Long-term overall and disease-specific mortality associated with benign gynecologic surgery performed at different ages

Abstract

Objective As bilateral salpingo-oophorectomy is frequently performed with hysterectomy for nonmalignant conditions, defining health outcomes associated with benign bilateral salpingo-oophorectomy performed at different ages is critical. Methods We assessed mortality risk associated with benign total abdominal hysterectomy or bilateral salpingo-oophorectomy among 52,846 Breast Cancer Detection and Demonstration Project Follow-up Study participants. Surgery and risk factor data were ascertained via baseline interview (1979-1986) and three questionnaires (1987-1998). During follow-up through December 2005 (mean=22.1 years), 13,734 deaths were identified. We estimated hazard ratios (HRs) and 95% confidence intervals (CIs) for overall and disease-specific mortality following total abdominal hysterectomy or bilateral salpingo-oophorectomy performed by ages 35, 40, 45, 50, or 55 years compared to not having surgery using landmark analyses and multivariable Cox regression. Results Undergoing bilateral salpingo-oophorectomy by age 35 was associated with increased mortality risk (HR35 years=1.20, 95% CI: 1.08, 1.34), which decreased with age (HR40 years=1.12, 95% CI: 1.04, 1.21; HR45 years=1.10, 95% CI: 1.03, 1.17). Total abdominal hysterectomy alone performed by age 40 was associated with increased mortality risk to a lesser extent (HR40 years=1.08, 95% CI: 1.01, 1.15). Analyses based on matched propensity scores related to having gynecological surgery yielded similar results. Elevated mortality risks were largely attributable to non-cancer causes. Conclusions Benign gynecologic surgeries among young women are associated with increased mortality risk, which attenuates with age.

Accelerated Accumulation of Multimorbidity After Bilateral Oophorectomy: A Population-Based Cohort Study

“…Our group 1–3 and others 4–6 have found that for most women without a cancer indication, the long-term risks of bilateral oophorectomy performed before menopause are greater than the benefits; therefore, the surgery should be limited to women who have a high-risk genetic variant predisposing the patient to cancer. 3,5 However, other authors continue to argue that, in the absence of a randomized clinical trial, the evidence against prophylactic oophorectomy derived from observational studies is not sufficient to change the practice.…”

Cardiovascular risk of BRCA1/2 mutation carriers: A review

“…In contrast, in a large prospective cohort of 25.448 women enrolled in the Women's Health Initiative Observational Study hysterectomy with salpingooophorectomy (n=14 254) was not associated with an increased risk of IHD and of total CVD [54]. Bilateral salpingo-oophorectomy increases the risk of CVD-related mortality, particularly when performed before the age of 45 years [48,55,56].…”

Nutrition in Gynecologic Cancer

“…Women, who underwent BSO prior to age 55 for treatment of their malignancy and survive, have an increased risk of cardiovascular disease [49].…”