Geography and Physician Caseload Are Key Factors in Oophorectomy Rates, According to Yale Study

Whether or not a woman’s ovaries are removed during hysterectomy depends partly on where she lives and her surgeon’s experience, according to a Yale School of Medicine study.

Removal of healthy ovaries-oophorectomy-is believed to be the most effective means of preventing ovarian cancer, the fourth most common cause of death in American women. The American College of Obstetrics and Gynecology recommends that oophorectomy may be considered when postmenopausal patients undergo hysterectomy, and that each patient should make their own decision about whether to have an oophorectomy after weighing the risks and benefits.

Published in the December issue of Obstetrics & Gynecology, the study raises concerns that women are not being presented with the information needed to make the decision to remove or keep their ovaries.

“Our study suggests that physician practice style, rather than patient preferences might be guiding the decision about oophorectomies,” said Cary P. Gross, M.D., assistant professor of internal and general medicine at Yale.

The study looked at postmenopausal women who had hysterectomies-removal of the uterus-in the state of Maryland. Whether the hysterectomies included oophorectomy depended on where in the state the women lived and whether they received a vaginal or abdominal hysterectomy. Additionally, women who were given a vaginal hysterectomy by a surgeon who frequently performed the procedure, were significantly more likely to have an oophorectomy.

“The final decision should lie in the hands of the patient,” said Gross. “Physicians have an obligation to explain the risks and benefits to their patients before oophorectomy is performed.”

The researchers used a comprehensive database to identify all postmenopausal women who had undergone a hysterectomy in Maryland during 1994 - 96. They found that 62 percent of these women had an oophorectomy. However, significant variation in the use of oophorectomy suggested that physicians, rather than patients, may be making the decision about who receives an oophorectomy.

“Women who had a hysterectomy in some areas of the state were significantly more likely to have had an oophorectomy than women in other areas,” said Gross. “The way the hysterectomy was performed was strongly associated with the likelihood of having an oophorectomy. While 89 percent of abdominal hysterectomies were accompanied by an oophorectomy, only 27 percent of hysterectomies performed vaginally had an oophorectomy.”

Surgeons who performed a high number of vaginal hysterectomies-a more technically difficult procedure-were 72 percent more likely to perform an oophorectomy than their less experienced counterparts, implying that their additional expertise translated into a higher likelihood of performing an oophorectomy.

The study was funded by the Robert Wood Johnson Clinical Scholars Program. In addition to Gross at Yale, the study’s investigators included Wanda Nicholson, M.D., and Neil Powe, M.D. from Johns Hopkins Medical Institutions.

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Karen N. Peart: karen.peart@yale.edu, 203-432-1326