Often, women who are recommended to have a hysterectomy are often recommended to have their ovaries removed (bilateral salpingo-oophorectomy; BSO) during the procedure regardless of their risk for ovarian cancer. A new study has found that a BSO under these circumstances reduces a woman’s overall risk of cancer. The findings were published in the June issue of the journal Obstetrics and Gynecology.
The study authors note that a hysterectomy is the most common gynecologic surgery procedure in the US. A BSO before the menopause deprives the women of ovarian hormones, which can be detrimental to a woman’s health. They note that data regarding cancer risks associated with BSO are needed to inform women at average risk of ovarian cancer of the risks and benefits of surgery. One previous comprehensive study has reported a lower overall risk of cancer; however, other studies were not in agreement The comprehensive study also found that hysterectomy with BSO was associated with lower breast cancer risk and higher lung cancer risk. However, the lung cancer investigations included smokers. To clarify the situation, the researchers assessed associations of simple hysterectomy and hysterectomy with BSO, compared to no surgery. The women were enrolled in the Cancer Prevention Study-II Nutrition Cohort. Lung cancer analyses were limited to women who were never or long-term former smokers. To compare their results with previous studies, the investigators also analyzed associations with hysterectomy including a BSO using simple hysterectomy as the reference group.
The study group comprised 66,802 postmenopausal women. During an average follow-up of 13.9 years, 8,621 cancers were diagnosed. Hysterectomy with BSO performed at any age (1,892 women), compared with no hysterectomy (5,586 women), was associated with a 10% reduction in all cancers. This inverse association was not found among women aged 55 years or older (583 women). Hysterectomy with BSO (715 women) was associated with a 20% reduction in breast cancer performed at any age. Hysterectomy without BSO was associated with a deceased cancer risk only if performed at age 45 years or younger (541 women) and overall was associated with a decreased risk of breast cancer (419 women).
The researchers concluded that in a large prospective (forward-looking) study, hysterectomy with BSO before age 55 years, relative to no surgery, was associated with a lower risk of total cancer. They noted that this information, particularly among lower risk in women younger than 45 years, should be considered in counseling women about ovarian management at the time of surgery.
Take home message:
This study points out an overall reduced risk of cancer among women premenopausal women who undergo a BSO at time of hysterectomy. Women with a family history of ovarian cancer or who have a genetic risk factor such as the BRCA1 or BRCA2 mutation should definitely consider a BSO. Although a BSO before menopause deprives a woman of ovarian hormones, hormone replacement therapy (HRT) can be given. A final decision should be made regarding a BSO should only be made after a thorough discussion with one’s gynecologist.