IS TUBAL-STERILIZATION ASSOCIATED WITH AN INCREASED RISK OF SUBSEQUENT HYSTERECTOMY BUT A DECREASED RISK OF OVARIAN-CANCER - A REVIEW OF RECENT LITERATURE

Recent epidemiologic studies have suggested that tubal sterilization ( TS) may lead to an increased incidence of subsequent hysterectomy but a decreased risk of ovarian cancer. This review evaluates the nature a nd magnitude of these two relationships, which should be of great conc ern and interest to women, clinicians and the administrators of family planning programs. The positive relationship between TS and subsequen t hysterectomy is more likely to be of a motivational rather than biol ogical nature, and a considerable number of unnecessary hysterectomies after TS could be avoided by changing the attitudes of physicians and women. The inverse relationship between TS and ovarian cancer appears causal, although the exact biological mechanisms remain to be clarifi ed. Theoretically, this non-contraceptive beneficial effect of TS coul d be used as a primary preventive measure to curb the incidence of the highly fatal ovarian cancer. However, a number of medical, ethical, a nd economic questions attending use of a generally irreversible contra ceptive procedure as a preventive measure must first be answered. The issue of whether TS is associated with any long-term sequelae, and, if so, whether the association is of a cause-and-effect nature or a by-p roduct of time passage and aging of the woman, should be addressed by well-designed studies.