Factors affecting gynaecologists' decision to perform prophylactic oophorectomy concomitantly with hysterectomy: a Belgian survey.

BACKGROUND

The recommendation to perform an elective bilateral salpingo-oophorectomy (BSO) at the time of a hysterectomy for a benign condition is complex.

AIM: This survey evaluated the effect of three factors on BSO: the patient's age, her menopausal status, and the presence of a family history of breast cancer.

MATERIALS AND METHOD: We conducted an anonymous written survey, sent to 1513 gynaecologists, evaluating their attitude towards performing a prophylactic BSO concomitantly with a hysterectomy. We used a clinical vignette of a patient presenting a large and painful fibroid. We modified three factors: her age (either 44 or 49 years old), menopausal status (pre-menopausal or peri-menopausal), the absence or presence of a breast cancer family history. We randomly sent one case to each gynaecologist, who was asked whether he/she would perform a BSO.

RESULTS

The recommendation to perform a BSO varied between 2% and 81%, in relation to the different cases (χ(2): 151; p<0.001). On average, a five year difference in the patients' age (44 years vs 49 years) was associated with a 40% increase in proceeding a BSO. Being peri-menopausal vs being pre-menopausal, was associated with a 20% increase in suggesting a BSO. Having had a mother, diagnosed with breast cancer, was associated with a 10% increase of BSO.

CONCLUSION

The physicians' recommendation to perform an elective bilateral salpingo-oophorectomy at the time of a hysterectomy, is strongly influenced by the patients' age, and to a lesser extent by her menopausal status, or a family history of breast cancer.