Analysis of Prophylactic Salpingo-oophorectomy at the Time of Hysterectomy for Benign Lesions

Prophylactic salpingo-oophorectomy refers to the removal of clinically normal ovaries at the time of hysterectomy for benign lesions, to reduce the risk of ovarian and breast cancer in future. This risk reduction holds true for high-risk women, i.e., those with strong family history of breast or/and ovarian cancer and those who carry germline mutations (BRCA-1 and BRCA-2). However, it is still one of the commonly performed surgeries in low-risk women and has fallen into controversy. It is said that the number needed to treat is 300. The aim of the study was to analyze and understand the reasons behind women opting for prophylactic oophorectomy in spite of the available evidence. We also aimed to study the histopathology reports of the ovaries and tubes removed prophylactically. This was a prospective study carried out at a tertiary care center which serves both rural and urban population. Of the 252 patients counseled, 86 patients who opted for prophylactic salpingo-oophorectomy were included in the study. A detailed history, clinical examination, relevant investigations (ultrasonography and CA 125 levels), indications for hysterectomy, reasons for prophylactic oophorectomy, intraoperative findings, and the histopathology findings were noted. Main reasons for opting for prophylactic oophorectomy were lack of understanding and thus dependent on their treating doctor for the decision-making, fear of ovarian malignancy in future, inability to follow-up, and previous one or more abdominal surgeries. We as gynecologists need to reconsider the age at which we recommend prophylactic oophorectomy. Too much negative counseling should be deferred.