Skip to main content

Advertisement

SpringerLink
Log in

Ovarian removal and subsequent breast cancer prognosis: a nationwide cohort study

  • Epidemiology
  • Published:
Breast Cancer Research and Treatment Aims and scope Submit manuscript

Abstract

Purpose

To evaluate whether previous ovarian removal concomitant with benign hysterectomy improves prognosis in a cohort of women with breast cancer.

Methods

In this nationwide register-based cohort study, risk of recurrence and mortality were examined in 4563 women with invasive breast cancer and previous bilateral salpingo-oophorectomy (BSO) concomitant with benign hysterectomy, during 1977–2018. Comparing with benign hysterectomy alone, hazard ratios (HRs) and 95% confidence intervals (CIs) were evaluated by Cox-proportional hazards regression models. Analyses were stratified on age at hysterectomy as a proxy for menopausal status (< 45, 45–54 and ≥ 55 years); tumor characteristics, estrogen receptor (ER)-status, and use of hormone therapy (HT) were included in multivariable models.

Results

Compared with hysterectomy alone, premenopausal (< 45 years) BSO at benign hysterectomy was associated with an age and calendar period adjusted HR of 1.48 (95% CI 0.83–2.65) for breast cancer recurrence within 10 years of follow-up, a HR of 1.07 (95% CI 0.66–1.72) for overall mortality after breast cancer, and a HR of 0.59 (95% CI 0.26–1.32) for breast cancer-specific mortality. The corresponding HRs for postmenopausal (≥ 55 years) BSO at benign hysterectomy were 1.51 (95% CI 0.73–3.12) for recurrences, 1.34 (95% CI 0.74–2.44) for overall mortality, and 1.78 (95% CI 0.74–4.30) for breast cancer mortality. Adjusting for tumor characteristics, ER-status and HT did not alter the results.

Conclusion

Results from this cohort study did not indicate an improvement in breast cancer prognosis when removing the ovaries at benign hysterectomy prior to the cancer diagnosis.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Data availability

The datasets generated and analyzed during the current study are not publicly available, since the authors do not have permission to share the data.

Abbreviations

BSO:

Bilateral salpingo-oophorectomy

CI:

Confidence interval

CBC:

Contralateral breast cancer

DBCG:

Danish Breast Cancer Group

ER:

Estrogen receptor

ER+:

Estrogen receptor positive

ER−:

Estrogen receptor negative

HR:

Hazard ratio

HT:

Hormone therapy

ICD:

International Classification of Diseases

N:

Number

References

  1. Parker WH, Broder MS, Chang E et al (2009) Ovarian conservation at the time of hysterectomy and long-term health outcomes in the Nurses’ Health Study. Obstet Gynecol 113(5):1027–1037

    Article  Google Scholar 

  2. Jacoby VL, Grady D, Wactawski-Wende J et al (2011) Oophorectomy vs ovarian conservation with hysterectomy: cardiovascular disease, hip fracture, and cancer in the Women’s Health Initiative Observational Study. Arch Intern Med 171(8):760–768

    Article  Google Scholar 

  3. Mytton J, Evison F, Chilton PJ et al (2017) Removal of all ovarian tissue versus conserving ovarian tissue at time of hysterectomy in premenopausal patients with benign disease: study using routine data and data linkage. BMJ 356:j372

    Article  Google Scholar 

  4. Gottschau M, Kjaer SK, Settnes A et al (2020) Ovarian removal at or after benign hysterectomy and breast cancer: a nationwide cohort study. Breast Cancer Res Treat 181(2):475–485

    Article  Google Scholar 

  5. Gaudet MM, Gapstur SM, Sun J et al (2014) Oophorectomy and hysterectomy and cancer incidence in the Cancer Prevention Study-II Nutrition Cohort. Obstet Gynecol 123(6):1247–1255

    Article  Google Scholar 

  6. Laughlin GA, Barret-Connor E, Kritz-Silverstein D et al (1999) Hysterectomy, oophorectomy, and endogenous sex hormone levels in older women: the Rancho Bernardo Study. J Clin Endocrinol Metab 85(2):645–651

    Google Scholar 

  7. Stanczyk FZ, Chaikittisilpa S, Sriprasert I et al (2019) Circulating androgen levels before and after oophorectomy in premenopausal and postmenopausal women. Climacteric 22(2):169–174

    Article  CAS  Google Scholar 

  8. Huang WY, Newman B, Millikan RC et al (2000) Hormone-related factors and risk of breast cancer in relation to estrogen receptor and progesterone receptor status. Am J Epidemiol 151(7):703–314

    Article  CAS  Google Scholar 

  9. Ma H, Bernstein L, Pike MC et al (2006) Reproductive factors and breast cancer risk according to joint estrogen and progesterone receptor status: a meta-analysis of epidemiological studies. Breast Cancer Res 8(4):R43

    Article  Google Scholar 

  10. Mouridsen HT, Bjerre KD, Christiansen P et al (2008) Improvement of prognosis in breast cancer in Denmark 1977–2006, based on the nationwide reporting to the DBCG Registry. Acta Oncol 47(4):525–536

    Article  Google Scholar 

  11. Foulkes WD, Reis-Filho JS, Narod SA (2010) Tumor size and survival in breast cancer–a reappraisal. Nat Rev Clin Oncol 7(6):348–353

    Article  CAS  Google Scholar 

  12. Roberson ML, Nichols HB, Olshan AF et al (2020) Premenopausal gynecologic surgery and survival among black and white women with breast cancer. Cancer Causes Control 31(2):105–112

    Article  Google Scholar 

  13. Nichols HB, Trentham-Dietz A, Newcomb PA et al (2013) Pre-diagnosis oophorectomy, estrogen therapy and mortality in a cohort of women diagnosed with breast cancer. Breast Cancer Res 15:R99

    Article  Google Scholar 

  14. Schmidt M, Pedersen L, Sorensen HT (2014) The Danish Civil Registration System as a tool in epidemiology. Eur J Epidemiol 29(8):541–549

    Article  Google Scholar 

  15. Schmidt M, Schmidt SA, Sandegaard JL et al (2015) The Danish National Patient Registry: a review of content, data quality, and research potential. Clin Epidemiol 7:449–490

    Article  Google Scholar 

  16. Gjerstorff ML (2011) The Danish Cancer Registry. Scand J Public Health 39(7 Suppl):42–45

    Article  Google Scholar 

  17. Helweg-Larsen K (2011) The Danish register of causes of death. Scand J Public Health 39(7 Suppl):26–29

    Article  Google Scholar 

  18. Blenstrup LT, Knudsen LB (2011) Danish registers on aspects of reproduction. Scand J Public Health 39(7 Suppl):79–82

    Article  Google Scholar 

  19. Jensen VM, Rasmussen AW (2011) Danish education registers. Scand J Public Health 39(7 Suppl):91–94

    Article  Google Scholar 

  20. Pottegard A, Schmidt SAJ, Wallach-Kildemoes H et al (2017) Data resource profile: the Danish National Prescription Registry. Int J Epidemiol 46(3):798-f

    Google Scholar 

  21. Christiansen P, Ejlertsen B, Jensen MB et al (2016) Danish Breast Cancer Cooperative Group. Clin Epidemiol 8:445–449

    Article  Google Scholar 

  22. Lynge E, Sandegaard JL, Rebolj M (2011) The Danish National Patient Register. Scand J Public Health 39(7 Suppl):30–33

    Article  Google Scholar 

  23. R Core Team (2021) R: a language and environment for statistical computing. R Foundation for Statistical Computing, Vienna

    Google Scholar 

  24. Faubion SS, Kuhle CL, Shuster LT et al (2015) Long-term health consequences of premature or early menopause and considerations for management. Climacteric 18(4):483–491

    Article  CAS  Google Scholar 

Download references

Acknowledgements

The authors would also like to express their gratitude to the Danish Clinical Quality Program (National Clinical Registries (RKKP)) and to the Danish Breast Cancer Group (DBCG). This study was supported by The Mermaid Project, the Danish Cancer Society’s Scientific Committee (KBVU) and Lilly and Herbert Hansen’s Foundation.

Funding

This work was supported by The Mermaid Project (Mermaid 3), the Danish Cancer Society’s Scientific Committee (KBVU) (Grant No. R167-A11019-17-S2) and Lilly and Herbert Hansen’s Foundation (Jr.no. 0145).

Author information

Authors and Affiliations

  1. Diet, Cancer and Health, Danish Cancer Society Research Center, Strandboulevarden 49, 2100, Copenhagen, Denmark

    Mathilde Gottschau, Jakob Hansen Viuff & Lene Mellemkjær

  2. Virus, Lifestyle and Genes, Danish Cancer Society Research Center, 2100, Copenhagen, Denmark

    Susanne K. Kjær & Christian Munk

  3. Department of Gynecology, Rigshospitalet University Hospital, University of Copenhagen, 2100, Copenhagen, Denmark

    Susanne K. Kjær

  4. Lifestyle, Reproduction and Genes, Danish Cancer Society Research Center, 2100, Copenhagen, Denmark

    Allan Jensen

  5. Department of Obstetrics and Gynecology, North Zealand Hospital, University of Copenhagen, 3400, Hillerød, Denmark

    Annette Settnes

Authors
  1. Mathilde Gottschau
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Susanne K. Kjær
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jakob Hansen Viuff
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Allan Jensen
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Christian Munk
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Annette Settnes
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Lene Mellemkjær
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

All authors contributed to the study conception and design. LM and MG reviewed the literature and provided input to design and data analyses. Data analyses were performed by JHV. The first draft of the manuscript was written by MG and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Lene Mellemkjær.

Ethics declarations

Competing Interests

LM has an immediate family member who is employed at Novo Nordisk, and an immediate family member who owns stocks in Novo Nordisk. The other authors have no conflicts of interest to declare.

Ethical approval

In Denmark, approval from the Ethical Committee System is not required for studies that are entirely register-based.

Consent to participate

In Denmark, written consents from individuals that are included in a register-based study is not required.

Consent to publish

Not applicable.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (DOC 2936 kb)

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Gottschau, M., Kjær, S.K., Viuff, J.H. et al. Ovarian removal and subsequent breast cancer prognosis: a nationwide cohort study. Breast Cancer Res Treat 197, 583–591 (2023). https://doi.org/10.1007/s10549-022-06825-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10549-022-06825-8

Keywords

Search

Navigation