番茄社区

Preventatively performing bilateral salpingo-oophorectomy (BSO) to remove the ovaries and fallopian tubes during a benign hysterectomy should not be recommended for younger women and should be carefully considered otherwise, according to a Danish cohort study.

In all age groups, women who underwent BSO had higher 10-year mortality, though the differences were statistically significant only for those ages 45 to 54 (risk difference [RD] 0.79 percentage point, 95% CI 0.27-1.30), reported Lene Mellemkjær, MSc, PhD, of the Danish Cancer Society Research Center in Copenhagen, and co-authors in the .

In addition, in most age groups, those who underwent BSO had a higher 10-year cumulative risk for cancer:

• Ages 45 to 54: RD 0.73 percentage point (95% CI 0.05-1.38)
• Ages 55 to 64: RD 1.92 percentage points (95% CI 0.69-3.25)
• Ages 65 and older: RD 2.54 percentage points (95% CI 0.91-4.25)

Women younger than 45 at the time of their hysterectomy with BSO also had a higher 10-year cumulative risk for hospitalization for cardiovascular disease compared with those who didn't have BSO (RD 1.19 percentage points, 95% CI 0.09-2.43).

"A clear beneficial effect of BSO was seen only in 20-year mortality among women having surgery during late postmenopausal ages," Mellemkjær and team noted.

This study "confirms that the adverse health risks outweigh the potential health benefits of BSO at benign hysterectomy in premenopausal women and thereby supports current guidelines for women without a high lifetime risk for ovarian cancer," they concluded. "The lack of a clear survival benefit and the cancer excess in postmenopausal women suggest the need for a cautious approach when deciding whether to perform BSO at hysterectomy in these women."

BSO at benign hysterectomy decreases the risk for ovarian cancer, and women at high risk for ovarian cancer will have a substantial survival benefit with BSO, Mellemkjær and colleagues said. Current guidelines for women without this increased risk are have a "more conservative approach," especially for premenopausal women, but also those who are postmenopausal and younger than 65.

Julie Gutierrez, MD, of the McGovern Medical School at UTHealth Houston, told 番茄社区 that this study supports the findings from past research in the U.S., such as the .

"Ovaries should be left in place at time of hysterectomy in most women under the age of 65," said Gutierrez, who was not involved in the study. "The effect of BSO on increasing total cancer and breast cancer in women 45 to 54 years old is a notable finding in this study and will further aid in counseling patients against BSO at time of hysterectomy in this age group."

This emulated target trial used data from a nationwide Danish health register from 1977 to 2017.

Eligible participants were at least 20 years old and reported having their uterus removed due to a benign condition. Women who had a family history of cancer, those who had already had cancer themselves, and people who had either uni- or bilateral oophorectomy before their hysterectomy were excluded.

The full cohort included 142,985 women, 22,974 who underwent BSO and 120,011 who did not. Half of those who underwent BSO were 45 to 54 at the time of hysterectomy, and 26% were ages 55 to 64. For the hysterectomy-alone group, 48% were ages 20 to 44 and 38% were 45 to 54.

The most common indications for benign hysterectomy in both groups were bleeding disorders, fibromas, prolapse, pain, and endometriosis, among others.

Mellemkjær and colleagues used age as a proxy for menopausal status, since menopausal data were not available, which was a limitation to the study.

Gutierrez also noted that "while the study [used] a very large public database in Denmark and eliminates recall bias, the ethnic makeup of their participants is not diverse and therefore their findings may not be applicable to all practices."

"Risk differences were quite small, so while there is an overall trend away from BSO in ages <65, it is important to take each patient's individual risks into account," she added.

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