Removing organs “just in case”—is prophylactic removal of the ovaries a good thing?

Bilateral prophylactic oophorectomy (also known as ovariectomy) is undertaken commonly and routinely as a prophylactic measure in women who are not at a known increased risk of ovarian cancer. In the UK in 2003, for example, about 41 000 women had an elective hysterectomy for benign conditions.1 Of these about 19 000 women aged less than 60 years, simultaneously had bilateral oophorectomy. Hysterectomy with bilateral oophorectomy is undertaken for a variety of conditions including; chronic pelvic pain, endometriosis, adenomyosis, uterine prolapse, and pelvic inflammatory disease. However, most women have a hysterectomy because of fibroids or menorrhagia (abnormal or heavy bleeding) and it has been estimated that in as many as 30% of these hysterectomies, oophorectomy is undertaken as an additional prophylactic measure against the possible future development of ovarian cancer.2 Although these figures relate to the UK, prophylactic oophorectomy with hysterectomy for benign conditions is undertaken in many countries.3–6

Ovarian cancer is comparatively common and currently not easily treated. Some 6000 women each year in the UK develop ovarian cancer and worldwide only about 40% of women diagnosed with ovarian cancer are alive at five years.7–9 Although genetic markers for the likelihood of development of ovarian cancer exist, most women undergoing oophorectomy or ovariectomy at the time of their hysterectomy are not tested for those genetic markers. (A small number of women …