Abstract
Objective
To evaluate the long-term risk of further gynaecological surgery and cancer in women with endometriosis.
Design
Cohort study.
Setting
Scotland.
Participants
281 937 women with nearly 5 million person years (4 923 628) of follow up from 1981 to 2010.
Methods
In this national population-based study we compared 17 834 women with a new surgical diagnosis of endometriosis with 83 303 women with no evidence of endometriosis at laparoscopy, 162 966 women who underwent laparoscopic sterilisation, and 17 834 age-matched women from the general population. Cox proportional hazards regression was used to calculate crude and adjusted hazard ratios with 95% confidence intervals.
Main outcome measures
Risk of further gynaecological surgery, number and type of repeat surgery and time to repeat surgery from the diagnosis of endometriosis. Cancer outcomes included subsequent risk of all cancer, gynaecological and non–gynaecological cancers.
Results
Women with endometriosis had a significantly higher risk of further surgery when compared with women with no evidence of endometriosis at laparoscopy [hazard ratio (HR) 1.69, 95% (confidence interval) CI 1.65–1.73], women who had undergone laparoscopic sterilisation (HR 3.30, 95% CI 3.23–3.37) and age-matched women from the general population (HR 5.95, 95% CI 5.71–6.20). They also have an increased risk of ovarian cancer when compared with general population counterparts (HR 1.77, 95% CI 1.08–2.89) or those with laparoscopic sterilisation (HR 1.75, 95% CI 1.2–2.45).
Conclusion
Women with surgically diagnosed endometriosis face an increased risk of multiple surgery. They have a higher chance of developing ovarian cancer in comparison with the general population and women with laparoscopic sterilisation.
To evaluate the long-term risk of further gynaecological surgery and cancer in women with endometriosis.
Design
Cohort study.
Setting
Scotland.
Participants
281 937 women with nearly 5 million person years (4 923 628) of follow up from 1981 to 2010.
Methods
In this national population-based study we compared 17 834 women with a new surgical diagnosis of endometriosis with 83 303 women with no evidence of endometriosis at laparoscopy, 162 966 women who underwent laparoscopic sterilisation, and 17 834 age-matched women from the general population. Cox proportional hazards regression was used to calculate crude and adjusted hazard ratios with 95% confidence intervals.
Main outcome measures
Risk of further gynaecological surgery, number and type of repeat surgery and time to repeat surgery from the diagnosis of endometriosis. Cancer outcomes included subsequent risk of all cancer, gynaecological and non–gynaecological cancers.
Results
Women with endometriosis had a significantly higher risk of further surgery when compared with women with no evidence of endometriosis at laparoscopy [hazard ratio (HR) 1.69, 95% (confidence interval) CI 1.65–1.73], women who had undergone laparoscopic sterilisation (HR 3.30, 95% CI 3.23–3.37) and age-matched women from the general population (HR 5.95, 95% CI 5.71–6.20). They also have an increased risk of ovarian cancer when compared with general population counterparts (HR 1.77, 95% CI 1.08–2.89) or those with laparoscopic sterilisation (HR 1.75, 95% CI 1.2–2.45).
Conclusion
Women with surgically diagnosed endometriosis face an increased risk of multiple surgery. They have a higher chance of developing ovarian cancer in comparison with the general population and women with laparoscopic sterilisation.
| Original language | English |
|---|---|
| Pages (from-to) | 64-72 |
| Number of pages | 9 |
| Journal | BJOG-An International Journal of Obstetrics and Gynaecology |
| Volume | 125 |
| Issue number | 1 |
| Early online date | 27 Sept 2017 |
| DOIs | |
| Publication status | Published - Jan 2018 |
Bibliographical note
Funded by Chief Scientist Office, ScotlandKeywords
- cancer
- endometriosis
- recurrent surgery
- hysterectomy
Access to Document
- Accepted Manuscript
This is the peer reviewed version of the following article:Saraswat L, Ayansina D, Cooper KG, Bhattacharya S, Horne AW, Bhattacharya S. Impact of endometriosis on risk of further gynaecological surgery and cancer: a national cohort study. BJOG 2018; 125:64–72., which has been published in final form at DOI: 10.1111/1471-0528.14793. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Self-Archiving.
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Dolapo Ayansina
- School of Medicine, Medical Sciences & Nutrition, Applied Health Sciences - Research Fellow
- School of Medicine, Medical Sciences & Nutrition, Medical Statistics
Person: Academic Related - Research