A Long-Term Study of Mortality in Men Who Have Undergone Vasectomy

Vasectomy is a reliable and widely accepted method of contraception, but there is some uncertainty and few data about a possible long-term adverse effect on health. We examined the relation between vasectomy and mortality rates from cardiovascular disease, cancer, and all causes in a retrospective cohort of husbands of members of the Nurses' Health Study. In 1989 we obtained data by questionnaire on 14,607 men who had undergone vasectomy as of 1976 and 14,607 men who had not. Among the men who were free of cancer at the start of the study, 1052 died: 446 of cardiovascular disease, 341 of cancer, and 265 of other causes. Vasectomy was associated with reductions in mortality from all causes (age-adjusted relative risk, 0.85; 95 percent confidence interval, 0.76 to 0.96) and mortality from cardiovascular disease (relative risk, 0.76; 95 percent confidence interval, 0.63 to 0.92). Vasectomy was unrelated to mortality from all forms of cancer (relative risk, 1.01; 95 percent confidence interval, 0.82 to 1.25). Among men who had a vasectomy at least 20 years earlier, the procedure had no relation to mortality from all causes (relative risk, 1.11; 95 percent confidence interval, 0.92 to 1.33) or that from cardiovascular disease (relative risk, 0.85; 95 percent confidence interval, 0.63 to 1.16). However, mortality from cancer was increased in men who had a vasectomy at least 20 years earlier (relative risk, 1.44; 95 percent confidence interval, 1.07 to 1.92). The excess risk of cancer in these men was due primarily to lung cancer. None of the observed associations were confounded by smoking habits, body-mass index, alcohol consumption, or educational level. Vasectomy is not associated with an increase in overall mortality or mortality from cardiovascular disease. Our study also found no increase in overall mortality from cancer after vasectomy, but there was an apparent increase in the risk of cancer 20 or more years after vasectomy that requires further study. (N Engl J Med 1992;326:1392–8.), VASECTOMY is an effective method of contraception that is widely accepted in both developing and developed countries. However, uncertainty persists about possible long-term adverse effects on health. Antibodies to spermatozoa form in up to two thirds of men who have undergone vasectomy,^{1 2 3} and they may persist for many years.⁴ Immune complexes formed from these antibodies have been postulated to injure the arterial walls and accelerate atherosclerosis. Advanced atherosclerosis has been observed after vasectomy in animals,^{5 , 6} but epidemiologic studies in humans generally have not demonstrated any increase in cardiovascular disease for up to 15 years after the procedure.^{7 8 9 10 11 12 13 14} However, one study…