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Women Who Keep Ovaries Live Longer
[The New York Times; Subscribe]
Each year, hundreds of thousands of women who undergo hysterectomies have their ovaries removed along with their uterus, a practice meant to protect them from ovarian cancer. But a new study has found that women who keep their ovaries live longer.
While women who had their ovaries removed developed fewer breast cancers and almost entirely eliminated their risk of ovarian cancer over 24 years of follow-up, they were more likely to develop heart disease than women who kept their ovaries, and they were more likely to die.
The new findings — from an analysis of data in the famous Nurses' Health Study, published in the May issue of the journal Obstetrics & Gynecology — raises questions about a widespread practice. Some 300,000 American women a year, about half of those who have hysterectomies, have their ovaries removed.
"This finding is contrary to 35 years of teaching in gynecology," said the lead author, Dr. William H. Parker of the John Wayne Cancer Institute in Santa Monica, Calif.
"In the 1970s, it was decided that taking out the ovaries to prevent ovarian cancer would be the new strategy," he said. "This study shows that you're more likely to die if you have your ovaries taken out, unless you're among a group of women with a family history that places you at high risk for ovarian cancer or breast cancer."
While ovarian cancer is difficult to detect and often deadly, it is also rare, Dr. Parker explained, noting that only 34 of the study participants who kept their ovaries died of ovarian cancer during the follow-up period. "Heart disease kills more than 20 times the number of women every year," he said.
The study analyzed data on 29,380 women who had participated in the Harvard Nurses' Health Study: 16,345 who had hysterectomy with both ovaries removed, and 13,035 who had hysterectomy but kept their ovaries.
After 24 years of follow-up, women in the first group had 895 cases of breast cancer — a 25 percent lower risk than those who kept their ovaries — and 96 percent less risk of ovarian cancer (just 5 cases). But they were 12 percent more likely to die during the follow-up period. Their risk of heart disease was 17 percent higher than the risk faced by women with ovaries. They also had a 17 percent greater risk of dying of cancer. And in an unexpected finding, they were at greater risk for lung cancer.
The risks of heart disease and death appeared to be even greater for women who had their uterus and ovaries removed before age 50 and did not take estrogen, compared with women who had a hysterectomy before 50 but kept their ovaries.
The study may add to the debate over estrogen and the role it plays in heart disease in women. Dr. Parker and other experts suggested that women who kept their ovaries lived longer because even though the ovaries make less estrogen after menopause, they produce androstenedione and testosterone, which are converted into estrogen by fat and muscle.
OPEN ACCESS: Ovarian Conservation at the Time of Hysterectomy and Long-Term Health Outcomes in the Nurses' Health Study
[Obstetrics & Gynecology]
Objective: To report long-term health outcomes and mortality after oophorectomy or ovarian conservation.
Methods: We conducted a prospective, observational study of 29,380 women participants of the Nurses' Health Study who had a hysterectomy for benign disease; 16,345 (55.6%) had hysterectomy with bilateral oophorectomy, and 13,035 (44.4%) had hysterectomy with ovarian conservation. We evaluated incident events or death due to coronary heart disease (CHD), stroke, breast cancer, ovarian cancer, lung cancer, colorectal cancer, total cancers, hip fracture, pulmonary embolus, and death from all causes.
Results: Over 24 years of follow-up, for women with hysterectomy and bilateral oophorectomy compared with ovarian conservation, the multivariable hazard ratios (HRs) were 1.12 (95% confidence interval [CI] 1.03-1.21) for total mortality, 1.17 (95% CI 1.02-1.35) for fatal plus nonfatal CHD, and 1.14 (95% CI 0.98-1.33) for stroke. Although the risks of breast (HR 0.75, 95% CI 0.68-0.84), ovarian (HR 0.04, 95% CI 0.01-0.09, number needed to treat=220), and total cancers (HR 0.90, 95% CI 0.84-0.96) decreased after oophorectomy, lung cancer incidence (HR=1.26, 95% CI 1.02-1.56, number needed to harm=190), and total cancer mortality (HR=1.17, 95% CI 1.04-1.32) increased. For those never having used estrogen therapy, bilateral oophorectomy before age 50 years was associated with an increased risk of all-cause mortality, CHD, and stroke. With an approximate 35-year life span after surgery, one additional death would be expected for every nine oophorectomies performed.
Conclusion: Compared with ovarian conservation, bilateral oophorectomy at the time of hysterectomy for benign disease is associated with a decreased risk of breast and ovarian cancer but an increased risk of all-cause mortality, fatal and nonfatal coronary heart disease, and lung cancer. In no analysis or age group was oophorectomy associated with increased survival.