Long-Term Mortality Associated With Oophorectomy Compared With Ovarian Conservation in the Nurses' Health Study

Parker, William H. MD; Feskanich, Diane ScD; Broder, Michael S. MD, MSHS; Chang, Eunice PhD; Shoupe, Donna MD; Farquhar, Cynthia M. MD, MPH; Berek, Jonathan S. MD, MMS; Manson, JoAnn E. MD, DrPH

doi: 10.1097/AOG.0b013e3182864350
Original Research
Journal Club

OBJECTIVE: To report long-term mortality after oophorectomy or ovarian conservation at the time of hysterectomy in subgroups of women based on age at the time of surgery, use of estrogen therapy, presence of risk factors for coronary heart disease, and length of follow-up.

METHODS: This was a prospective cohort study of 30,117 Nurses' Health Study participants undergoing hysterectomy for benign disease. Multivariable adjusted hazard ratios for death from coronary heart disease, stroke, breast cancer, epithelial ovarian cancer, lung cancer, colorectal cancer, total cancer, and all causes were determined comparing bilateral oophorectomy (n=16,914) with ovarian conservation (n=13,203).

RESULTS: Over 28 years of follow-up, 16.8% of women with hysterectomy and bilateral oophorectomy died from all causes compared with 13.3% of women who had ovarian conservation (hazard ratio 1.13, 95% confidence interval 1.06–1.21). Oophorectomy was associated with a lower risk of death from ovarian cancer (four women with oophorectomy compared with 44 women with ovarian conservation) and, before age 47.5 years, a lower risk of death from breast cancer. However, at no age was oophorectomy associated with a lower risk of other cause-specific or all-cause mortality. For women younger than 50 years at the time of hysterectomy, bilateral oophorectomy was associated with significantly increased mortality in women who had never used estrogen therapy but not in past and current users: assuming a 35-year lifespan after oophorectomy: number needed to harm for all-cause death=8, coronary heart disease death=33, and lung cancer death=50.

CONCLUSIONS: Bilateral oophorectomy is associated with increased mortality in women aged younger than 50 years who never used estrogen therapy and at no age is oophorectomy associated with increased survival.

LEVEL OF EVIDENCE: I

Bilateral oophorectomy is associated with increased mortality in women aged younger than 50 years who never used estrogen therapy; at no age is oophorectomy associated with increased survival.

John Wayne Cancer Institute, Santa Monica, the Partnership for Health Analytic Research, LLC, Beverly Hills, the Keck School of Medicine at the University of Southern California, Los Angeles, and the Department of Obstetrics & Gynecology, Stanford University School of Medicine, Stanford Women's Cancer Center, Stanford Cancer Institute, Stanford, California; the Channing Division of Network Medicine, Department of Medicine, and the Division of Preventive Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts; and the University of Auckland, Auckland, New Zealand.

Corresponding author: William H. Parker, MD, 1450 Tenth Street, Santa Monica, CA 90401; e-mail: wparker@ucla.edu.

Supported by a National Institutes of Health grant for data collection and cohort maintenance for the Nurses’ Health Study: CA87969 and HL34594 from the National Institutes of Health; study grants from Ethicon, Inc and Partnership for Health Analytic Research.

Financial Disclosure The authors did not report any potential conflicts of interest.

© 2013 The American College of Obstetricians and Gynecologists