Ovarian conservation at Hysterectomy: Nurses health study

Question 1

Ovarian conservation at the time of hysterectomy and long-term health outcomes: Nurses health study
- study type, N

Answer 1

Parker et al
2009
Prospective observational study
N 29380

Aim: Determine the relationship between oophorectomy for benign disease and impact on cancer, CHD and fracture incidence and survival

24 year followup

Question 2

Study design: Ovarian conservation at ttime of hysterectomy and long-term health outcomes Nurses health study

Answer 2

30-55yo undergoing hysterectomy for benign disease

(55. 6% with bilat oophorectomy
44. 4% ovarian conservation

Exclusion criteria:

• PHx unilateral or partial oophorectomy
• Unknown ovarian status
• PHx of 1˚/2˚ outcomes of interest

Similar baseline risk factor between 2 groups, but women in the oophorectomy group tended to be slightly older and more likely to be on HRT.

Question 3

Limitation: Ovarian conservation at ttime of hysterectomy and long-term health outcomes Nurses health study

Answer 3

In women not at INC risk for ovarian CA (esp <50yo)
– BSO DEC breast + ovarian CA but INC overall mortality, CHD, stroke + lung CA.

No improved survival and affects long-term health/death – so do NOT do preventative Rx if no clear benefit

Pitfalls: homogenous population
Strengths
- Long followup up period
- baseline data available for participants

Question 3

Results: Ovarian conservation at ttime of hysterectomy and long-term health outcomes Nurses health study

Answer 3

• Long-term events/death for:
• CHD [INC slight HR 1.17]
• Stroke [INC HR 1.14]/ no diff
• Lung CA [INC slight OR 1.26]
• Breast CA [Dec OR 0.75]
• Ovarian CA [Dec OR 0.04]
• CRC [no diff]
• Hip # [no diff]
• PE [no diff]
• Total CA Dec OR 0.90, but INC in total CA mortality; OR 1.17]
• Total mortality [INC HR 1.12]

2nd outcome: For every 9 women with BSO – 1 extra death