Clinical opinionGlobal epidemiology of hysterectomy: possible impact on gynecological cancer rates
Section snippets
Hysterectomy by indication
Hysterectomy is most commonly performed because of benign disease, such as fibroids, bleeding disorders, endometriosis, and uterine prolapse. In 2000–2004, hysterectomy caused by benign disease accounted for 90% of all hysterectomies in the United States; malignant disease, such as uterine cancer, cervical cancer, and ovarian cancer, accounted for the remaining 10%.1 Hysterectomy may also include the removal of both ovaries (bilateral oophorectomy). In 2000–2004, approximately 54% of women
Surgical procedure
Hysterectomy can be performed vaginally or abdominally or by a laparoscopic approach. Most commonly, hysterectomy includes removal of the uterine cervix, but subtotal or supracervical hysterectomy, in which the cervix is left intact, is also an option. The latter approach is not a common procedure in the United States (7.5%),6 in the United Kingdom (4%),7 and in Germany (4.8%),8 whereas it has been more common in the Scandinavian countries such as Sweden and Denmark during the past 20 years.9,
Hysterectomy incidence across countries
In the past years, several papers have been published on hysterectomy incidence rates in developed countries (Table 1). The incidence rate is very high in countries such as the United States (510 per 100,000 in 2004),1 ranging from 430 of 100,000 for women living in the Northeast to 630 per 100,000 for those living in the South, whereas lower hysterectomy incidence rates have been reported in several European countries, including Denmark (173 per 100,000 in 2011).2
The hysterectomy incidence
The impact of hysterectomy and oophorectomy on gynecological cancer rates
The incidence rate of cervical cancer has declined significantly in developed countries after implementation of cervical cancer screening programs,20 but the same phenomenon has not been seen in uterine and ovarian cancer, presumably because of the lack of an efficient screening tool.13, 21, 22 Table 1 summarizes the incidence rate of cervical, uterine, and ovarian cancer in the United States, in Australia, and in 3 European countries. As shown, the cervical cancer incidence is higher in
Age-specific cancer rates after correction for hysterectomy
A few studies have reported that the difference in hysterectomy corrected vs uncorrected incidence rates of cervical cancer is highest in older women because hysterectomy incidence is cumulative with age.13, 14, 26, 29 These studies all found that older women were at highest risk of cervical cancer (Figure) after adjusting for hysterectomy. In Finland, women older than 70 years had the highest cervical cancer incidence regardless of hysterectomy status,13 whereas a German study found a 67%
Conclusion
Despite the growing evidence from previous studies, national reporting of gynecological cancer incidence rarely removes the proportion of women who have undergone hysterectomy or oophorectomy from the population-at-risk denominator. This is important when calculating incidence rates on all gynecological cancers; however, for cervical cancer it is especially important that the incidence rate reflects the true population at risk because national screening guidelines are based, in part, on
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2024, American Journal of Geriatric PsychiatryHysterectomy and thyroid cancer risk: A systematic review and meta-analysis
2023, Global EpidemiologyBilateral salpingo-oophorectomy at the time of benign hysterectomy among females with disabilities: a population-based cross-sectional study
2023, American Journal of Obstetrics and GynecologyUnderscreening, overscreening, and guideline-adherent cervical cancer screening in a national cohort
2022, Gynecologic OncologyCitation Excerpt :In another study by Vicus et al., authors found that in women over the age of 30, having had a cervical cancer screening 3–36 months prior to diagnosis of cervical cancer was protective of mortality with an OR of 0.28–0.60 [36]. Therefore, lack of guideline-adherent screening is a concern, especially as more women age with their uterus in place due to improved medical treatments for abnormal bleeding and other conditions that previously led to hysterectomy [37]. In addition, the COVID-19 pandemic has further decreased screening rates, which may further impact future cancer incidence and mortality [38].
A.H. has received a nonrestricted grant (no. DKK 50,000) from Sanofi Pasteur MSD (Denmark). The other authors report no conflicts of interest.