Determinants of the decision to perform prophylactic oophorectomy in association with a hysterectomy for a benign condition.

BACKGROUND: The decision to perform an elective bilateral salpingo-oophorectomy (BSO) at the time of a hysterectomy for a benign condition is complex. AIM: To assess the determinants of the decision to proceed to a prophylactic BSO during a hysterectomy for a benign condition. MATERIALS AND METHODS: We collected demographic and clinical data, including age, menopausal status and risk of ovarian cancer. Using a regression model we analysed the decision perform a prophylactic BSO in women successively admitted for a hysterectomy for a benign condition, in relation to the collected demographic and clinical data. RESULTS: Data were collected for 43 women, aged between 37 and 65 years (mean age 48.6 years, SD 6.9), on the day before their hysterectomy. Thirty-six (84%) had a total hysterectomy and 7 (16%) a subtotal hysterectomy; 40 (93%) had a laparoscopic procedure. Prophylactic BSO was significantly associated with age: none of the women aged under 40 years had the procedure, compared with 8% of those aged 41-45 years, 29% of those aged 46-50 years and 83% of those aged 51 years or more (χ(2)=23; P<0.001). Of the postmenopausal women, 67% had a prophylactic BSO, compared with 24% of the premenopausal women (χ(2)=6; P<0.047). In this small series of patients no relationship was found between the decision to perform a BSO and the risk of ovarian cancer. Age was the only significant variable in the regression model (pseudo R(2) Nagelkerke=0.6, P<0.05). CONCLUSION: The physician's recommendation to perform an elective BSO at the time of a hysterectomy for a benign condition is strongly influenced by the patients' age.

Factors affecting gynaecologists' decision to perform prophylactic oophorectomy concomitantly with hysterectomy: a Belgian survey.

BACKGROUND: The recommendation to perform an elective bilateral salpingo-oophorectomy (BSO) at the time of a hysterectomy for a benign condition is complex. AIM: This survey evaluated the effect of three factors on BSO: the patient's age, her menopausal status, and the presence of a family history of breast cancer. MATERIALS AND METHOD: We conducted an anonymous written survey, sent to 1513 gynaecologists, evaluating their attitude towards performing a prophylactic BSO concomitantly with a hysterectomy. We used a clinical vignette of a patient presenting a large and painful fibroid. We modified three factors: her age (either 44 or 49 years old), menopausal status (pre-menopausal or peri-menopausal), the absence or presence of a breast cancer family history. We randomly sent one case to each gynaecologist, who was asked whether he/she would perform a BSO. RESULTS: The recommendation to perform a BSO varied between 2% and 81%, in relation to the different cases (χ(2): 151; p<0.001). On average, a five year difference in the patients' age (44 years vs 49 years) was associated with a 40% increase in proceeding a BSO. Being peri-menopausal vs being pre-menopausal, was associated with a 20% increase in suggesting a BSO. Having had a mother, diagnosed with breast cancer, was associated with a 10% increase of BSO. CONCLUSION: The physicians' recommendation to perform an elective bilateral salpingo-oophorectomy at the time of a hysterectomy, is strongly influenced by the patients' age, and to a lesser extent by her menopausal status, or a family history of breast cancer.