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Lentevergadering VVOG

This article discusses the rationale for prophylactic oophorectomy in hysterectomy, the risks and benefits, and long-term survival rates. It also addresses the impact on ovarian function and the potential health consequences.

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Lentevergadering VVOG

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  1. Lentevergadering VVOG Debat Ovarëctomie bij hysterectomie Contra Prof. Tjalma Pro Prof. Vergote Oostende, 6 maart 2010 Prof. Dr. Tjalma Wiebren.Tjalma@uza.be

  2. Hysterectomy & Prophylactic Oophorectomy How often ? • 1965 : 25 % • 1999 : 55 % • Age 18 – 44: 38 % • Age 45 – 64 : 78 %

  3. The “rational” for a prophylactic oophorectomy

  4. ovarian cancer Life time risk 1,4 % At age 50 risk is 1 in 500 The silent killer

  5. Chances • BrCa 1 carrier developing ova cancer 1 in 3 • BrCa 2 carrier developing ova cancer 1 in 5 • Miscarriage 1 in 7 • Developing breast cancer 1 in 9 • Getting three balls in the lottery 1 in 11 • Premature birth 1 in 15 • Birth defect in the baby 1 in 20 • Developing ovarian cancer 1 in 70 • Death of the baby 1 in 100 • Getting four balls in the lottery 1 in 206 • Women of 60 years to die 1 in 170 • Death after sex (leading to PID) 1 in 100 000 • Death by using tampons 1 in 300 000 • Cerebral palsy in the baby 1 in 400 • Women of 50 years to die 1 in 500 • Women of 40 years to die 1 in 1 000 • Death by motor cycling 1 in 1 000

  6. Facts What happens if we take out the uterus ? It will reduce the risk of ovarian cancer by 40 % !

  7. Fact What happens if we take out the ovaries ? Women are deprived of beneficial ovarian functions !

  8. Pre- and perimenopausal women: Oophorectomy Serious health consequences • Vasomotor symptoms • Sleep quality • Mood changes • Urogenital symptoms • Sexual well-being • Skin changes • Bone loss • Coronary heart disease • Neurological

  9. Statement In the menopauze the ovaries stop working ! Rubbish !

  10. Ovaries in the menopause Testosterone Androstenedione Benefits of preserving ovarian function Lower risks of osteoporotic fracture Lower risks of coronary heart disease Converted to estrogen peripherally

  11. Mortality by age 80 (%) when prophylactic oophorectomy at age 50 – 54 Ovarian Prophylactic conservation Oophorectomy Alive at age 80 (%) 62.5 + 8.5 54.0 Hip fracture 3.4 + 1.6 5.0 Ovarian cancer 0.5 - 0.5 0.0 Breast cancer 1.8 0.0 1.8 Stroke 2.6 + 0.1 2.5 Coronary Heart Disease 7.6 + 8.4 16.0 Other 21.7 - 0.7 21.0

  12. Example • When 10.000 women, age 50 – 54, whould have a hysterectomy and prophylactic oophorectomy, then by the time they reach age 80 there would be: • CHD + 838

  13. CHD: After oophorectomy Atherogenic lipids Stress-induced lipids Higher stress-induced systolic Diastolic blood pressures More subclinical atherosclerosis, as measured by carotid artery intima-media thickness

  14. Example • When 10.000 women, age 50 – 54, whould have a hysterectomy and prophylactic oophorectomy, then by the time they reach age 80 there would be: • CHD + 838 • Hip fracture + 158 • Ovarian cancer - 47 • Overall mortality excess 858 per 10.000

  15. Risk of death in function of age at oophorectomy (CI 95%) Oophorectomy Ovarian conservation Risk of death (%) 8.5% 3.9% Survival advantage N.S. Age of oophorectomy

  16. Conclusions • Risk ovarian cancer is low • Hysterectomy alone reduces ovarian cancer • Ovarian conservation before 65 benefits long-term survival

  17. Chicken out

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