26: Ovarian Conservation at the Time of Hysterectomy for Benign Disease

Abstract

Prophylactic oophorectomy is often recommended concurrent with hysterectomy for benign disease. The optimal age for this recommendation in women not at high risk for ovarian cancer has not been determined. A Markov decision analysis model was used to determine the optimal strategy to maximize survival for women not at high risk of ovarian cancer. For each 5-year age group from 40–80, four strategies were compared: ovarian conservation or oophorectomy; and use of ERT or non-use. Literature review. Using published age-specific data, both with and without oophorectomy, for ovarian cancer, coronary heart disease (CHD), hip fracture, breast cancer, and stroke, absolute and relative risk were calculated and applied to the model. Outcomes as proportion of women alive at age 80 were measured. Sensitivity analyses were performed varying both relative and absolute risk estimates across the range of reported values. Ovarian conservation until age 65 benefits long-term survival for women undergoing hysterectomy for benign disease; women with oophorectomy before age 55 have 8.38% excess mortality by age 80. There is sustained, but decreasing, benefit until the age of 75. Ovarian conservation until at least age 65 benefits long-term survival for women not at high risk of ovarian cancer when undergoing hysterectomy for benign disease.