Evidence of Benefit
The degree of risk of ovarian cancer, potential morbidity and mortality of surgery, and the risks associated with early menopause, should be taken into account when considering prophylactic oophorectomy for high-risk women. Adverse effects of bilateral oophorectomy and premature menopause include infertility, vasomotor symptoms, decline in sexual interest and activity, cardiovascular disease, and osteoporosis. Among women who have not taken hormone therapy, women undergoing bilateral oophorecotmy were twice as likely to have moderate or severe hot flashes than women who underwent natural menopause (odds ratio [OR] = 2.44; 95% CI, 1.03-5.77). Women at increased hereditary risk of ovarian cancer who underwent oophorectomy without hormone therapy reported statistically significantly more vasomotor symptoms than women choosing screening or those using hormone replacement therapy (HRT). These women also reported lower sexual function scores but the difference was not statistically significant. A meta-analysis of early menopause as a risk factor for cardiovascular disease observed a pooled risk of 4.55 (95% CI, 2.56-8.01) among women with bilateral oophorectomy and early menopause (defined as younger than 50 years). Early menopause is also associated with an increased risk of fracture (OR = 1.5; 95% CI, 1.2-1.8).
Nonhereditary Factors Associated With an Increased Risk of Ovarian Cancer
Hormone replacement therapy/hormone therapy
Postmenopausal use of HRT, also called hormone therapy (HT), is associated with an increased risk of developing ovarian cancer.[22,23,24] The risk may vary by use of estrogen replacement therapy (ERT), also called estrogen therapy (ET), or estrogen-progestin replacement therapy (EPRT). A cohort study of women who participated in the Breast Cancer Detection Demonstration Project showed an increased risk of ovarian cancer associated with use of ERT/ET and ERT/ET followed by EPRT. A RR of 3.2 (95% CI, 1.7-5.7) was associated with 20 or more years use of ERT/ET only, with a statistically significant trend of increasing risk with increasing duration of use. Although no risk of ovarian cancer associated with EPRT use alone was observed, the number of women in this subgroup was small and an associated risk cannot be ruled out. A case-control study of ovarian cancer also did not find an association between combined estrogen and progestin, but use of estrogen-only therapy for more than 10 years was associated with an increased risk. An association between postmenopausal estrogen use and ovarian cancer mortality also has been shown. Vital status of 211,581 postmenopausal women, all of whom completed a baseline questionnaire in 1982 documenting no history of cancer, hysterectomy, or ovarian surgery was assessed through December 31, 1996. Women who were using estrogen at baseline had a significantly higher risk of ovarian cancer death than women who never used estrogen (RR = 1.51; 95% CI, 1.16-1.96). The risk increased with longer duration of use; women using estrogen at baseline and those who had used estrogen for at least 10 years had a higher risk of ovarian cancer death than did women who had never used estrogen, respectively (RR = 2.20; 95% CI, 1.53-3.17).