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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