title: Oophorectomy vs ovarian conservation with hysterectomy: cardiovascular disease, hip fracture, and cancer in the Women's Health Initiative Observational Study.
abstract: BACKGROUND
  Elective bilateral salpingo-oophorectomy (BSO) is routinely performed with hysterectomy for benign conditions despite conflicting data on long-term outcomes.
  
  
  METHODS
  This is a prospective cohort of 25 448 postmenopausal women aged 50 to 79 years enrolled in the Women's Health Initiative Observational Study who had a history of hysterectomy and BSO (n = 14 254 [56.0%]) or hysterectomy with ovarian conservation (n = 11 194 [44.0%]) and no family history of ovarian cancer. Multivariable Cox proportional hazards regression models were used to examine the effect of BSO on incident cardiovascular disease, hip fracture, cancer, and death.
  
  
  RESULTS
  Current or past use of estrogen and/or progestin was common irrespective of BSO status (78.6% of cohort). In multivariable analyses, BSO was not associated with an increased risk of fatal and nonfatal coronary heart disease (hazard ratio, 1.00 [95% confidence interval, 0.85-1.18]), coronary artery bypass graft/percutaneous transluminal coronary angioplasty (0.95 [0.82-1.10]), stroke (1.04 [0.87-1.24]), total cardiovascular disease (0.99 [0.91-1.09]), hip fracture (0.83 [0.63-1.10]), or death (0.98 [0.87-1.10]). Bilateral salpingo-oophorectomy decreased incident ovarian cancer (0.02% in the BSO group; 0.33% in the ovarian conservation group; number needed to treat, 323) during a mean (SD) follow-up of 7.6 (1.6) years, but there were no significant associations for breast, colorectal, or lung cancer.
  
  
  CONCLUSIONS
  In this large prospective cohort study, BSO decreased the risk of ovarian cancer compared with hysterectomy and ovarian conservation, but incident ovarian cancer was rare in both groups. Our findings suggest that BSO may not have an adverse effect on cardiovascular health, hip fracture, cancer, or total mortality compared with hysterectomy and ovarian conservation.
authors.affiliation: Departments of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, CA 94115, USA. JacobyV@obgyn.ucsf.edu
authors.forename: Vanessa L
authors.initials: VL
authors.lastname: Jacoby
authors.forename: Deborah
authors.initials: D
authors.lastname: Grady
authors.forename: Jean
authors.initials: J
authors.lastname: Wactawski-Wende
authors.forename: JoAnn E
authors.initials: JE
authors.lastname: Manson
authors.forename: Matthew A
authors.initials: MA
authors.lastname: Allison
authors.forename: Miriam
authors.initials: M
authors.lastname: Kuppermann
authors.forename: Gloria E
authors.initials: GE
authors.lastname: Sarto
authors.forename: John
authors.initials: J
authors.lastname: Robbins
authors.forename: Lawrence
authors.initials: L
authors.lastname: Phillips
authors.forename: Lisa W
authors.initials: LW
authors.lastname: Martin
authors.forename: Mary Jo
authors.initials: MJ
authors.lastname: O'Sullivan
authors.forename: Rebecca
authors.initials: R
authors.lastname: Jackson
authors.forename: Rebecca J
authors.initials: RJ
authors.lastname: Rodabough
authors.forename: Marcia L
authors.initials: ML
authors.lastname: Stefanick
mesh_terms: D000368:Aged; D002318:Cardiovascular Diseases / Q000453:epidemiology* / Q000517:prevention & control; D015986:Confounding Factors, Epidemiologic; D005260:Female; D006620:Hip Fractures / Q000453:epidemiology* / Q000517:prevention & control; D006801:Humans; D007044:Hysterectomy / Q000379:methods*; D015994:Incidence; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D010051:Ovarian Neoplasms / Q000453:epidemiology* / Q000517:prevention & control; D010052:Ovariectomy; D010053:Ovary / Q000601:surgery; D017698:Postmenopause; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D058994:Salpingectomy; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D016387:Women's Health