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Tubal Ligation and Risk of Endometrial Cancer: Findings From the Women’s Health Initiative
  1. Ira Winer, MD, PhD*,
  2. Amy Lehman, MAS,
  3. Jean Wactawski-Wende, PhD,
  4. Randal Robinson, MD§,
  5. Michael Simon, MD, MPH and
  6. Michele Cote, PhD
  1. *Division of Gynecologic Oncology, Department of Oncology, Karmanos Cancer Institute and Wayne State University, Detroit, MI;
  2. Center for Biostatistics, Ohio State University, Columbus, OH;
  3. Department of Epidemiology and Environmental Health, University at Buffalo, Buffalo, NY;
  4. §Division of Reproductive Endocrinology and Infertility, University of Texas, Health Sciences Center, San Antonio, TX;
  5. Department of Oncology, Karmanos Cancer Institute and Wayne State University; and
  6. Population Studies and Disparities Program, Karmanos Cancer Institute, Detroit, MI.
  1. Address correspondence and reprint requests to Ira Winer, MD, PhD, Division of Gynecologic Oncology, Department of Oncology, Karmanos Cancer Institute and Wayne State University, Harper Professional Building, Suite 721, Mail Code HP07GO, 4160 John R, Detroit, MI 48201. E-mail:


Objective Bilateral tubal ligation (BTL) is a common form of birth control in the United States. There are limited, contradictory data examining BTL and the risk of endometrial cancer and none examining type I and type II cancers separately. We investigated the association between BTL and endometrial cancer risk using the Women’s Health Initiative (WHI) Observational and Dietary Modification Studies.

Methods Demographic information and history of BTL were obtained from the baseline questionnaires from 76,483 WHI participants in the Observational and Dietary Modification Studies. Univariable and multivariable models were used to examine the association of BTL with type I and type II endometrial cancers.

Results A total of 1137 women were diagnosed with incident endometrial cancer (972 type I and 128 type II) during a mean follow-up of 11.3 years. Overall, 14,499 (19%) women had undergone BTL. There were no statistically significant associations noted between BTL and age at BTL for type I or type II cancers.

Conclusions We examined the largest patient cohort to date in an effort to determine the impact of BTL on endometrial cancer risk. In the WHI trial, we observed no overall effect of BTL on the risk of type I or type II endometrial cancer, suggesting that patients undergoing this popular birth control method likely do not have an associated change in their baseline risk for endometrial cancer.

  • Tubal ligation
  • Endometrial cancer
  • Women’s Health Initiative

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  • Supported by the National Heart, Lung, and Blood Institute; National Institutes of Health; and US Department of Health and Human Services through contracts HHSN268201100046C, HHSN268201100001C, HHSN268201100002C, HHSN268201100003C, HHSN268201100004C, and HHSN271201100004C.

  • The authors declare no conflicts of interest.

  • Supplemental digital content is available for this article. Direct URL citation appears in the printed text and is provided in the HTML and PDF versions of this article on the journal’s Web site (