Bilateral oophorectomy and cancer risk and mortality in African American women

项目摘要/摘要子宫切除术是美国最常见的外科手术之一，每年约有60万美国妇女接受子宫切除术，其中约一半的妇女还接受双侧卵巢切除术。令人关切的是，其中一些程序没有医学指征。非裔美国女性比白人女性更有可能接受妇科手术，尤其是在年轻时。双侧卵巢切除术导致卵巢功能突然丧失。有证据表明，子宫切除术可能导致卵巢功能受损。关于双侧卵巢切除术和子宫切除术对健康结果的长期影响知之甚少。基于有限的流行病学数据，双侧卵巢切除术与乳腺癌风险降低有关，但与结直肠癌、肺癌、癌症死亡率和全因死亡率增加有关。保留一个或两个卵巢的子宫切除术对长期健康结果的影响尚不清楚。迄今为止，关于卵巢切除术和子宫切除术与癌症发病率和死亡率之间关系的研究很少包括非洲裔美国妇女，也没有单独报道过这一人群。我们将使用来自黑人妇女健康研究（BWHS）的数据，这是一项正在进行的59,000名非洲裔美国妇女的队列研究，以解决双侧卵巢切除术和子宫切除术影响癌症发病率和死亡率的假设。具体来说，我们建议前瞻性地研究双侧卵巢切除术和子宫切除术（保留一个或两个卵巢）与女性最常见癌症（乳腺癌、结肠直肠癌和肺癌）发病率以及癌症死亡率和全因死亡率的关系。妇女于1995年被纳入BWHS，每两年通过邮寄问卷进行跟踪调查。在基线和每次随访问卷中确定了妇科手术史。估计有1 925例乳腺癌病例、370例结直肠癌病例、360例肺癌病例、855例癌症死亡病例和2 425例总死亡病例将用于1995-2011年的后续分析。鉴于早期卵巢功能的丧失可能对长期健康产生更大的影响，并且非洲裔美国妇女最有可能在更年轻的年龄进行妇科手术，我们将进一步调查手术年龄是否影响卵巢切除术或子宫切除术与癌症发病率和死亡率的关系。此外，我们还将评估绝经期激素的使用是否会影响卵巢和子宫切除术与癌症发病率和死亡率的关系。这将是第一个研究双侧卵巢切除术和子宫切除术与非裔美国妇女癌症发病率和死亡率之间关系的研究。由于双侧卵巢切除术和子宫切除术的高流行率，阐明双侧卵巢切除术和子宫切除术对这类妇女的长期健康影响尤为重要。

DESCRIPTION (provided by applicant): PROJECT SUMMARY/ABSTRACT Hysterectomy is one of the most common surgical procedures in the U.S. About 600,000 U.S. women undergo hysterectomy each year, and about half of these women also undergo bilateral oophorectomy. There is concern that some of these procedures are not medically indicated. African American women are much more likely than white women to have gynecologic surgery, particularly at younger ages. Bilateral oophorectomy results in abrupt loss of ovarian function. Evidence suggests that hysterectomy may lead to impaired ovarian function. Little is known about the long-term effects of bilateral oophorectomy and hysterectomy on health outcomes. Based on limited epidemiologic data, bilateral oophorectomy has been associated with a reduced risk of breast cancer but an increased risk of colorectal cancer, lung cancer, cancer mortality, and all-cause mortality. The effect of hysterectomy with retention of one or both ovaries on long-term health outcomes is less clear. Studies to date on the relation of oophorectomy and hysterectomy to cancer incidence and mortality have included few African American women, and none has reported separately on this population group. We will use data from the Black Women's Health Study (BWHS), an ongoing cohort study of 59,000 African American women, to address the hypothesis that bilateral oophorectomy and hysterectomy influence cancer incidence and mortality. Specifically, we propose to prospectively examine the relation of bilateral oophorectomy and hysterectomy with retention of one or both ovaries to incidence of the most common cancers in women (breast, colorectal, and lung) and to cancer mortality and all-cause mortality. Women were enrolled in the BWHS in 1995 and have been followed biennially by mailed questionnaire. History of gynecologic surgery has been ascertained at baseline and on each follow-up questionnaire. An estimated 1,925 breast cancer cases, 370 colorectal cancer cases, 360 lung cancer cases, 855 cancer deaths, and 2,425 total deaths will contribute to analyses in follow-up from 1995-2011. Given that loss of ovarian function earlier in life may have a more considerable effect on long-term health, and that African American women are most likely to have gynecologic surgery at younger ages, we will further investigate whether age at surgery influences the relation of oophorectomy or hysterectomy to cancer incidence and mortality. In addition, we will also assess whether use of menopausal hormones influences the relation of oophorectomy and hysterectomy to cancer incidence and mortality. This will be the first study to examine the relation of bilateral oophorectomy and hysterectomy to cancer incidence and mortality among African American women. It is particularly important to elucidate the long-term health effects of bilateral oophorectomy and hysterectomy in this population of women because of the high prevalence of these surgeries. PUBLIC HEALTH RELEVANCE: PROJECT NARRATIVE Bilateral oophorectomy has been linked to increased cancer mortality. African American women are much more likely than white women to have these gynecologic surgeries, particularly at younger ages. The proposed study will provide much needed information on the relation of bilateral oophorectomy and hysterectomy to cancer incidence and mortality among African American women, allowing clinicians and patients to make more informed decisions regarding the long-term health risks and benefits of bilateral oophorectomy and hysterectomy.