March 25, 2013 | by Hiu Chung So
In the U.S., approximately 600,000 hysterectomies are performed each year and about half of them are accompanied by a bilateral oophorectomy, the removal of both ovaries. The rationale is that their removal will practically eliminate the risk of ovarian cancer and substantially lower the risk of breast cancer, too.
However, a new study published in the April issue of Obstetrics & Gynecology may prompt women planning a hysterectomy to reconsider ovarian removal, too; it showed that women who chose to keep their ovaries actually lived longer.
In the paper, the authors tracked over 30,000 women from the Nurses’ Health Study who have had undergone a hysterectomy without a gynecologic cancer diagnosis. Of those, almost 17,000 also had a bilateral oophorectomy while the others elected for ovarian conservation.
After 28 years of follow-up, they have found that 13.3 percent of women who opted for ovarian conservation had died from any cause, versus 16.8 percent of women who opted for ovarian removal during their hysterectomy.
And while participants who had their ovaries removed showed a lower risk of dying from ovarian cancer (four women versus 44 from the ovarian conservation group), and a significantly lower risk of dying from breast cancer if the ovaries were removed before 47.5 years of age, the authors wrote that these benefits "were overshadowed by the significantly increased risks of dying from other causes.” These included a 23 percent increased risk of dying from coronary heart disease, 49 percent increased risk of dying from colorectal cancer and 13 percent increased risk of mortality from all causes.
Leslie Bernstein, Ph.D., professor and director of City of Hope's Division of Cancer Etiology, commented to Reuters that, “it looks like, if given a choice [when planning a hysterectomy], you should keep your ovaries.”
Bernstein, who was not also involved in this study, also noted that there could be other health factors that contributed to the difference in mortality risk.
In a separate study, Bernstein and her colleagues found that women who have had hysterectomy and bilaterial oophorectomy were no more likely to die than women who didn’t have that procedure. Those findings were published in Jan. 2012 issue of Fertility and Sterility.
While the findings seem contradictory, both sides agree that this warrants further study and that women considering a hysterectomy should have a candid conversation with their doctors about ovarian removal and conservation options as well.