Ovarian conservation at the time of hysterectomy and long-term health outcomes in the nurses' health study.
OBJECTIVE
To report long-term health outcomes and mortality after oophorectomy or ovarian conservation.


METHODS
We conducted a prospective, observational study of 29,380 women participants of the Nurses' Health Study who had a hysterectomy for benign disease; 16,345 (55.6%) had hysterectomy with bilateral oophorectomy, and 13,035 (44.4%) had hysterectomy with ovarian conservation. We evaluated incident events or death due to coronary heart disease (CHD), stroke, breast cancer, ovarian cancer, lung cancer, colorectal cancer, total cancers, hip fracture, pulmonary embolus, and death from all causes.


RESULTS
Over 24 years of follow-up, for women with hysterectomy and bilateral oophorectomy compared with ovarian conservation, the multivariable hazard ratios (HRs) were 1.12 (95% confidence interval [CI] 1.03-1.21) for total mortality, 1.17 (95% CI 1.02-1.35) for fatal plus nonfatal CHD, and 1.14 (95% CI 0.98-1.33) for stroke. Although the risks of breast (HR 0.75, 95% CI 0.68-0.84), ovarian (HR 0.04, 95% CI 0.01-0.09, number needed to treat=220), and total cancers (HR 0.90, 95% CI 0.84-0.96) decreased after oophorectomy, lung cancer incidence (HR=1.26, 95% CI 1.02-1.56, number needed to harm=190), and total cancer mortality (HR=1.17, 95% CI 1.04-1.32) increased. For those never having used estrogen therapy, bilateral oophorectomy before age 50 years was associated with an increased risk of all-cause mortality, CHD, and stroke. With an approximate 35-year life span after surgery, one additional death would be expected for every nine oophorectomies performed.


CONCLUSIONS
Compared with ovarian conservation, bilateral oophorectomy at the time of hysterectomy for benign disease is associated with a decreased risk of breast and ovarian cancer but an increased risk of all-cause mortality, fatal and nonfatal coronary heart disease, and lung cancer. In no analysis or age group was oophorectomy associated with increased survival.
Parker
William H
WH
From the John Wayne Cancer Institute at Saint John's Health Center, Santa Monica, California; UCLA School of Medicine, Los Angeles, California; Partnership for Health Analytic Research, Los Angeles, California; Channing Laboratory, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts; School of Medicine, University of Auckland, Auckland, New Zealand; Cerner Health Insights, Beverly Hills, California; Keck School of Medicine, University of Southern California, Los Angeles, California; Stanford University School of Medicine, Stanford, California; Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts; and Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts.
Broder
Michael S
MS
Chang
Eunice
E
Feskanich
Diane
D
Farquhar
Cindy
C
Liu
Zhimae
Z
Shoupe
Donna
D
Berek
Jonathan S
JS
Hankinson
Susan
S
Manson
JoAnn E
JE
D000328:Adult; D002318:Cardiovascular Diseases / Q000453:epidemiology*; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006620:Hip Fractures / Q000453:epidemiology*; D006801:Humans; D007044:Hysterectomy; D008875:Middle Aged; D009369:Neoplasms / Q000453:epidemiology*; D009726:Nurses / Q000706:statistics & numerical data; D017063:Outcome Assessment, Health Care; D010052:Ovariectomy; D011183:Postoperative Complications; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D015996:Survival Rate