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Grand Rounds

Does Hysterectomy with Salpingo-Oophorectomy for Benign Indications Reduce the Risk of Breast Cancer?

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BACKGROUND AND PURPOSE:

  • It is unclear whether hysterectomy with bilateral salpingo-oophorectomy (BSO) reduces risk of breast cancer in women with average risk and benign indications
  • There have been reports of increased mortality associated with BSO in younger women who do not receive hormone therapy, potentially due to increased risk for
    • Hyperlipidemia | Cardiac arrhythmias | Coronary artery disease | Arthritis | COPD | Osteoporosis
  • Chow et al. (AJOG, 2020) estimated breast cancer risk after hysterectomy with and without BSO for benign indications

METHODS:

  • Retrospective cohort study (2001 to 2015)
    • Integrated healthcare system (Kaiser Permanante)
  • Participants
    • Women ≥18 years who had hysterectomy alone or also with BSO
    • Exclusion: Women with at higher risk for breast cancer (gene mutation, previous history of breast cancer, gynecologic cancer)
  • Data analysis
    • Descriptive and bivariate analyses were used to describe and compare demographic and clinical characteristics
    • Breast cancer incidence rates were calculated per 100,000 person-years
    • Survival analysis and Cox proportional hazard models were conducted to compare the risk of developing breast cancer

Note:  Data on hormone therapy use were not included

RESULTS:

  • 49,215 women underwent hysterectomy
    • Hysterectomy with BSO: 19,826 women
  • Average age
    • Hysterectomy alone: 45.5 years
    • With BSO: 50.8 years
  • Breast cancer diagnoses: 915
  • Age-specific breast cancer incidence rates were higher in women >60 years who had underwent hysterectomy and BSO
    • With BSO: 471.2 (95% CI, 386.2 to 556.2)
    • Without BSO: 463.0 (95% CI, 349.6 to 576.5)
  • Women with BSO had a lower risk of breast cancer vs women with hysterectomy alone
    • HR 0.86 (95% CI, 0.75 to 0.98)
  • All-cause mortality was higher with BSO than hysterectomy alone (P<0.0001)
    • With BSO: 64.4%
    • Without BSO: 35.6%
  • No difference was seen for breast cancer mortality (P=0.14)

CONCLUSION:

  • Women with BSO had a 14% lower risk of breast cancer than women with hysterectomy alone for benign indications
  • However, all-cause mortality was higher in women with oophorectomy
  • The authors conclude that

Perimenopausal patients undergoing hysterectomy for benign indications should be counseled on the risks and benefits of oophorectomy at the time of surgery

Learn More – Primary Sources:

Breast cancer risk after hysterectomy with and without salpingo-oophorectomy for benign indications

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Related ObG Topics:

Does a Hysterectomy before 50 Shorten Lifespan?
Is Ultrasound Screening a Viable Alternative to Oophorectomy for Women with BRCA1?
Are There any Minor Risks Involved with the ‘Opportunistic’ Removal of Fallopian Tubes to Prevent Cancer During Hysterectomy or Sterilization Procedures

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