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Increased mortality associated with oophorectomy

Clinical Question:
Is bilateral oophorectomy for benign indications at the time of hysterectomy associated with different mortality risks than hysterectomy with ovarian conservation?

Bottom Line:
Bilateral oophorectomy at the time of hysterectomy for any indication other than gynecological cancer is associated with increased all-cause mortality as compared with ovarian conservation, despite the fact that deaths due to ovarian cancer decreased. No subgroup of women was identified in which oophorectomy conferred mortality benefit. The number of women included in this study who were at high risk for ovarian cancer or breast cancer on the basis of family history was too small to evaluate. (LOE = 2b)

Reference:
Parker WH, Feskanich D, Broder MS, et al. Long-term mortality associated with oophorectomy compared with ovarian conservation in the Nurses' Health Study. Obstet Gynecol 2013;121(4):709-716.  [PMID:23635669]

Study Design:
Cohort (prospective)

Funding:
Government

Setting:
Population-based

Synopsis:
This paper reports an analysis of the Nurses' Health Study cohort to evaluate mortality risk associated with bilateral oophorectomy as opposed to ovarian conservation at the time of hysterectomy. The cohort began in 1976 and included 121,700 women. This analysis included 16,914 women who underwent hysterectomy with bilateral oophorectomy and 13,203 who had ovarian conservation. The cohort is relatively homogeneous with regard to race (94% white) and socioeconomic status. Life-table analysis was performed using Cox proportional hazards models with censoring at oophorectomy subsequent to hysterectomy, death, or the end of follow-up in June 2008. Three subcohorts were modeled separately according to age at hysterectomy: younger than 50 years, 50 to 59 years, and 60 years or older. Multiple analyses were conducted based on estrogen use and cardiovascular risk. All-cause mortality was higher among women who had oophorectomy (hazard ratio [HR] = 1.13; 95% CI, 1.06-1.21), despite reduced risk for ovarian cancer mortality (HR = 0.06; 0.02-0.17). Significant associations with increased mortality after oophorectomy were identified for coronary heart disease, lung cancer, colorectal cancers, and total cancers. Analysis based on age at hysterectomy did not demonstrate any age at which oophorectomy conferred a survival benefit. For women younger than 50 years at the time of hysterectomy with oophorectomy there was increased all-cause mortality among women who never used estrogen therapy (HR = 1.41; 12.04-1.91; number needed to treat to harm = 8), but not among women who were past users or current users of estrogen. An analysis of the subgroup of women with at least 15 years of follow-up subsequent to their hysterectomy also showed oophorectomy was significantly associated with death from all causes (HR = 1.09; 1.01-1.17). The subgroup of women at high risk for ovarian and breast cancers on the basis of their family history (mother or sister) did not identify a different pattern, but the total number was too small for meaningful analysis.

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