Elective Bilateral Oophorectomy at the Time of Hysterectomy
Elective Bilateral Oophorectomy at the Time of Hysterectomy
A total of 1,002 surveys were mailed, and 443 (44%) were returned completed. As seen in Table 1 , approximately 60% of the respondents were male, and almost 80% were white. Although most of the participants were aged 51 to 55 years (20%), their years in practice after completion of residency ranged from 2 to 48 years (median, 23 y). The obstetricians and gynecologists from the south (39%) were represented the most in our study, followed by those from the west (25%). Most of the participants were trained in a university hospital (68%) and were in private practice (86%). Half of the respondents reported their practice location as suburban. The majority (94%) of those surveyed were in general practice. About two thirds reported that they performed zero to three hysterectomies monthly, and a quarter performed four to six. Seventy-eight (18%) respondents omitted at least one of the main questions. Many of the nonresponses were accompanied by comments. No particular pattern was seen in missing data.
As seen in Figure 1, for women with an average risk of ovarian cancer, 131 (32%) favored elective BO before 51 years of age. It was interesting that approximately 4% of respondents considered this procedure in women between 41 and 45 years of age. Sixty-three percent of the respondents recommend this procedure to women aged 51 to 65 years, whereas only 6% would wait until after 65 years of age (Figure 1). Three (0.7%) practitioners were against elective BO in any woman with an average risk, regardless of age. Elective BO recommendation for women younger than 51 years was not influenced by a physician’s age (P = 0.20), sex (P = 0.20), or geographic region (P = 0.80). Similarly, elective BO recommendation for women aged 51 to 65 years was not affected by a physician’s age (P = 0.31), sex (P = 0.33), and geographic region (P = 0.79). Those who performed four or more hysterectomies a month and those who performed three or less hysterectomies did not respond to either question differently (P = 0.80 and P = 0.74, respectively).
(Enlarge Image)
Figure 1.
Recommendation of obstetrician-gynecologists (OB/GYNs) in favor of elective bilateral oophorectomy by hysterectomy candidate’s age group.
As Figure 2 demonstrates, the opinions of obstetrician-gynecologists significantly changed when the hysterectomy candidate had either a personal history of breast cancer or a family history of ovarian cancer (P < 0.0001 for each comparison). When counseling a woman with a personal history of breast cancer, 305 (77%) physicians favored BO in women younger than 51 years, and only 1% would wait until after 65 years. Regarding a woman with a significant family history of ovarian cancer, 261 (64%) of the participants recommended elective bilateral ovarian removal at less than 51 years of age, and only 1% would not favor it before 65 years.
(Enlarge Image)
Figure 2.
Recommendation of obstetrician-gynecologists (OB/GYNs) in favor of elective bilateral oophorectomy before 51 years of age significantly increased when the hysterectomy candidate had a personal history of breast cancer or a family history of ovarian cancer. P values were below 0.0001 for each comparison. HX, history; CA, cancer.
When the respondents were asked what they would do if the woman described was 30 to 35 years old and demanded an elective BO, 66% indicated that they would honor her request.
Having a close friend or family member with a history of breast or ovarian cancer did not change the physicians’ recommendations regarding elective BO. When 208 (51% of all responding physicians) physicians who reported this history were compared with those who did not, the proportions of those favoring elective BO in both groups were not statistically different for either those women younger than 51 years (33% and 31%, respectively; P = 0.63) or those women between 51 and 65 years (64% and 61%, respectively; P = 0.62). The findings of the WHI affected 112 (26%) participants’ opinions regarding elective BO. Elective oophorectomy recommendations below 45, 51, and 65 years of age were compared between respondents who finished residency training before 2002 (the year when the first WHI evidence was published) and those who completed training after this time point (Figure 3). No significant difference was noted (P=0.63, P=0.38,and P = 0.91, respectively).
(Enlarge Image)
Figure 3.
Recommendation of obstetrician-gynecologists (OB/GYNs) in favor of elective bilateral oophorectomy before 51 years of age was not significantly different between those who completed residency before 2002 and those who completed residency after year 2002, when the Women’s Health Initiative findings were published (P = 0.38).
The factors in a woman’s personal history that also influenced the physician’s recommendation about elective BO were as follows: a woman’s personal history of osteoporosis (23%), sexual dysfunction (23%), CVD (21%), and previous contraceptive use (15%). Only a small fraction of the survey participants took a family history of osteoporosis (12%) and CVD (10%) into consideration when counseling women regarding ovarian conservation before hysterectomy for benign indications.
Results
A total of 1,002 surveys were mailed, and 443 (44%) were returned completed. As seen in Table 1 , approximately 60% of the respondents were male, and almost 80% were white. Although most of the participants were aged 51 to 55 years (20%), their years in practice after completion of residency ranged from 2 to 48 years (median, 23 y). The obstetricians and gynecologists from the south (39%) were represented the most in our study, followed by those from the west (25%). Most of the participants were trained in a university hospital (68%) and were in private practice (86%). Half of the respondents reported their practice location as suburban. The majority (94%) of those surveyed were in general practice. About two thirds reported that they performed zero to three hysterectomies monthly, and a quarter performed four to six. Seventy-eight (18%) respondents omitted at least one of the main questions. Many of the nonresponses were accompanied by comments. No particular pattern was seen in missing data.
As seen in Figure 1, for women with an average risk of ovarian cancer, 131 (32%) favored elective BO before 51 years of age. It was interesting that approximately 4% of respondents considered this procedure in women between 41 and 45 years of age. Sixty-three percent of the respondents recommend this procedure to women aged 51 to 65 years, whereas only 6% would wait until after 65 years of age (Figure 1). Three (0.7%) practitioners were against elective BO in any woman with an average risk, regardless of age. Elective BO recommendation for women younger than 51 years was not influenced by a physician’s age (P = 0.20), sex (P = 0.20), or geographic region (P = 0.80). Similarly, elective BO recommendation for women aged 51 to 65 years was not affected by a physician’s age (P = 0.31), sex (P = 0.33), and geographic region (P = 0.79). Those who performed four or more hysterectomies a month and those who performed three or less hysterectomies did not respond to either question differently (P = 0.80 and P = 0.74, respectively).
(Enlarge Image)
Figure 1.
Recommendation of obstetrician-gynecologists (OB/GYNs) in favor of elective bilateral oophorectomy by hysterectomy candidate’s age group.
As Figure 2 demonstrates, the opinions of obstetrician-gynecologists significantly changed when the hysterectomy candidate had either a personal history of breast cancer or a family history of ovarian cancer (P < 0.0001 for each comparison). When counseling a woman with a personal history of breast cancer, 305 (77%) physicians favored BO in women younger than 51 years, and only 1% would wait until after 65 years. Regarding a woman with a significant family history of ovarian cancer, 261 (64%) of the participants recommended elective bilateral ovarian removal at less than 51 years of age, and only 1% would not favor it before 65 years.
(Enlarge Image)
Figure 2.
Recommendation of obstetrician-gynecologists (OB/GYNs) in favor of elective bilateral oophorectomy before 51 years of age significantly increased when the hysterectomy candidate had a personal history of breast cancer or a family history of ovarian cancer. P values were below 0.0001 for each comparison. HX, history; CA, cancer.
When the respondents were asked what they would do if the woman described was 30 to 35 years old and demanded an elective BO, 66% indicated that they would honor her request.
Having a close friend or family member with a history of breast or ovarian cancer did not change the physicians’ recommendations regarding elective BO. When 208 (51% of all responding physicians) physicians who reported this history were compared with those who did not, the proportions of those favoring elective BO in both groups were not statistically different for either those women younger than 51 years (33% and 31%, respectively; P = 0.63) or those women between 51 and 65 years (64% and 61%, respectively; P = 0.62). The findings of the WHI affected 112 (26%) participants’ opinions regarding elective BO. Elective oophorectomy recommendations below 45, 51, and 65 years of age were compared between respondents who finished residency training before 2002 (the year when the first WHI evidence was published) and those who completed training after this time point (Figure 3). No significant difference was noted (P=0.63, P=0.38,and P = 0.91, respectively).
(Enlarge Image)
Figure 3.
Recommendation of obstetrician-gynecologists (OB/GYNs) in favor of elective bilateral oophorectomy before 51 years of age was not significantly different between those who completed residency before 2002 and those who completed residency after year 2002, when the Women’s Health Initiative findings were published (P = 0.38).
The factors in a woman’s personal history that also influenced the physician’s recommendation about elective BO were as follows: a woman’s personal history of osteoporosis (23%), sexual dysfunction (23%), CVD (21%), and previous contraceptive use (15%). Only a small fraction of the survey participants took a family history of osteoporosis (12%) and CVD (10%) into consideration when counseling women regarding ovarian conservation before hysterectomy for benign indications.