巢的女性患乳腺癌的风险降低（相对风险（RR）= 0.7，95%置信区间（CI）= 0.6 - 0.8）。在40岁之前或15年或更久以前接受手术的女性中，风险最低；早年手术比过去很久之前手术提供了更大的保护。保留一个或两个卵巢的子宫切除术也与乳腺癌风险呈负相关（RR = 0.8，95% CI = 0.7 - 0.9），但未发现与手术年龄或手术时间有关。接受输卵管绝育术的女性患乳腺癌的风险略有增加，具有边缘统计学意义（RR = 1.2，95% CI = 1.0 - 1.3）。然而，未发现与手术年龄或手术时间有关。数据表明，双侧卵巢切除术的子宫切除术可降低55岁以下女性患乳腺癌的风险，可能是通过在关键时期减少卵巢功能实现的。然而，未进行双侧卵巢切除术的子宫切除术和输卵管绝育术似乎都不会显著改变这个年龄段女性患乳腺癌的风险。
