Removing ovaries at hysterectomy may offer benefit without significant risk

May 6, 2011

Bilateral salpingo-oophorectomy (BSO) at the time of hysterectomy reduces the already small risk of subsequent ovarian cancer and doesn?t appreciably raise other risks, such as cardiovascular disease and hip fracture, a new study has found.

Bilateral salpingo-oophorectomy (BSO) at the time of hysterectomy reduces the already small risk of subsequent ovarian cancer and doesn’t appreciably raise other risks, such as cardiovascular disease and hip fracture, a new study has found.

The large, prospective cohort study analyzed data from the Women’s Health Initiative Observational Study on 25,448 postmenopausal women 50 to 79 years of age with no family history of ovarian cancer who had had a hysterectomy with or without BSO. Mean followup was 7.6 years. The rate of subsequently diagnosed ovarian cancer was 0.33% among women whose ovaries weren’t removed compared with 0.02% in women who had had elective BSO at the time of hysterectomy (56% of women in the study). Past or present hormone replacement therapy didn’t affect the results of the study, which was published in the Archives of Internal Medicine (2011;171[8]:760-768).

University of California San Francisco researchers note that their findings don’t necessarily suggest that women without a known risk for ovarian cancer should undergo BSO with hysterectomy as a precaution. “Given the very low rate of ovarian cancer after hysterectomy with ovarian preservation, BSO may provide minimal additional benefit,” they write.

No association between BSO and increased risk of fatal and nonfatal coronary heart disease, coronary artery bypass graft/percutaneous transluminal coronary angioplasty, stroke, total cardiovascular disease, hip fracture, or death was seen. Further, the results did not demonstrate significant associations between BSO and breast, lung, or colorectal cancer. “Our findings suggest that BSO may not have an adverse effect on cardiovascular health, hip fracture, cancer, or total mortality compared with hysterectomy and ovarian conservation,” the authors write.

Their findings differ from those of the Nurses’ Health Study, the only other large prospective cohort study to compare the risks of BSO with hysterectomy without BSO, which found an association between BSO and increased risk of coronary heart disease, death from lung cancer or any other cancer, and total mortality. Although women in both studies underwent hysterectomy in their 40s, those in the Women’s Health Initiative study were older at enrollment and were followed for a shorter time. “These differences may explain some of the variation in our findings,” the authors write. Long-term risks associated BSO are largely unknown.