Yale Bulletin and Calendar

December 13, 1999-January 17, 2000

Volume 28, Number 16

Study questions who is choosing
oophorectomy option

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 School of Medicine study.

Removal of healthy ovaries -- called 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 be considered when postmenopausal patients undergo hysterectomy, and that each patient make her own decision about whether to have an oophorectomy after weighing the risks and benefits.

The Yale study, published in the December issue of Obstetrics & Gynecology, raises concerns that women are not given the information they need 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," says Dr. Cary P. Gross, assistant professor of internal and general medicine.

"The final decision should lie in the hands of the patient," he adds. "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 in Maryland who had undergone a hysterectomy (removal of the uterus) between 1994 and 1996. 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.

"The way the hysterectomy was performed was strongly associated with the likelihood of having an oophorectomy," says Gross. "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, notes Gross.

Furthermore, "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," says Gross, noting that this related to whether the women's doctors were located in urban or suburban areas.

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

-- By Karen Peart

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