Question 71

Hysterectomy Does Not Prevent Ovarian Cancer?

Doctor N,

I had a total hysterectomy last year due to pre-cancer of the uterus and large fibroids. I decided to have my ovaries removed in order to prevent the silent killer, ovarian cancer. I just received an e-mail from a woman who had a total hysterectomy in '93 and now has ovarian cancer! Could you comment on this. Several of my friends have opted for a total hysterectomy in order to rule out ovarian cancer in the future---was this fallacious thinking?

Reply:

I am certain that hearing this must be disturbing for you. The condition you are referring to is peritoneal papillary serous carcinoma and it can occur in women who have had their ovaries removed. It is thought to be uncommon, however there are no studies that I know of regarding its actual frequency. The lifetime risk for a woman who has ovaries and does not have an inherited genetic trait is about 1 in 70.

The possibility of this happening to you if you do not have a genetic abnormality that predisposes you to ovarian cancer would be extremely low. I have included below a summary of an article that may be of interest to you.

Dr N

Genetic susceptibility testing and prophylactic oophorectomy.
Authors: Berchuck A , Carney ME , Futreal PA
Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, NC 27710, USA.
Eur J Obstet Gynecol Reprod Biol 1999 Feb;82(2):159-64
Article Number: UI99221250

Abstract: About 10% of ovarian cancer cases are thought to have a hereditary basis and family history is the strongest risk factor for the development of this disease. In the past, prophylactic oophorectomy has been advocated for women with two or more affected first-degree relatives. More recently, with the identification of the genes responsible for most hereditary ovarian cancers (BRCA1, BRCA2), oophorectomy can now be offered specifically to women who are mutation carriers. Conversely, non-carriers in these families can be reassured that their risk of ovarian cancer is not increased. The value of oophorectomy in mutation carriers has not yet been proven, however, and there are concerns that the benefit may be less than intuitively expected. First, although the lifetime risk of ovarian cancer initially was reported to be as high as 60%, more recent studies have reported risks in the range of 15-30%. A better understanding of the genetic and/or environmental basis of variable penetrance is needed to augment our ability to counsel women regarding their risk. In addition, peritoneal papillary serous carcinoma indistinguishable from ovarian cancer occurs in some women following oophorectomy. Studies that better define how often this occurs also are needed to establish more firmly the value of prophylactic oophorectomy. In view of the uncertainty regarding the efficacy of prophylactic oophorectomy, chemopreventive and early detection approaches also deserve consideration as strategies for decreasing ovarian cancer mortality in women who carry mutations in ovarian cancer susceptibility genes.