H.Hasan et al (AMJOB June 24, 2023 DOI:https://doi.org/10.1016/j.ajog.2023.06.043) provided an up-to-date systematic review on “the long-term outcomes of bilateral salpingo-oophorectomy (BSO) at the time of hysterectomy” and performed a meta-analysis for the reported associations.
Hysterectomy with BSO in young women compared to hysterectomy or no surgery was associated with decreased risk of breast cancer (HR:0.78, 95% CI: 0.73-0.84), but with increased risk of colorectal cancer (HR:1.27, 95%CI:1.10-1.47). Additionally, it was associated with increased risk of total cardiovascular diseases, coronary heart disease and stroke with hazard ratios 1.18 (95%CI: 1.11-1.25), 1.17 (95%CI: 1.10-1.25), 1.20(95% CI: 1.10-1.31), respectively.
Compared to no surgery hysterectomy with BSO before the age of 50 was associated with increased risk of hyperlipidaemia (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:1.06-1.20), dementia (HR:1.70, 95%CI:1.07-2.69) and depression (HR:1.39, 95%CI:1.22-1.60). Evidence on the association with all-cause mortality in young women showed substantial heterogeneity between the studies (I2:85%, p-value: <0.01).
Conclusion
Hysterectomy with BSO is associated with multiple long-term outcomes. The benefits of the addition of BSO to hysterectomy should be balanced against the risks.