Background: Leiomyosarcomas may originate from pre-existing uterine fibroids. However, recent studies showed that leiomyosarcomas do not arise from malignant changes of fibroids. Epidemiological data on the long-term risk of uterine malignancy with uterine fibroids are lacking. We aimed to determine whether uterine fibroids are a risk factor for uterine cancer. Methods: Patient data (2007-2020) from the Korean Health Insurance program were obtained. Using procedure and diagnostic codes, data from patients who underwent myomectomy and appendicitis (control group) were extracted Using 1:1 propensity-score matching, 84,507 women were each allocated to the uterine fibroids and control groups. Results: Endometrial cancer occurred in 36 and 44 women in the uterine fibroids and control groups (p=0.371), respectively; 6/36 and 4/44 cases of uterine corpus cancer occurred in the respective groups. Total uterine cancer (excluding cervical cancer) occurred in 46 and 39 patients in the uterine fibroids and control groups, respectively (p=0.323). Conclusion: A higher risk of uterine malignancy was not found in women with uterine fibroids confirmed by myomectomy. Therefore, surgery is not recommended for asymptomatic uterine fibroids because of the cancer risk. If surgery is indicated, myomectomy can be safely performed without increasing the cancer risk.