RANZCOG - MANAGING ADNEXAE GUIDELINE

Question 1

What are the risks associated with oophorectomy at time of hysterectomy for benign disease?

Answer 1

• increased mortality due to coronary heart disease
• increased morbidity and mortality due to osteoporosis and fractures
• increased risk of cognitive disease including dementia
• increased risk of depressive and anxiety symptoms
• in pre-menopausal women - more severe and prolonged VMS, reduction in libido and sexual function

Question 2

what is the UKTOCS study?

Answer 2

The UK Collaborative Trial of Ovarian Cancer Screening (UKCTOCS) was a randomised
controlled trial of postmenopausal women aged 50–74 years, with the aim to determine if
population screening can reduce deaths due to ovarian cancer.

Question 3

Outline the key findings of the UKTOC study

Answer 3

o At a median follow-up of 16.3 years, ovarian cancer was diagnosed in
- 1.0% annual multimodal screening group
- 1.0% annual USS-only group
- 1.0% no screening group
o Compared with no screening, there was a 47·2% (95% CI 19·7 to 81·1)
increase in stage I and 24·5% (−41·8 to –2·0) decrease in stage IV disease
incidence in the MMS group.
o Overall the incidence of stage I or II disease was 39·2% (95% CI 16·1 to 66·9)
higher in the MMS group than in the no screening group, whereas the
incidence of stage III or IV disease was 10·2% (−21·3 to 2·4) lower.
o 0.6% died of the disease in each group - No significant reduction in ovarian
and tubal cancer deaths was observed in the MMS (p=0·58) or USS (p=0·36)
groups compared with the no screening group.
o The reduction in stage III or IV disease incidence in the MMS group was not
sufficient to translate into lives saved.
o Given that screening did not significantly reduce ovarian and tubal cancer
deaths, general population screening cannot be recommended.