Risk for Oophorectomy After Hysterectomy

Abstract

Some clinicians have recommended prophylactic oophorectomy at the time of hysterectomy to reduce the risk for ovarian cancer. Previous estimates for risk for subsequent oophorectomy in women who have ovarian preservation at hysterectomy range from 2.9% to 7.7%. These estimates are questionable because they were derived from studies that were not population based, lacked a comparison group, and had short follow-up. The absolute risk for a future ovarian malignancy and subsequent oophorectomy after ovarian preservation during benign hysterectomy is unclear. The aim of this study was to compare the risk for subsequent oophorectomy among a community cohort of women who underwent hysterectomy for benign indications with those who did not and had intact uteri. Data from the Rochester Epidemiology Project were used to identify 4931 women who underwent ovary-sparing hysterectomy for benign indications (case group) between 1965 and 2002 and 4931 age-matched controls (referent group). The Kaplan-Meier method was used to estimate the cumulative incidence of subsequent oophorectomy. Cox proportional hazard models were used to compare the effect of hysterectomy on the risk for subsequent oophorectomy. The participants had a median duration of follow-up of 19.5 years. The respective cumulative incidences of subsequent oophorectomy at 10, 20, and 30 years after hysterectomy were 3.5%, 6.2%, and 9.2% in the case group and 1.9%, 4.8%, and 7.3% in the referent group. Overall risk for subsequent oophorectomy in the case group was slightly higher than in the referent group; the hazard ratio was 1.20, with a 95% confidence interval of 1.02 to 1.42; P = 0.03. Compared with the women who had only 1 ovary preserved, the women who had both ovaries preserved at hysterectomy had an increased risk for subsequent oophorectomy (hazard ratio, 2.15; 95% confidence interval, 1.51–3.07; P < 0.001). These data suggest that women with ovarian preservation at the time of hysterectomy are at low risk for subsequent oophorectomy, which, on average, is less than 2 absolute percentage points higher at 30-year follow-up than in women with intact reproductive organs.