Ovarian conservation at the time of hysterectomy for benign disease has certainly become more common, mainly as the result of the landmark paper of Parker and colleagues [1]. This was a focal point in the beginning of a turnaround in the thinking of many clinicians. Now a new body of work examining a portion of this argument comes from the Cancer Prevention Study-II Nutrition Cohort published in [i]Obstetrics & Gynecology[/i] by Gaudet and colleagues [2].
It was a fairly straightforward cohort study involving over 66,000 postmenopausal women. In a median follow-up of just under 14 years, 8621 cancers were diagnosed (12.9% of the cohort). The authors compared hysterectomy with BSO at any age (1892 cases) with no hysterectomy (5586 cases) and found a statistically significant 10% reduction in all cancers. However, if the surgery was performed at age 55 or older, there was no reduction in overall cancer, yet hysterectomy with BSO at any age resulted in a 20% reduction in breast cancer that was statistically significant.
Finally, hysterectomy [i]without[/i] BSO if performed in women at age 45 or younger, was associated with a 12% decrease in all cancer, and, at any age, with a 14% decrease in breast cancer, both of which were statistically significant. The authors concluded that this information should be used in counseling women undergoing hysterectomy.
Author(s)
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Steven R. Goldstein, MD
Professor of Obstetrics and Gynecology, New York University School of Medicine, New York, New York, USA
Citations
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Parker WH, Broder MS, Liu Z, Shoupe D, Farquhar C, Berek JS. Ovarian conservation at the time of hysterectomy for benign disease. Obstet Gynecol 2005;106:219-26
http://www.ncbi.nlm.nih.gov/pubmed/19384117 -
Gaudet MM, Gapstur SM, Sun J, Teras LR, Campbell PT, Patel AV. Oophorectomy and hysterectomy and cancer incidence in the Cancer Prevention Study-II Nutrition Cohort. Obstet Gynecol 2014;123:1247-55
http://www.ncbi.nlm.nih.gov/pubmed/24807324 -
Parazzini F, Negri E, La Vecchia C, Luchini L, Mezzopane R. Hysterectomy, oophorectomy, and subsequent ovarian cancer risk. Obstet Gynecol 1993;81:363-6
http://www.ncbi.nlm.nih.gov/pubmed/8437787 -
Chiaffarino F, Parazzini F, Decarli A, et al. Hysterectomy with or without unilateral oophorectomy and risk of ovarian cancer. Gynecol Oncol 2005;97:318-22
http://www.ncbi.nlm.nih.gov/pubmed/15863124 -
Siddle N, Sarrel P, Whitehead M. The effect of hysterectomy on the age at ovarian failure: identification of a subgroup of women with premature loss of ovarian function and literature review. Fertil Steril 1987;47:94-100
http://www.ncbi.nlm.nih.gov/pubmed/3539646 -
National Cancer Institute, Statistical Research and Applications Branch. DevCan database: SEER 13 incidence and mortality, 2000-2002, release April 2005, based on the November 2004 submission. For more information see:
http://www.srab.cancer.gov/devcan/ -
American Heart Association. Heart disease and stroke statistics 2005 update. Available at:
http://www.americanheart.org./presenter.jhtml?identifier+1200026
