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Tubal sterilization is the most common form of birth control used in the world. 1 Between 1994 and 1996, more than 2 million tubal sterilizations were performed in the US, 2 with 28% of women aged 15-44 years relying on this method of contraception. 3 Advances in laparoscopic techniques have resulted in a substantial increase in the number of women undergoing tubal sterilization, with nearly all interval procedures (i.e. not timed with a pregnancy) currently being performed in an outpatient setting. 2 A reduced risk of ovarian cancer has consistently been seen following tubal sterilization in both case-control 4 and cohort 5 studies. No association with either endometrial or cervical cancer has been established however. Results from this Danish, population-based record-linkage study 6 support the established protective effect of tubal sterilization against ovarian cancer and indicate a similar protective effect on endometrial cancer. Although the study involved over 65 000 women with a tubal sterilization, there were only 30 endometrial cancer cases making it difficult to form conclusions regarding the risk of this tumour type. No link was found with cervical cancer. The reduced risk of ovarian cancer was apparent for the non- mucinous subtypes only, supporting claims that mucinous ovarian cancer may have a somewhat separate aetiology. 7 The study also reports an elevated risk of cervical intraepithelial neoplasia (CIN) 3 in the first year after sterilization, which is likely due to a screening effect from Pap smears accompanying the sterilization procedures. The protective effect of tubal sterilization on ovarian cancer appeared to persist for many years after the procedure, which is consistent with the findings of a number of other studies. 4,5 A similar effect was seen for endometrial cancer. This finding is inconsistent with the association that would be expected if the protective effect was due to screening for pre-malignancy during the procedure. The association is therefore likely to be biological. But what is the biological link? Earlier reports suggested that the tubal sterilization procedure may result in reduced blood supply to the ovary and thus alter ovarian hormone levels and function. 8 Tubal sterilization has also been linked to a reduced risk of breast cancer, 9 supporting a hormonal effect of the surgery. However, recent data do not support an effect of tubal sterilization on ovarian function 10 or on hormone levels. 11 This apparent inconsistency may be due to changes in sterilization methods over time, with recent laparoscopic techniques possibly causing less damage to the tube and the surrounding mesosalpinx. 12 It is possible then that

Commentary: Does tubal sterilization reduce the risk of gynaecological cancers?