Attitudes of Israeli gynecologists towards risk reduction salpingo-oophorectomy at hysterectomy for benign conditions and the use of hormonal therapy

Wissam Assaf; Marah Andraous; Ofer Lavie; Yakir Segev

doi:10.1016/j.ejogrb.2022.03.017

Attitudes of Israeli gynecologists towards risk reduction salpingo-oophorectomy at hysterectomy for benign conditions and the use of hormonal therapy

Wissam Assaf, Marah Andraous, Ofer Lavie, Yakir Segev

European journal of obstetrics, gynecology, and reproductive biology · 2022 · vol. 272 , pp. 48–54 · doi:10.1016/j.ejogrb.2022.03.017 · PMID:35279641 · W4220713292

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This study investigated Israeli gynecologists' attitudes regarding risk-reducing salpingo-oophorectomy during hysterectomy for benign conditions and their use of hormonal therapy.

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Abstract

OBJECTIVES: To investigate the perspectives and attitudes of gynecologists towards risk reduction bilateral salpingo-oophorectomy (RRBSO) in average-risk women at the time of hysterectomy procedure for benign indications divided by age groups, and whether they recommend the use of hormonal therapy post oophorectomy. METHODS: A questionnaire was distributed during staff meetings either by a printed questionnaire or by a link to a total number of 360 gynecologists include seniors and practitioners. Three hundred and one gynecologists participated in a national survey. Participants completed a structured questionnaire including three different scenarios. The subject group included both attending (senior) and second-year and above resident gynecologists, from divergent subspecialties. The demographic information of the survey responders included sex, age, years of experience, working domain, and subspecialty. RESULTS: There was a 95% consensus rate among Israeli gynecologists, in favor of the ovarian conservation approach among 45-year-old women, elected for hysterectomy due to benign indications. Whereas in 50-year-old perimenopause women, without any evident family history of ovarian cancer, 39% of gynecologists advocated BSO at the time of hysterectomy, for benign indications. As for 46-year-old women, with a first-degree relative diagnosed with ovarian cancer at the age of 65 years old, 70.4% voted for prophylactic BSO. For the second part of the questionnaire regarding the utilization of hormone therapy (HT) after BSO, 66.1% of our responders proclaimed they would always encourage the use of HT in 45-year-old-women, while 52.8% recommended HT in 46-year-old-women with a family history of ovarian cancer and 39.5% for 50-year-old perimenopause women. CONCLUSION: Our national survey confirms the wide variability in attitudes among gynecologists towards performing RRBSO at hysterectomy for a benign indication in women aged 45-50, with family history being a major factor in the decision.

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MeSH descriptors

Ovarian Neoplasms Ovarian Neoplasms Ovarian Neoplasms Salpingo-oophorectomy Aged Attitude Carcinoma, Ovarian Epithelial Female Humans Hysterectomy Hysterectomy Israel Middle Aged Ovariectomy Risk Reduction Behavior

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References (28)

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[1] Oophorectomy vs ovarian conservation with hysterectomy: cardiovascular disease, hip fracture, and cancer in the Women's Health Initiative Observational Study 2011

[2] Ovarian conservation vs removal at the time of benign hysterectomy 2017

[3] Prophylactic bilateral oophorectomy or removal of remaining ovary at the time of hysterectomy in the United States, 1979-2004 2010

[4] Hormone Replacement Therapy Prescription after Premature Surgical Menopause 2020