Hysterectomy: Spare Ovaries, Boost Health?
Ovary Removal Decreases Ovarian Cancer Risk but Increases Risk of Heart Disease and Death, Study Says
April 21, 2009 -- Ovary removal during a hysterectomy is often done to reduce the risk of ovarian cancer. But doing so also boosts the risk of heart disease and death long-term, according to a new study.
For women without a strong family history of ovarian cancer or genetic predisposition to it, these heart disease and death risks appear to outweigh the benefit of the decreased cancer risk, says William H. Parker, MD, the study's lead author and a gynecologic surgeon and researcher at the John Wayne Cancer Institute at St. John's Health Center, Santa Monica, Calif. The study is published in the May issue of Obstetrics & Gynecology.
It's time to rethink the routine removal of ovaries, Parker says. "For the past 35 years, any woman over 40 or 45, when they needed a hysterectomy, would be told by the doctor, 'We should take out the ovaries to prevent ovarian cancer,'" Parker tells WebMD.
Ovary Removal or Not? Study Details
Although the advice to remove the ovaries is undoubtedly good for women at high risk for ovarian cancer, Parker began to wonder years ago if the advice was sound for the general population, whose overall risk of ovarian cancer is typically low, especially in comparison to other health risks as they age, such as heart disease.
To find out, Parker and his colleagues from Harvard Medical School and numerous other institutions tracked the health outcomes of 29,380 women participants in the long-running Nurses' Health Study. All had a hysterectomy for reasons other than cancer. More than half, or 16,345, had both ovaries removed; the other 13,035 women kept their ovaries.
Ovary Removal or Not? Study Results
After 24 years of follow up, the researchers found some health risks increased among those who had their ovaries removed compared to those who did not. Among them:
- The risk of death from any cause increased 12%.
- The risk of heart disease -- sometimes fatal -- increased by 17%. Put another way, for every 130 women who have both ovaries removed during hysterectomy, one extra death from heart disease will occur that is directly attributed to the ovary removal.
Lung cancer risk increased 26%, a finding the researchers can't explain.
As expected, the risks of ovarian and breast cancer declined in those who had ovary removal. Breast cancer risk declined by 25%, ovarian cancer totally, Parker says.
Among the more than 13,000 women who kept their ovaries, 99 got ovarian cancer and 34 died.
Ovary Removal or Not? Perspective
"Ovarian cancer is a terrible disease and we still don't know how to find it early, cure it," Parker says. "But compared to heart disease, it is a rare cause of death."
For years, he says, doctors have talked about the value of routine ovary removal during a hysterectomy to reduce ovarian cancer risk. "Now that is overshadowed by all these other risks that are much more common and much more likely to kill you."