Prophylactic and Risk-Reducing Bilateral Salpingo-oophorectomy: recommendations based on risk of ovarian cancer.
Authors: Berek JS, Chalas E, Edelson M, Moore DH, Burke WM, Cliby WA, Berchuck A; Society of Gynecologic Oncologists Clinical Practice Committee.
Study From: Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Stanford University School of Medicine.
Journal: Obstetrics and Gynecology 2010 September, v. 116:733-43.
Problem: Nearly 300,000 US women have their ovaries removed unnecessarily every year.
Study: The authors examined all the studies about whether women should, or should not, have their ovaries removed when they have a hysterectomy.
Authors’ Conclusions: Women who do not have the BRCA cancer gene or a strong family history of ovarian cancer should strongly consider keeping their ovaries, especially if they are not menopausal.
Dr. Parker’s Comments: Traditionally, doctors have recommended removing the ovaries and tubes (medical term – bilateral salpingo-oophorectomy) in order to prevent the later development of ovarian cancer. While ovarian cancer remains a terrible disease, it affects less than 1% of women without a family history of ovarian cancer.
Recent studies show that the ovaries continue to make some hormones until at least age 80 and these hormones protect against heart disease, osteoporosis, and possibly lung cancer. Since these conditions kill 30 times more women per year than ovarian cancer, women without a family history of ovarian cancer should consider keeping their ovaries if they choose to have a hysterectomy. For women with the BRCA gene or a strong family history of ovarian cancer, there is a very strong recommendation to have their ovaries removed since the risk of ovarian cancer is high.
While this study is not a “fibroid” study, this issue comes up continually on my blog as women continue to get recommendations from their doctors to remove their ovaries at the time of (often unnecessary) hysterectomies. The first author of this paper, Dr. Jonathan Berek, was a co-author of a study we published last May that showed, among women in the Nurses’ Health Study, the long-term health benefits of keeping ovaries.
The important issue for me is that this paper was endorsed by the Society of Gynecologic Oncologists, for the past 30 years the major force convincing doctors to remove ovaries. So, this is a major reversal of policy and, I think, the right one.
You can find a summary of our Nurses’ Health Study on this webpage: Do you need a hysterectomy for fibroids?
Bill Parker, MD
