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While increasing levels of obesity and other risk factors seem likely to be contributing to increases in uterine cancer incidence,[1] it has long been recognised that rates of uterine cancer are influenced by the prevalence of "hysterectomised" women in the population.[2] The figure shows trends in age-standardised hysterectomy rates in Scotland over the past 32 years. The decrease in rates of hysterectomy since the mid-1990s has been noted previously in England[3] and, more recently, in Scotland.[4] In the short-term, this may result in fewer cancers being detected as incidental findings, following routine pathological assessment of resected specimens. However, in the longer term it leaves a larger population at risk of developing uterine cancer, and therefore may also be contributing to the increases in uterine cancer incidence reported by the UK cancer registries. To obtain a true picture of underlying risk in the population, uterine cancer incidence rates should, ideally, be "corrected" for hysterectomy prevalence, when possible.[2,5-7]
References
1. Kmietowicz Z. Obesity is blamed for large rise in uterine cancers in UK. BMJ 2016;353:i2093. (13 April.)
2. Lyon JL, Gardner JW. The rising frequency of hysterectomy: Its effect on uterine cancer rates. Am J Epidemiol 1977;105:439–43.
3. Reid PC, Mukri F. Trends in number of hysterectomies performed in England for menorrhagia: examination of health episode statistics, 1989 to 2002-3. BMJ 2005;330:938-9.
4. Chittenden BG, Dallas S, Jack SA. Trends in the surgical options for the treatment of menorrhagia in Scotland: examination of health episode statistics, 2000-2008. Scott Med J 2012;57:92-4.
5. Redburn JC, Murphy MF. Hysterectomy prevalence and adjusted cervical and uterine cancer rates in England and Wales. BJOG 2001;108:388-95.
6. Luoto R, Raitanen J, Pukkala E, Anttila A. Effect of hysterectomy on incidence trends of endometrial and cervical cancer in Finland 1953–2010. Br J Cancer 2004;90:1756–9.
7. Sherman ME, Carreon JD, Lacey JV Jr, Devesa SS. Impact of hysterectomy on endometrial carcinoma rates in the United States. J Natl Cancer Inst 2005;97:1700-2.
Changing hysterectomy prevalence may also be a factor
While increasing levels of obesity and other risk factors seem likely to be contributing to increases in uterine cancer incidence,[1] it has long been recognised that rates of uterine cancer are influenced by the prevalence of "hysterectomised" women in the population.[2] The figure shows trends in age-standardised hysterectomy rates in Scotland over the past 32 years. The decrease in rates of hysterectomy since the mid-1990s has been noted previously in England[3] and, more recently, in Scotland.[4] In the short-term, this may result in fewer cancers being detected as incidental findings, following routine pathological assessment of resected specimens. However, in the longer term it leaves a larger population at risk of developing uterine cancer, and therefore may also be contributing to the increases in uterine cancer incidence reported by the UK cancer registries. To obtain a true picture of underlying risk in the population, uterine cancer incidence rates should, ideally, be "corrected" for hysterectomy prevalence, when possible.[2,5-7]
References
1. Kmietowicz Z. Obesity is blamed for large rise in uterine cancers in UK. BMJ 2016;353:i2093. (13 April.)
2. Lyon JL, Gardner JW. The rising frequency of hysterectomy: Its effect on uterine cancer rates. Am J Epidemiol 1977;105:439–43.
3. Reid PC, Mukri F. Trends in number of hysterectomies performed in England for menorrhagia: examination of health episode statistics, 1989 to 2002-3. BMJ 2005;330:938-9.
4. Chittenden BG, Dallas S, Jack SA. Trends in the surgical options for the treatment of menorrhagia in Scotland: examination of health episode statistics, 2000-2008. Scott Med J 2012;57:92-4.
5. Redburn JC, Murphy MF. Hysterectomy prevalence and adjusted cervical and uterine cancer rates in England and Wales. BJOG 2001;108:388-95.
6. Luoto R, Raitanen J, Pukkala E, Anttila A. Effect of hysterectomy on incidence trends of endometrial and cervical cancer in Finland 1953–2010. Br J Cancer 2004;90:1756–9.
7. Sherman ME, Carreon JD, Lacey JV Jr, Devesa SS. Impact of hysterectomy on endometrial carcinoma rates in the United States. J Natl Cancer Inst 2005;97:1700-2.
Competing interests: No competing interests