Date of Award
Medical Doctor (MD)
Bilateral salpingo-oophorectomy (BSO) at the time of hysterectomy for benign disease is a complicated decision due to the conflicting evidence about the health effects of BSO and ovarian cancer risk in the general population. This decision is based on the patient’s baseline background and understanding of these topics in addition to the counseling provided to her by her physician. This study aims to identify 1) patient preference regarding BSO, specifically the oophorectomy component, 2) opinions on health outcomes related to BSO, and 3) perceived physician counseling patterns for the decision for prophylactic BSO at the time of hysterectomy. A pilot survey study of 50 women scheduled to undergo hysterectomy for benign etiologies was conducted at Yale New Haven Hospital. Only 9 (18%) patients underwent BSO with hysterectomy. For women undergoing BSO, reducing ovarian cancer risk was the most important reason in making their decision, whereas for women who chose ovarian conservation, ‘menopause symptoms’ was the most common primary motivator. In general women were most concerned about ‘menopause symptoms’ among the health effects of BSO. While patients received more counseling from their physician prior to surgery about BSO and associated health effects compared to individual ovarian cancer risk factors, 18% and 50% respectively did not receive any counseling in either category, including topics such as reduction in ovarian cancer risk through BSO, family history of cancer, and long-term health effects of surgical menopause. Almost half (48%) of women had an opinion about BSO prior to counseling by the physician with only 16% of those with an opinion changing their mind about performing the procedure following counseling. Finally, majority of women felt the physician took their opinion into account (86%) and they had the ultimate say in the decision for BSO with hysterectomy (82%). In conclusion, ‘menopause symptoms’ was the most prominent factor for women in making the decision about BSO. While patients did feel involved in the decision-making process, there was inadequate counseling by physicians about health effects of BSO/oophorectomy and ovarian cancer risk in the study group. This data will aid in developing an individualized shared decision making tool which may help women make a more informed decision about BSO.
Kunitomo, Yukiko, "The Patient Perspective: Prophylactic Bilateral Salpingo-Oophorectomy At The Time Of Benign Hysterectomy" (2017). Yale Medicine Thesis Digital Library. 2136.