Hysterectomy with ovary, fallopian tube removal yields some cancer benefits, CV detriments

Key takeaways:

• Hysterectomy with bilateral salpingo-oophorectomy dropped risks for breast cancer for younger women and ovarian cancer.
• Still, surgery was linked to increased total CVD, coronary heart disease and stroke risk.

Compared with simple or no surgery, hysterectomy with bilateral salpingo-oophorectomy was associated with reduced risks for ovarian and breast cancer for some women, but increased risks for colorectal cancer and CVD, researchers reported.

Despite hysterectomy with bilateral salpingo-oophorectomy reducing the risk for ovarian cancer and ovarian cancer-related mortality, women who receive oophorectomy, particularly before menopause onset, are at risk for unfavorable health outcomes, researchers noted.

“Most of these surgeries are done in women at general population level risk for ovarian cancer. Therefore, the reduction in ovarian cancer risk should be balanced against other long-term outcomes,” Hend Hassan, MPhil, PhD student in the department of public health and primary care at the Centre for Cancer Genetic Epidemiology at the University of Cambridge, United Kingdom, and colleagues wrote.

Hassan and colleagues searched PubMed, Web of Science and Embase and identified 21 studies published from January 2015 to August 2022 that evaluated women who had a hysterectomy with bilateral salpingo-oophorectomy compared with hysterectomy with ovarian conservation or no surgery.

This systematic review and meta-analysis, published in the American Journal of Obstetrics & Gynecology, found that hysterectomy with bilateral salpingo-oophorectomy was associated with a substantial reduction in risk for ovarian cancer and ovarian cancer-related mortality (HR = 0.11; 95% CI, 0.09-0.15).

Hysterectomy with bilateral salpingo-oophorectomy compared with hysterectomy or no surgery was associated with reduced risk for breast cancer among women younger than 45 years (HR = 0.78; 95% CI, 0.73-0.84), but not women who had the procedure after age 50 years (HR = 1.05; 95% CI, 0.96-1.15). Conversely, hysterectomy with bilateral salpingo-oophorectomy was associated with increased risk for colorectal cancer among women younger than 45 years (HR = 1.27; 95% CI, 1.1-1.47) and older than 50 years (HR = 1.25; 95% CI, 1.04-1.51).

In addition, the procedure was associated with increased risks for total cardiovascular diseases (HR = 1.18; 95% CI, 1.11-1.25), coronary heart disease (HR = 1.17; 95% CI, 1.1-1.25) and stroke (HR = 1.2; 95% CI, 1.1-1.31).

Hysterectomy with bilateral salpingo-oophorectomy among women younger than 50 years was associated with increased risks for hyperlipidemia (HR = 1.44; 95% CI, 1.25-1.65), diabetes (HR = 1.16; 95% CI, 1.09-1.24), hypertension (HR = 1.13; 95% CI, 1.06-1.2), dementia (HR = 1.7; 95% CI, 1.07-2.69) and depression (HR = 1.39; 95% CI, 1.22-1.6).

Researchers also noted that evidence of the association between hysterectomy with bilateral salpingo-oophorectomy and all-cause mortality in young women showed substantial heterogeneity between all included studies (P < .01).

“More studies with better adjustment for confounders are needed to ascertain the associations with CVD, neuropsychiatric outcomes, osteoporosis and all-cause mortality,” the researchers wrote.