Q&A Of The Week:  Tubal Ligation and Cancer

Kim writes: I'm 38, and we are finished having children.  My husband and I are looking into the pros and cons of vasectomy vs. a tubal ligation.  While surfing the net I came across information that said that a tubal will increase my chances of getting cervical and endometrial cancer, and then in another place, I saw that it would decrease my chances of getting ovarian cancer.  In still another place, I saw that there was no increased risk of endometrial cancer.  To tell you the truth, I can't understand why a tubal would have anything to do with cancer at all!  Can you explain all this to me?

It doesn't make much intuitive sense, does it?  Let's take these one at a time:

Ovarian Cancer - There is a well-established protective effect.  Tubal ligations seem to cut the risk of ovarian cancer by about 30%, which is substantial.  The mechanism is unknown at this time.  Two of the most prominent ideas about this are 1)  interference with the blood supply to the ovary or some other mechanism reduces the level of hormones produced, which may reduce risk, or  2) closing off the Fallopian tubes protects the ovaries from environmental carcinogens, such as talc (the relationship between talc and ovarian cancer remains controversial, however, there is some evidence to support talc contributing to ovarian cancer).

Endometrial Cancer - Although there have been studies showing  increased endometrial cancer with tubal ligations, more well-controlled studies have shown there to be no effect.  This is one of those cases where one study may show a correlation between two things, but you can't really tell whether one has anything directly to do with the other, or whether there is a third factor involved that statistically "joins the two".  In this case, the original study was probably partly picking up what is called "detection bias", which means that people who have medical procedures like tubal ligations are more likely to see doctors, so other conditions are more likely to be found.

Cervical Cancer - There has never been strong evidence of this connection that I can find.  I have found studies showing no effect.  In a case such as this, you would wonder whether women who get tubal ligations might be less likely to use barrier methods of contraception, such as condoms, that have a protective effect against HPV.

For more info to help you in your search, check out  Sterilization - His or Hers? from About's Women's Health site.

Good luck with your decision!
 
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