Oophorectomy In Premenopausal Women Research Articles

Ovarian preservation compared to oophorectomy in premenopausal women with early-stage, low-grade endometrial Cancer: A cost-effectiveness analysis

ObjectivesStandard treatment for endometrial cancer is a hysterectomy, bilateral salpingo-oophorectomy, and lymph node assessment. In premenopausal women, removal of the ovaries may not be necessary and could increase the risk of all-cause mortality. We sought to estimate the outcomes, costs, and cost-effectiveness of oophorectomy versus ovarian preservation in premenopausal women with early-stage, low-grade endometrial cancer. MethodsA decision-analytic model was designed using TreeAge software comparing oophorectomy to ovarian preservation in premenopausal women with early-stage, low-grade endometrial cancer. We used a theoretical cohort of 10,600 women to represent our population of interest in the United States in 2021. Outcomes included cancer recurrences, ovarian cancer diagnoses, deaths, rates of vaginal atrophy, costs, and quality-adjusted life years (QALYs). The cost-effectiveness threshold was set at $100,000/QALY. Model inputs were derived from the literature. Sensitivity analyses were conducted to evaluate the robustness of the results. ResultsOophorectomy resulted in more deaths and higher rates of vaginal atrophy, while ovarian preservation resulted in 100 cases of ovarian cancer. Ovarian preservation resulted in lower costs and higher QALYs making it cost effective when compared to oophorectomy. Sensitivity analyses demonstrated the probability of cancer recurrence after ovarian preservation and probability of developing ovarian cancer were the most impactful variables in our model. ConclusionOvarian preservation is cost-effective in premenopausal women with early-stage, low-grade endometrial cancer when compared to oophorectomy. Ovarian preservation may prevent surgical menopause, which may improve quality of life and overall mortality without compromising oncologic outcomes, and should be strongly considered in premenopausal women with early stage disease.

A population-based cohort study on the risk of obstructive lung disease after bilateral oophorectomy

There is increasing evidence that sex hormones may impact the development of obstructive lung disease (OLD). Therefore, we studied the effect of bilateral oophorectomy (oophorectomy) on the development of OLD. Women were identified from the Mayo Clinic Cohort Study of Oophorectomy and Aging-2. Data were collected using the Rochester Epidemiology Project records-linkage system. A total of 1653 women who underwent oophorectomy and 1653 referent women of similar age were assessed for OLD using diagnostic codes and medical record abstraction. Women who underwent oophorectomy had an overall higher risk of all OLD, all chronic obstructive pulmonary disease (COPD), emphysema, and chronic bronchitis but not of all asthma, confirmed asthma, or confirmed COPD. The association with all OLD was stronger in women who were age ≤45 years at oophorectomy, never smokers, non-obese, and in women with benign indications; however, the interactions were not statistically significant. There was an increased risk of all asthma in women age ≤45 years at oophorectomy who took estrogen therapy. Never smokers of all ages had a stronger association of oophorectomy with all asthma and all COPD, whereas smokers had a stronger association of oophorectomy with emphysema and chronic bronchitis. Non-obese women of all ages had a stronger association of oophorectomy with all COPD, emphysema, and chronic bronchitis. The results of this study combined with the increased risk of several chronic diseases reported in previous studies suggest that oophorectomy in premenopausal women should be avoided unless there is clear evidence of a high genetic risk of ovarian cancer.

Association of Premenopausal Bilateral Oophorectomy With Parkinsonism and Parkinson Disease

The association of premenopausal bilateral oophorectomy with parkinsonism and Parkinson disease (PD) remains controversial. To assess whether women who underwent premenopausal bilateral oophorectomy were at increased risk of parkinsonism and PD and whether the associations varied by age at oophorectomy and by receipt of estrogen replacement therapy. This cohort study used data from a combination of 2 independent cohort studies, the Mayo Clinic Cohort Study of Oophorectomy and Aging 1 and 2, which were based on the Rochester Epidemiology Project medical records-linkage system. A population-based sample of 5499 women from Olmsted County, Minnesota, were included; of those, 2750 women underwent bilateral oophorectomy for a benign indication before spontaneous menopause between January 1, 1950, and December 31, 2007 (oophorectomy cohort), and 2749 age-matched women who did not undergo bilateral oophorectomy were randomly sampled from the general population (reference cohort). Data were analyzed from March 1 to April 30, 2022. The date of oophorectomy was considered the index date for both groups. Medical record documentation of bilateral oophorectomy abstracted from a medical records-linkage system (Rochester Epidemiology Project). Incidence and risk of parkinsonism or PD, with diagnoses confirmed by in-person examination or medical record review. Among 5499 participants (median [IQR] age, 45.0 [40.0-48.0] years; 5312 [96.6%] White), 2750 women (2679 White [97.4%]) underwent bilateral oophorectomy at a median age of 45.0 years (IQR, 40.0-48.0 years), and 2749 women (2633 White [95.8%]) with a median age of 45.0 years (IQR, 40.0-48.0 years) at the index date were included in the reference cohort. Bilateral oophorectomy was associated with an increased risk of parkinsonism overall (hazard ratio [HR], 1.59; 95% CI, 1.02-2.46) and in women younger than 43 years at oophorectomy (HR, 7.67; 95% CI, 1.77-33.27). There was a pattern of increasing risk with younger age at the time of oophorectomy using 4 age strata (≥50 years: HR, 1.43 [95% CI, 0.50-4.15]; 46-49 years: HR, 1.55 [95% CI, 0.79-3.07]; 40-45 years: HR, 1.36 [95% CI, 0.64-2.89]; <40 years: HR, 8.82 [95% CI, 1.08-72.00]; P = .02 for trend). The number needed to harm was 53 women overall and 27 women younger than 43 years at the time of oophorectomy. Bilateral oophorectomy was also associated with an increased risk of PD in women younger than 43 years at oophorectomy (HR, 5.00; 95% CI, 1.10-22.70), with a number needed to harm of 48 women. Among women who underwent oophorectomy at 45 years and younger, the risk was lower in women who received estrogen after the procedure and through age 50 years compared with women who did not. For parkinsonism, the HRs were 1.72 (95% CI, 0.54-5.53) vs 2.05 (95% CI, 0.80-5.23); for PD, the HRs were 1.53 (95% CI, 0.29-8.23) vs 2.75 (95% CI, 0.84-9.04). However, the differences were not significant. In this study, premenopausal women who underwent bilateral oophorectomy before age 43 years had an increased risk of parkinsonism and PD compared with women who did not undergo bilateral oophorectomy. These findings suggest that a reduction in the practice of prophylactic bilateral oophorectomy in premenopausal women at average risk of ovarian cancer may have substantial benefit for reducing the risk of parkinsonism and PD.

Efficacy of minodronic acid for the prevention of osteoporosis in premenopausal women with gynaecologic disease who undergo bilateral oophorectomy: a single-centre, non-randomised controlled, experimental study

We evaluated the efficacy of minodronic acid for osteoporosis prevention after bilateral oophorectomy for gynaecologic disease in premenopausal women. Bone mineral density (BMD) and young adult mean (YAM) data from the lumbar vertebrae and femur and bone alkaline phosphatase (BAP)/tartrate-resistant acid phosphatase 5 b (TRACP 5 b) data were obtained for 101 patients. The primary endpoint was the efficacy of minodronic acid for osteoporosis prevention. Fifty-five and 31 patients were assigned to medication and no medication groups, respectively. The decrease in BMD and YAM and the increase in BAP/TRACP-5b were significantly more suppressed in the medication group. There were no significant between-group differences in age at oophorectomy, cancer type, body mass index (BMI), and adjuvant therapy. There were no adverse events due to minodronic acid. Minodronic acid may prevent osteoporosis after oophorectomy in premenopausal women with gynaecologic disease, independent of age at oophorectomy, cancer type, BMI, or adjuvant therapy. Impact statement What is already known on this subject? Although the current strategy for osteoporosis prevention after premenopausal bilateral oophorectomy (b-OVX) is hormone therapy (HT), there is no consensus on the treatment duration or adverse events. What do the results of this study add? Therefore, we planned a prospective study to evaluate the efficacy of prophylactic treatment for osteoporosis after b-OVX in premenopausal women with gynaecologic disease using minodronic acid, an oral bisphosphonate, which have a strong evidence of the treatment for osteoporosis. The result showed minodronic acid significantly suppressed the decrease in bone mineral density (BMD) and young adult mean (YAM) and the increase in bone alkaline phosphatase (BAP)/tartrate-resistant acid phosphatase 5b (TRACP 5b). Minodronic acid may prevent osteoporosis after oophorectomy in premenopausal women with gynaecologic disease, independent of age at oophorectomy, cancer type, BMI, or adjuvant therapy. What are the implications of these findings for clinical practice and/or further research? Minodronic acid treatment for osteoporosis prevention after premenopausal b-OVX may be effective as a therapeutic agent after the cessation of HT, or alternative for patients who are contraindicated for HT in breast cancer and thrombosis and should be administered with caution with a history of uterine or ovarian cancer.

Ovarian preservation compared to oophorectomy in premenopausal women with early-stage, low-grade endometrial cancer: A cost-effectiveness analysis

Objectives: Estimate the outcomes, costs, and cost-effectiveness of oophorectomy vs. ovarian preservation in premenopausal women with early-stage, low-grade endometrial cancer and benign-appearing ovaries.

Long-term Risk of Cognitive Impairment and Dementia Following Bilateral Oophorectomy in Premenopausal Women—Time to Rethink Policies?

Long-term Risk of Cognitive Impairment and Dementia Following Bilateral Oophorectomy in Premenopausal Women—Time to Rethink Policies?

Loss of Ovarian Hormones and Accelerated Somatic and Mental Aging.

Bilateral oophorectomy in premenopausal women is a unique condition causing the abrupt and premature loss of ovarian hormones, primarily estrogen. Bilateral oophorectomy causes an alteration of several fundamental aging processes at the cellular, tissue, organ, and system levels, leading to multimorbidity, frailty, and reduced survival. However, many questions remain unanswered.

Personal, reproductive, and familial characteristics associated with bilateral oophorectomy in premenopausal women: A population-based case-control study

ObjectivesWe investigated the association of personal, reproductive, and familial characteristics with bilateral oophorectomy performed for nonmalignant indications in a US population. Study designIn an established cohort study, we used the records-linkage system of the Rochester Epidemiology Project (REP http://www.rochesterproject.org) to identify 1653 premenopausal women who underwent bilateral oophorectomy in Olmsted County, Minnesota between 1988 and 2007 for a nonmalignant indication. Each woman was matched by age (±1 year) to a population-based referent woman who had not undergone bilateral oophorectomy as of the index date. We used case-control analyses to investigate several characteristics associated with bilateral oophorectomy. Odds ratios and their 95% confidence intervals were adjusted for race, education, and income. ResultsIn the overall analyses, infertility was more common in women who underwent bilateral oophorectomy than in the controls, whereas use of oral contraceptives, a history of breast feeding, and fibrocystic breast disease were less common. The women who underwent bilateral oophorectomy weighed more than controls, had a higher body mass index and were younger at menarche. The associations were more pronounced for women who underwent the bilateral oophorectomy before age 46 years, and some associations were different for women with or without a benign ovarian indication. Reported family histories of uterine and other cancers were more common in women without a benign ovarian indication. ConclusionsWe identified a number of personal, reproductive, and familial characteristics that were associated with bilateral oophorectomy over a 20-year period. Our historical findings may help inform decision-making about oophorectomy in the future.

Inappropriate oophorectomy at time of benign premenopausal hysterectomy∗

We assessed rates of oophorectomy during benign hysterectomy around the release of the American College of Obstetricians and Gynecologists 2008 practice bulletin on prophylactic oophorectomy, and evaluated predictors of inappropriate premenopausal oophorectomy. A cross-sectional administrative database analysis was performed utilizing the California Office of Statewide Health Planning Development Patient Discharge Database for years 2005 to 2011. After identifying all premenopausal women undergoing hysterectomy for benign conditions, International Classification of Diseases (ICD)-9 diagnosis codes were reviewed to create a master list of indications for oophorectomy. We defined appropriate oophorectomy as cases with concomitant coding for ovarian cyst, breast cancer susceptibility gene carrier status, and other diagnoses. Using patient demographics and hospital characteristics to predict inappropriate oophorectomy, a logistic regression model was created. We identified 57,776 benign premenopausal hysterectomies with oophorectomies during the period studied. Of the premenopausal oophorectomies, 37.7% (21,783) were deemed "inappropriate" with no documented reason for removal. The total number of premenopausal inpatient hysterectomies with oophorectomy decreased yearly (12,227/y in 2005 to 5,930/y in 2011). However, the percentage of inappropriate oophorectomies remained stable. In multivariate analysis, Hispanic and African American ethnicity/race associated with increased odds of inappropriate oophorectomy (P < 0.001). Urban and at low Medi-Cal utilization hospitals showed increased odds of inappropriate oophorectomy. In premenopausal women undergoing benign hysterectomy, over one-third undergo oophorectomy without an appropriate indication documented. The rate of inappropriate oophorectomy in California has not changed since the 2008 American College of Obstetricians and Gynecologists guidelines. Whereas the absolute number of inpatient hysterectomies for benign indications has decreased, our work suggests persistent utilization of oophorectomy in premenopausal women, despite well-documented long-term adverse health implications.

Ovarian function and ovarian blood supply following premenopausal abdominal hysterectomy.

IntroductionThe issue of conserving the ovaries at hysterectomy in premenopausal women with benign gynecologic disease has been the subject of considerable controversy. Some clinicians prefer prophylactic oophorectomy in premenopausal women during hysterectomy to prevent future development of malignant changes in conserved ovaries. Other clinicians prefer to conserve apparently normal ovaries, because bilateral oophorectomy in premenopausal women results in an abrupt imbalance, sudden onset of menopausal symptoms, decreased libido, increased cardiovascular risk and osteoporosis.Material and methodsTwo hundred and twenty multipara women (who had completed their families), with benign uterine pathology were included in this prospective study for abdominal hysterectomy with bilateral ovarian preservation. Pre-operative vaginal ultrasound, Doppler studies, diagnostic hysteroscopy and endometrial biopsy were done followed by laboratory studies including Anti-mullerian hormone (AMH), follicle stimulating hormone (FSH) and estradiol for all studied women. Doppler studies, AMH, FSH and estradiol were repeated 6 and 12 months post-operative for assessment of the ovarian function and ovarian blood supply after hysterectomy.ResultsPre-operative AMH, FSH and estradiol of the studied women were statistically insignificant compared to AMH, FSH and estradiol 6 and 12 months post-operative. Twelve months post-operative right and left ovarian volumes (6.92 ± 0.18 and 6.85 ± 0.19 cm3, respectively) were significantly larger than pre-operative right and left ovarian volumes (6.19 ± 0.22 and 5.86 ± 0.23 cm3, respectively), and, 12 months post-operative right and left ovarian pulsatility indices (2.92 ± 0.15 and 2.96 ± 0.16 cm/s, respectively) were significantly lower than pre-operative right and left ovarian pulsatility indices (3.45 ± 0.19 and 3.36 ± 0.2 cm/s, respectively). Eight (3.6%) cases of the studied women developed an ovarian cyst 6 months after hysterectomy, 3 were spontaneously resolved and the remaining 5 (2.27%) cases underwent exploratory laparotomy.ConclusionsThere is no evidence of ovarian dysfunction affecting conserved ovaries one year after hysterectomy in premenopausal women as evident by AMH, FSH and estradiol. Furthermore, an increased ovarian volume and reduced ovarian pulsatility indices indicate a possible increase in ovarian blood supply, and preserved non-compromised ovarian function.

Effects on survival of menstrual cycle phase of adjuvant surgical oophorectomy in premenopausal women with breast cancer

Adjuvant surgical oophorectomy is an effective and remarkably cost effective treatment for premenopausal women with hormone receptor positive operable breast cancer. Previously published secondary analyses indicated a survival benefit for patients whose surgery was performed in the luteal phase of the menstrual cycle as opposed to the follicular. This study utilizes additional follow-up and more fully examines this hypothesis and the general implications of long-term follow-up on trial design. Beginning in 1993 we recruited women to a multicenter randomized clinical trial of adjuvant surgical oophorectomy and tamoxifen for 5 years. We recorded the reported day 1 of the patients' last menstrual cycle on the day of their adjuvant surgery. We conducted secondary analyses of the association of history-estimated luteal or follicular phase oophorectomy surgery with disease-free and overall survival. In multivariable Cox analyses, disease-free survival (DFS) exhibited a positive trend and overall survival (OS) showed a significant improvement in patients whose surgery was estimated to have occurred in the luteal phase of the menstrual cycle compared to the follicular (HR for DFS: 0.66, 95% CI: 0.37-1.16; HR for OS: 0.49, 95% CI: 0.27-0.88). From the hazard function plots, it appears that the luteal phase surgery effect on DFS diminishes after 6 years of follow-up. In conclusion, adjuvant surgical oophorectomy during the luteal phase of the menstrual cycle resulted in a reduced hazard of recurrence as compared to oophorectomy in the follicular phase during the first 5.5 years of follow-up. The practical and biological implications of these findings deserve rigorous evaluation in clinical trials.

Abstract PD09-01: Oophorectomy, Adiposity, and Mortality in NHANES III, a Nationally Representative Sample

Abstract Background: Adiposity is a risk factor for many chronic diseases, including postmenopausal breast cancer. Oophorectomy is often performed to prevent ovarian cancer during elective hysterectomy. An estimated 300,000 oophorectomies are performed yearly in the U.S. Bilateral oophorectomy is also associated with reduced risk of breast cancer and is employed as a risk reduction strategy for women with BRCA 1/2 mutations. In the general population, oophorectomy has been associated with increased all-cause mortality and cardiovascular disease (CVD). We hypothesized that abrupt estrogen and androgen deprivation resulting from bilateral oophorectomy in premenopausal women may increase adiposity and thereby contribute to mortality. Methods: To test our hypothesis we evaluated the association between oophorectomy and adiposity (weight, BMI &amp; waist circumference [WC]) cross-sectionally in NHANES III among women age 40 and older interviewed 1988-1994. We also evaluated the association between oophorectomy, BMI and all-cause, cancer, and CVD mortality through 2006. Women reporting bilateral oophorectomy or no oophorectomy with complete data on adiposity measures were included (N=3814). Survey weights were used in all analyses. Linear regression was used to calculate differences in mean adiposity, adjusting for demographic, behavioral and reproductive factors and BMI at age 25. Hazard Ratios (HRs) of all-cause, cancer, and CVD mortality were estimated using Cox regression. Cross-product terms were included in models to assess interaction and the Wald test was used to test statistical significance. Results: 20% of women reported a bilateral oophorectomy (N=530). Overall, there were no significant differences in adiposity between women reporting oophorectomy and those with intact ovaries after multivariate adjustment. However, women who had an oophorectomy before age 40 had significantly increased adiposity (Weight β=6.8 lbs p=0.009; BMI β=1.2kg/m2 p=0.009; WC β =3.4cm p=0.009). Results were similar after excluding estrogen users. Neither oophorectomy nor age at oophorectomy were independently associated with mortality, but the combined effect of prior bilateral oophorectomy and obesity was significantly associated with mortality. Women with BMI≥30 kg/m2 had 1.2 times the risk of all-cause mortality (HR=1.21 95% CI 1.03-1.42) and 1.4 times the risk of CVD mortality (HR=1.36 95% CI 1.00-1.86). Women who reported having a prior oophorectomy and had a BMI ≥30 kg/m2 had 1.7 times higher all-cause mortality (HR=1.65 95% CI 1.11-2.45, p-interaction=0.029) and 2.0 times higher CVD mortality (HR=1.97 95% CI 1.06-3.67, p-interaction=0.079) compared to women with intact ovaries who were not obese. Further, women with an oophorectomy &amp;lt;40 and BMI ≥30 kg/m2 had two fold increased all-cause mortality (HR=2.11 95% CI 1.00-4.48, p-interaction=0.047) and 3.8 fold increased CVD mortality (HR=3.77 95% CI 1.32-10.73, p-interaction 0.218). Significant interactions between oophorectomy and BMI were not observed for cancer mortality but the sample size was small. Conclusion: This study suggests that obesity is an important modifier of the association between oophorectomy and overall mortality. Future studies are needed to understand the temporality of these findings. Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr PD09-01.

Hysterectomy and concurrent oophorectomy for endometrial cancer: which women benefit?

Recent evidence has challenged the traditional paradigm in gynecology that women over the age of 45 years who are undergoing hysterectomy should also undergo prophylactic oophorectomy. Oophorectomy in young women is associated with an increased risk in cardiac disease, osteoporosis and all-cause mortality. With the increasing incidence of endometrial cancer in young women, the decision of whether to perform an oophorectomy in premenopausal women undergoing endometrial cancer staging is becoming increasingly common. We present the risks and benefits of oophorectomy, as well as discuss the literature concerning oophorectomy in young women with endometrial cancer.

Prophylactic oophorectomy in premenopausal women and long-term health.

To review the data on long-term outcomes in women who underwent prophylactic bilateral oophorectomy, a common surgical procedure that has more than doubled in frequency since the 1960s. Literature review of the published data on the consequences of prophylactic bilateral oophorectomy. Special emphasis was given to the Mayo Clinic Cohort Study of Oophorectomy and Aging. Main outcome measures Overall mortality, cardiovascular disease, cognitive impairment and dementia, parkinsonism, osteoporosis, psychological wellbeing and sexual function. There is a growing body of evidence suggesting that the premature loss of ovarian function caused by bilateral oophorectomy performed before natural menopause is associated with several negative outcomes. In particular, studies have revealed an increased risk of premature death, cardiovascular disease, cognitive impairment or dementia, parkinsonism, osteoporosis and bone fractures, decline in psychological wellbeing and decline in sexual function. The effects involve different organs (e.g. heart, bone, or brain), and different functions within organs (e.g. cognitive, motor, or emotional brain functions). Estrogen treatment may prevent some but not all of these negative outcomes. The potential adverse effects of prophylactic bilateral oophorectomy on heart health, neurological health, bone health and quality of life should be carefully weighed against its potential benefits for cancer risk reduction in women at average risk of ovarian cancer.

Increased Risk of Cognitive Impairment or Dementia in Women Who Underwent Oophorectomy Before Menopause

There is increasing laboratory evidence that estrogen has neuroprotective effects that may include improved synapse formation, increased cerebral blood flow and glucose metabolism, antioxidant activity, and reduced deposition of β-amyloid in the brain. Clinical and epidemiological evidence, however, has lagged behind. It could well be that there is a critical age window within which neuroprotective effects express themselves. This study examined the association between oophorectomy, performed before the start of menopause for reasons unrelated to tumor, with the risk of subsequent cognitive impairment or dementia as disclosed by a modified form of the Telephone Interview for Cognitive Status. The final study groups included 813 women having unilateral oophorectomy; 676 having bilateral oophorectomy; and 1472 referent women matched for age with the surgical groups. Compared to referent women, those undergoing unilateral or bilateral oophorectomy had an increased risk of cognitive impairment or dementia. The hazard ratio was 1.46 and the 95% confidence interval 1.13-1.90 after adjusting for education and a history of depression. The risk of cognitive dysfunction or dementia increased as the age at the time of oophorectomy declined, and was significantly increased when oophorectomy was done before age 49 years. The findings were independent of the indication for oophorectomy, and were similar following unilateral and bilateral oophorectomy. Oophorectomy-either unilateral or bilateral-appears to carry with it an increased risk of cognitive impairment or dementia when performed before the start of menopause. This study is one of the first to support the idea of a critical age window for protective effects of estrogen on the brain. The findings encourage a reassessment of prophylactic oophorectomy in premenopausal women and also of estrogen therapy following oophorectomy.

A diagnostic dilemma following risk-reducing surgery for BRCA1 mutation – a case report of primary papillary serous carcinoma presenting as sigmoid cancer

BackgroundWomen that carry germ-line mutations for BRCA1 or BRCA2 genes are at an increased risk of developing breast, ovarian and peritoneal cancer. Primary peritoneal carcinoma is a rare tumour histologically identical to papillary serous ovarian carcinoma. Risk-reducing surgery in the form of mastectomy and oophorectomy in premenopausal women has been recommended to prevent breast and ovarian cancer occurrence and decrease the risk of developing primary peritoneal cancer.Case presentationWe present a case report of a woman with a strong family history of breast cancer who underwent risk-reducing surgery in the form of bilateral salpingo-oophorectomy following a mastectomy for a right-sided breast tumour. Following the finding of a BRCA1 mutation, a prophylactic left-sided mastectomy was performed. After remaining well for twenty-seven years, she presented with rectal bleeding and altered bowel habit, and was found to have a secondary cancer of the sigmoid colon. She was finally diagnosed with primary papillary serous carcinoma of the peritoneum (PSCP).ConclusionPSCP can present many years after risk-reducing surgery and be difficult to detect. Surveillance remains the best course of management for patients with known BRCA mutations.

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Oophorectomy in Premenopausal Women

To compare health-related quality-of-life outcomes and sexual functioning among premenopausal women who underwent bilateral salpingo-oophorectomy (BSO) versus ovarian conservation at the time of hysterectomy. This is a secondary data analysis of premenopausal women who underwent hysterectomy for benign gynecologic disease in the Medicine or Surgery and the Total or Supracervical Hysterectomy randomized trials. Bilateral salpingo-oophorectomy was performed at the patients' requests or to treat intraoperative ovarian pathology. Health-related quality-of-life outcomes and sexual functioning were assessed using the Medical Outcomes Study SF-36, Sexual Problems Scales, and several other measures at 4 weeks, 6 months, and 2 years after hysterectomy. Mean age at hysterectomy was higher for the 49 women who underwent BSO compared with the 112 women with ovarian conservation (45 versus 40, P<.001). At 6 months, the BSO group demonstrated less improvement than women with ovarian conservation on scales for body image (2 versus 14, P=.01), sleep problems (4 versus 16, P<.01), and the SF-36 Mental Component Summary (4 versus 10, P=.03). There were no differences in any measure of sexual functioning between the groups. Hot flushes, urinary incontinence, and pelvic pain were similar in both groups. At 2-year follow-up, all measures of health-related quality-of-life and sexual functioning appeared similar by BSO status. Women who underwent BSO had less improvement in some aspects of health-related quality of life within the first 6 months following hysterectomy compared to women with ovarian conservation. However, these differences were not apparent 2 years after surgery. II.

Survival patterns after oophorectomy in premenopausal women: a population-based cohort study

A statistical model of death due to ovarian cancer, breast cancer, coronary heart disease, hip fracture, and stroke has suggested that women who undergo prophylactic bilateral oophorectomy are at increased risk of death for all causes. We aimed to investigate survival patterns in a population-based sample of women who had received an oophorectomy and compare these with women who had not received an oophorectomy. From an existing cohort of all women who underwent unilateral or bilateral oophorectomy while residing in Olmsted County, MN, USA, in 1950-87, we analysed those who had received an oophorectomy for a non-cancer indication before the onset of menopause. Every member of the cohort was matched by age to a referent woman in the same population who had not undergone oophorectomy. 1293 women with unilateral oophorectomy, 1097 with bilateral oophorectomy, and 2390 referent women were eligible for the study. Women were followed up until death or the end of the study (staggered over 2001-06) by use of direct or proxy interviews, medical records in a records-linkage system, and death certificates. Overall, mortality was not increased in women who underwent bilateral oophorectomy compared with referent women. However, mortality was significantly higher in women who had received prophylactic bilateral oophorectomy before the age of 45 years than in referent women (hazard ratio 1.67 [95% CI 1.16-2.40], p=0.006). This increased mortality was seen mainly in women who had not received oestrogen up to the age of 45 years. No increased mortality was recorded in women who underwent unilateral oophorectomy in either overall or stratified analyses. Although prophylactic bilateral oophorectomy undertaken before age 45 years is associated with increased mortality, whether it is causal or merely a marker of underlying risk is uncertain.

Prophylactic oophorectomy in premenopausal women with non-metastatic colon cancer: A decision analysis

6130 Background: There is data to suggest that prophylactic oophorectomy (PO) in premenopausal women with colon cancer may improve survival. However, the potential for improved survival must be balanced against the trade-off of premature menopause and its affect on quality of life (QOL). The objective of this study was to determine the value of PO in premenopausal women undergoing surgical excision of colon cancer. Methods: We constructed a decision-analytic model comparing PO versus no PO for premenopausal women undergoing resection of stage I-III colon cancer. The model included detection of ovarian micrometastases (OMM), adjuvant chemotherapy, development of metachronous ovarian metastases, subsequent risk of ovarian cancer and QOL. Probabilities and utilities were estimated from published data. Life expectancy (LE) and quality adjusted LE (QALE) were calculated using the Declining Exponential Approximation of Life Expectancy. Results: With a baseline OMM incidence of 8%, a 5 yr survival of OMM removed (19%) vs OMM left in situ (11%), there was a gain in LE of 2.8 months with PO. With QOL adjustments for menopause (utility 0.77) and colon cancer (utility 0.37–0.85 ), QALE was 1.7 months less with PO. One-way sensitivity analysis (SA) demonstrated that the utility of menopause had the greatest effect on QALE differences, with a threshold value of 0.86 at which QALE was greater with PO. With increasing OMM incidence and 5-year survival with removed OMM, QALE became greater in the PO cohort. All 1, 2, and 3 way SAs demonstrated that the model was robust through the probable range of variables. Conclusions: Our model demonstrated the significant effect of menopause QOL on overall QALE. Although PO may lead to a small gain in LE, the trade-off of premature menopause must be considered when counseling patients. No significant financial relationships to disclose.