Should Prophylactic Oophorectomy Be Performed During Hysterectomy?

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Should Prophylactic Oophorectomy Be Performed During Hysterectomy?

These researchers suggest that women younger than 65 would benefit from ovarian conservation.

More than half of all hysterectomies for benign disease (i.e., >300,000 yearly in the U.S.) are accompanied by prophylactic bilateral oophorectomy, and many physicians recommend oophorectomy for all women who undergo hysterectomy after age 40, despite a lack of evidence that this practice improves outcomes. Investigators used published age-specific data on absolute and relative risks for ovarian cancer, coronary heart disease, stroke, hip fracture, and breast cancer to estimate long-term survival among simulated cohorts of women undergoing hysterectomy with or without bilateral oophorectomy and treated or not treated with exogenous estrogen.

The proportion of women alive at age 80 was used as the outcome measure for 5-year age groups from age 40 to 80. The authors' analysis indicated that women younger than 65 would benefit from ovarian conservation, and clear benefit from oophorectomy was not noted at any age.

Comment: These researchers present a hypothesis that cannot be easily tested by randomized trials because of the time required to determine whether oophorectomy affects lifespan. The authors' statistical model used probability estimates derived mostly from case-control studies, with all their inherent biases. Nonetheless, physicians should remember that prophylactic oophorectomy can create harms that oppose the benefit of lowering ovarian cancer risk and therefore should weigh this issue for each individual patient.

— Robert W. Rebar, MD

Published in Journal Watch General Medicine September 2, 2005