Ovarian conservation at the time of hysterectomy for benign disease.
OBJECTIVE
Prophylactic oophorectomy is often recommended concurrent with hysterectomy for benign disease. The optimal age for this recommendation in women at average risk for ovarian cancer has not been determined.


METHODS
Using published age-specific data for absolute and relative risk, both with and without oophorectomy, for ovarian cancer, coronary heart disease, hip fracture, breast cancer, and stroke, a Markov decision analysis model was used to estimate the optimal strategy for maximizing survival for women at average risk of ovarian cancer. For each 5-year age group from 40 to 80 years, 4 strategies were compared: ovarian conservation or oophorectomy, and use of estrogen therapy or nonuse. Outcomes, as proportion of women alive at age 80 years, were measured. Sensitivity analyses were performed, varying both relative and absolute risk estimates across the range of reported values.


RESULTS
Ovarian conservation until age 65 benefits long-term survival for women undergoing hysterectomy for benign disease. Women with oophorectomy before age 55 have 8.58% excess mortality by age 80, and those with oophorectomy before age 59 have 3.92% excess mortality. There is sustained, but decreasing, benefit until the age of 75, when excess mortality for oophorectomy is less than 1%. These results were unchanged following multiple sensitivity analyses and were most sensitive to the risk of coronary heart disease.


CONCLUSIONS
Ovarian conservation until at least age 65 benefits long-term survival for women at average risk of ovarian cancer when undergoing hysterectomy for benign disease.
Parker
William H
WH
The David Geffen School of Medicine, University of California, Los Angeles, California, USA. wparker@ucla.edu
Broder
Michael S
MS
Liu
Zhimei
Z
Shoupe
Donna
D
Farquhar
Cindy
C
Berek
Jonathan S
JS
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000209:etiology; D003327:Coronary Disease / Q000209:etiology; D015914:Estrogen Replacement Therapy / Q000009:adverse effects / Q000401:mortality; D005260:Female; D006620:Hip Fractures / Q000209:etiology; D006801:Humans; D007044:Hysterectomy; D008390:Markov Chains; D008875:Middle Aged; D010051:Ovarian Neoplasms / Q000517:prevention & control; D010052:Ovariectomy / Q000009:adverse effects / Q000401:mortality; D012680:Sensitivity and Specificity; D020521:Stroke / Q000209:etiology; D017741:Survivors