Study Suggests Higher Risk Of Death Associated With Removal Of Ovaries

Main Category: Ovarian Cancer
Also Included In: Heart Disease;  Lung Cancer;  Women's Health / Gynecology
Article Date: 23 Apr 2009 - 4:00 PDT

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Women who undergo a bilateral oophorectomy -- the removal of both ovaries -- during a hysterectomy have a higher risk of death, including death from coronary heart disease and lung cancer, than women who keep their ovaries, according to a study published in the May issue of Obstetrics and Gynecology, the Los Angeles Times reports. The study's findings are at odds with the long-held belief that removing ovaries during a hysterectomy produces the highest chance of long-time survival, the Times reports. For decades, doctors have recommended the removal of ovaries during hysterectomies to prevent ovarian cancer later in life, which accounts for about 3% of all cancers and 1% of deaths in women. The Times reports that 600,000 U.S. women undergo a hysterectomy annually. Of them, about 300,000 have their ovaries removed. Although ovarian cancer is rare, it is difficult to detect and treat, and many women elect to have their ovaries removed, the Times reports.

The study examined data on 29,380 women from the national Nurse's Health Study, which has analyzed the health of 122,700 female registered nurses ages 30 to 55 since 1976. Of the 29,380 participants, 16,345 had hysterectomies that included ovary removal, while 13,035 had hysterectomies that did not include ovary removal. The study included pre- and post-menopausal women, some of whom were taking estrogen replacement therapy. None of the women had cancer at the time of hysterectomy. For the study, an international team led by William Parker -- an adjunct faculty member at the John Wayne Cancer Institute -- and researchers from Harvard Medical School divided the participants into three age groups and analyzed incidence and deaths from coronary heart disease, stroke, pulmonary embolism, several cancers -- including colorectal, ovarian, breast and lung -- and hip fracture.

According to the study, the risk of death overall prior to age 50 increased by 40% among the women whose ovaries were removed, despite a decrease in the risk of ovarian and breast cancer. In addition, the risk of heart disease and stroke for women younger than age 50 almost doubled after ovary removal. The Times reports that the study's findings do not indicate that ovary removal provides an overall survival benefit for any age group, largely because heart disease, stroke and lung cancer are each more common than ovarian cancer. Among the group of women who had never used estrogen replacement, those whose ovaries were removed when they were younger than age 50 had a dramatically higher risk of death from coronary heart disease, stroke and any cause than did older women.

Parker said that "an automatic recommendation" to remove a woman's ovaries during a hysterectomy "is no longer warranted." The study's authors said the findings should encourage women to speak to their doctors about their best options regarding the removal of ovaries. Parker said that women with a strong family history of ovarian cancer or those who are carriers of the BRCA1 and BRCA2 genetic mutations, which increase the risk of breast and ovarian cancers, "should strongly consider having their ovaries removed." However, for women with a strong family history of heart disease or stroke, Parker said that "maybe keeping your ovaries makes sense" (Shelton, Los Angeles Times, 4/21).

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