NEW YORK (Reuters Health) – New research suggests that for hysterectomy patients who are not at high risk for ovarian cancer, removing the ovaries does not improve survival and may adversely impact long-term health.

Oophorectomy at the time of hysterectomy for benign disease is often done to prevent the future development of ovarian cancer. While this practice can prevent the malignancy, there is also evidence that early surgical menopause increases the risk of coronary heart disease.

To investigate the relative pros and cons of oophorectomy during hysterectomy, Dr. William H. Parker, from Saint John’s Health Center, Santa Monica, California, and colleagues analyzed data from 29,380 women enrolled in the Nurses’ Health Study; 16,345 of them had a hysterectomy plus bilateral oophorectomy and 13,035 had a hysterectomy alone.

The findings during 24 years of follow-up are reported in the May issue of Obstetrics & Gynecology.

“For women with hysterectomy and bilateral oophorectomy compared with ovarian conservation, the multivariable hazard ratios were 1.12 for total mortality, 1.17 for fatal plus nonfatal coronary heart disease, and 1.14 for stroke,” the investigators report.

With oophorectomy, the risks of ovarian, breast, and all cancers fell, with HRs of 0.75, 0.04, and 0.90, respectively. At the same time, however, the HR for lung cancer was 1.26, and it was 1.17for total cancer mortality.

The authors estimate that for women who survive 35 years after surgery, one extra death would occur for every nine oophorectomies performed.

“Preventive surgery should not be performed if it does not clearly benefit the patient,” the authors emphasize. “Given that approximately 300,000 US women per year undergo elective oophorectomy, these findings have important public health implications.”

Reference:
Obstet Gynecol 2009;113:1027-1037.