Invited commentary: reproductive organ surgeries and breast cancer risk--apples, oranges, or fruit cocktail?

Case-control and cohort studies are almost always complicated by nonrandom exposure allocation, which must be minimized in the design and analysis phases. Tubal sterilization is a common gynecological procedure that may be associated with other reproductive organ surgeries, which in turn may be asso...

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Bibliographic Details
Published in:American journal of epidemiology 2013-03, Vol.177 (6), p.500-503
Main Authors: Press, David J, Bernstein, Leslie
Format: Article
Language:English
Subjects:
Breast cancer
Breast Neoplasms - epidemiology
Female
Humans
Hysterectomy
Meta-analysis
Original Contributions
Reproductive sterilization
Risk factors
Sterilization, Tubal
Womens health
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Summary:Case-control and cohort studies are almost always complicated by nonrandom exposure allocation, which must be minimized in the design and analysis phases. Tubal sterilization is a common gynecological procedure that may be associated with other reproductive organ surgeries, which in turn may be associated with breast cancer risk. In this issue of the Journal, Gaudet et al. (Am J Epidemiol. 2013;177(6):492-499) argue successfully that tubal sterilization is unassociated with breast cancer risk. Scrutiny of the heterogeneous studies included in their meta-analysis underscores the role of confounding and effect modification in observational epidemiologic studies. Specifically, tubal sterilization is unassociated with breast cancer risk, but either oophorectomy or hysterectomy, or both, and the timing of these procedures warrant careful consideration in the design, analysis, and interpretation of observational research on reproductive factors.
ISSN:0002-9262
1476-6256
DOI:10.1093/aje/kws438