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Grand Rounds: Hysterectomy sans oophorectomy: The case for leaving a woman's ovaries alone

If there's no cancer present, why remove a woman's ovaries during hysterectomy? Does the reduced risk of ovarian cancer outweigh the consequences of eliminating the protective hormones secreted by a healthy pair of ovaries? A team of researchers offers some thought-provoking conclusions.

The cumulative lifetime mortality rate for women from ovarian cancer after hysterectomy for benign disease is 0.47%, or fewer than one in 200. This is lower than the often-stated lifetime risk of one in 70, a number that includes women with BRCA1 or BRCA2 mutations or other high-risk germ-line mutations.

Despite these important health concerns, many women feel that they do not have enough information about long-term risks and benefits to help them make a decision regarding the prophylactic removal of ovaries when they are having a hysterectomy for benign disease.3 A recent decision analysis for women with inherited BRCA1/2 mutations and at high risk for ovarian cancer (and breast cancer) found that prophylactic oophorectomy was clearly beneficial after completion of childbearing.4 But a recommendation for women with average risk of ovarian cancer has not been established.

The ideal way to study this issue would be with a prospective, randomized trial. However, to be statistically valid and yield meaningful outcomes, such a study would require 8,000 women randomized to oophorectomy or ovarian conservation and then followed for 40 years. So it's unlikely that outcomes will ever be studied in this way.