Ovarian Cancer in Women with Prior Hysterectomy
Drs. Randy Davis, James B. Unger
Louisiana State University Health Sciences Center
Shreveport, Louisiana

Objective: To determine the proportion of women with ovarian cancer treated at our institution who may have had their disease prevented if oophorectomy had been performed during prior hysterectomy.
Materials and Methods: 112 women with ovarian cancer treated at our institution were identified through records in our Gynecologic Oncology office. We identified 19 women who had undergone prior hysterectomy without bilateral oophorectomy (Group 1). We compared age at cancer diagnosis, stage of disease, and cell type between these women and the 93 without prior hysterectomy (Group 2). Chi square analysis was performed to compare categorical data and independent t-test for continuous data between the two groups. P < .05 was considered statistically significant.
Results: Overall, 19 women (16.4%) identified in our records presenting with ovarian cancer had had prior hysterectomy without bilateral oophorectomy. The mean age at hysterectomy for women in Group 1 was 33.8±5.9 years (range 21-44 years). There were 7 women over the age of 35 years and 3 women over the age of 40 years at time of hysterectomy. The average age of ovarian cancer diagnosis in these women was 53.7±2.2 years compared to 45.6±1.7 years for women in Group 2, t(1) = -2.96, p=.005. There was no significant difference between the groups for stage at presentation, with Stage 3 being the most common in each, Group 1 = 57.0%, Group 2 = 57.9%, x²(4)=1.83, p = .77. There was no difference in proportion of cell types between the groups, with epithelial being most common in each, Group 1 = 84.2%, Group 2 = 79.5%, x²(4) =4.9, p = .29. However, there were 8 cases of tumor of low malignant potential identified in Group 2 and none in Group 1. There were also 4 germ cell tumors in Group 2 and none in Group 1. Overall, 16.4% of ovarian cancer cases theoretically could have been prevented if bilateral oophorectomy had been performed at the time of hysterectomy. However, this drops to only 6.2% if oophorectomy was limited to women over 35 years.
Conclusion: Advanced epithelial cell cancer was the most common presentation in women with ovarian cancer at our institution whether or not they had had prior hysterectomy.  Women in our study who underwent hysterectomy did so at a relatively young age. This limited the impact prophylactic oophorectomy could have had on ovarian cancer prevention in our population.
Key words:  ovarian cancer, prophylactic oophorectomy, hysterectomy