Removal of Ovaries May affect Heart

[Celebration]

http://www.ajc.com/health/content/health/0805/01ovaries.html

Apparently doctors have often been taking out ovaries along with the uterus, thinking that that would prevent ovarian cancer (rare but dangerous) and that women could take HRT.

Among the 600,000 American women who have hysterectomies each year, thousands may die prematurely of heart disease because doctors removed their ovaries along with their wombs, a new study suggests.

snip

The analysis found that 9 percent fewer women whose ovaries had been removed between ages 50 and 54 lived to see their 80th birthdays than did those who had hysterectomies during those years but who had kept their ovaries. As many as 18,000 women a year may die prematurely because of ovarian surgery, said Dr. William H. Parker, the study's lead author.

snip

Cutler reported in a scientific journal back in 1984 that the practice of removing healthy ovaries could not withstand scientific scrutiny, but the controversy persisted. The latest federal data, from the late 1990s, have found that 78 percent of women between ages 45 and 64 who undergo a hysterectomy have their ovaries taken out as well, though most are not at particular risk for ovarian cancer.

snip

Doctors had long relied on the assumption that women could take hormone replacement pills to substitute for lost ovaries, but research three years ago suggested that in many cases, those hormones did more harm than good.

[intheflow]

1. Huh. And heart disease is the number one killer of women.

I'll bet this is a contributing factor.

http://www.cbs.com/cbs_cares/heart_disease/index.shtml

...we learned that many women and their doctors do not realize that, after menopause, women are at least as much at risk of heart attacks as men. We also learned that heart disease kills more women than all the cancers combined, including breast cancer.

[NVMojo]

2. gee, I'd have to argue this statistic!

[DemBones DemBones]

3. Great! Let's scare women about something else.

Since the article includes anecdotal information about one woman whose heart disease MAY be associated with removal of her ovaries, I'd like to present anecdotal evidence of my own: I know an 89 year-old woman who is in excellent health for a woman her age, has never had a heart attack, heart disease, breast cancer, any of that, though her ovaries were removed forty years ago and she's been on hormone replacement treatment ever since. Just to keep things a bit more balanced for the other women reading this!

*************************************************************************************

I read the article and it says precious little about the study, such as methodology, number of subjects, other factors examined, etc. Is this just a case study review or what?

"An editorial (in 'Obstetrics and Gynecology') suggests that although the study must still be confirmed by other research, doctors will now rethink the advice they give about ovary removal, which is called an oophorectomy."

Too bad the emphasis added is mine -- the AJC could have added emphasis to that key phrase. These results are not written in stone.

I'm not convinced doctors rethinking ovary removal is a good thing, given that ovarian cancer is particularly hard to detect until it's quite advanced, meaning patients often die within a few months, regardless of treatment.

The AJC article, by the way, says that women without ovaries cannot get ovarian cancer, which you would think would be the case. But in fact, women without ovaries can and do get primary peritoneal cancer, which is basically ovarian cancer outside the ovaries. However, this is less common than getting ovarian cancer in ovaries, so being ovary-less offers a good bit of protection against a very bad cancer, IMHO.

A MAJOR problem about heart disease in women is that it's very poorly understood, having been thought to behave like heart disease in men. It doesn't. Women, for example, can have microvascular heart disease, which is harder to detect. Women often have very atypical symptoms when having a heart attack as well. Medicine has been inexcusably slow to figure this out.

All women should really read up on particular health risks for women, such as microvascular heart disease and primary peritoneal cancer, ovarian cancer, as well as the very well-publicized breast cancer. Women are also at particular risk for a number of autoimmune diseases, such as lupus erythematosus (usually just called "lupus," but there are also less serious types of lupus; lupus erythematosus is the bad one) and thyroid diseases like Hashimoto's disease. Thyroid disease is very common in women over 50 and many doctors never bother to check a woman's thyroid levels.

Women should be INFORMED but not SCARED. The press is not very responsible about informing, often preferring to scare. We've had to tolerate far too many scare stories about oral contraceptive risks, hormone replacement risks, breast cancer risks, DES exposure risks. You can bet a lot of women who've had oophorectomies will cringe when they hear or read about this study -- it's not as if they can have their ovaries put back in place, after all.

I'm going to call around and see if I can get a copy of the article from 'Obstetrics & Gynecology.' Any OB-GYN's here who could help me out?

Note: I mentioned the AJC here because that's the link given; but the AJC reprinted a story from the Boston Globe. So we can thank the Boston Globe reporter for a skewed article featuring a scare story about one woman who had a hysterectomy with oophorectomy and now has a heart condition, lousy sex life, etc. That is, of course, terrible for her, but it's also anecdotal -- how representative is it?

And the final quotes agreeing with the study? Please note that they're from a
co-author of the study!!! Wow, no doubt he's objective. :eyes:

:rant: over. For now.

[beam me up scottie]

4. Wow, DemBones, excellent post !

Excellent summation.
Thanks for the info.

[DemBones DemBones]

6. Thank you. I appreciate your comments. nt

[beam me up scottie]

8. No problem, thanks

for addressing the idiotic sensationalism that frequently accompanies the results of medical studies on women.
How many times have they done this with mammogram research?

[DemBones DemBones]

11. Yes, mammograms and also breast self exams.

After years of badgering women to examine their breasts every month, now they've decided it's not that helpful after all. (Or have they changed back and I missed that memo?) Mammograms and ultrasounds certainly beat diagnostic exploratory surgery but those procedures can give false results, images that look like a tumour or cyst, thus causing stress if not panic when patients get a call back for another mammogram and ultrasound.

[Celebration]

5. no doubt some will overreact

I would love for you to take a look at the study. The press can do a far better job on reporting like this.

In all fairness not all the medical professionals quoted had a connection with the study.

As far as the anecdote goes, I have experience writing health articles for the mainstream public, and anecdotes are usually required. They are also extremely hard to get because people don't want their health issues spread all over some newspaper or magazine.

The article, by quoting the editorial in the journal, puts a proper perspective on the study--


"An editorial suggests that although the study must still be confirmed by other research, doctors will now rethink the advice they give about ovary removal, which is called an oophorectomy.

"While this study is certainly not definitive," the editorial said, "it is sure to provide significant impact upon clinical practice." Doctors' conversations with older women about ovary removal used to be "brief and pointed. This is no longer likely to be the case.""

[DemBones DemBones]

7. I should apologize if anyone thought I was

criticizing you for posting the article here. Clearly, it is science news, and you simply reported on this report. It was the article that earned my rant. I have seen this done so many times before to women, who do have a lot of health issues that men don't have, due to differences in male and female reproductive systems, and who are so often talked down to by physicians. (Sadly, that includes female physicians, as many women who get through med school have a God complex as big as any male M.D.'s)

I would love to see the study. Do you know how I could access it? I'm not sure if -- oh, wait, a DUer friend is a medical librarian at a hospital; I'll check with her about FAXing me a copy. But if it's available online and you can get a copy, others might like to read it, too. Since you have written articles about health for the general public, you may have membership to some online services that I don't. I don't even have Lexis-Nexus, alas.

I understand that anecdotes personalize an article and are a sort of 'hook' as well, but I fear far too many people focus on anecdotes such as the panicked comments of the woman who is suffering and merely skim over paragraphs such as the quotes from the editorial you mention. I think writers have a responsibility to inform and make clear why a study may be important without alarming readers unduly.

It would have helped if the writer of the article had restated that editorial's comments more clearly at the end of the article, in words something like this:

"More study MUST be done before we even know if this is true. A positive result of this new study is that doctors will now be spending a bit more time talking to women about whether oophorectomy is best for them, going over all the plusses and minuses to help each patient make her decision."

(Another bonus is that perhaps med schools will no longer teach their students the axiom that "No testicle is bad enough to remove, no ovary is good enough to save.")

[Celebration]

9. I would have to go to the library

There is a med school library here but not really conveniently located.

It also might be interesting to read the accompanying editorial comments to get a more complete picture.

Clearly, though, it seems that heart health, at least after menopause, was not a factor in the risk/benefit equation for removing ovaries. Now it is.

Believe me, when it comes to getting medical anecdotes, you have to take what you can get as a writer. It is very hard to get people on the record. It's not really my thing (and that is one reason) and I haven't written anything in a while. The experience has made me far more sympathetic towards reporters. Because of this, I actually allowed myself to be interviewed on local TV about an attempted burglary at my house (by a then infamous burglar). I never would have done it but I felt sorry for the reporter!! But I doubt if I would ever allow myself to be quoted about a medical problem. It is tough enough just to get the name of someone to interview. Think about it. How do you do that? The internet has helped somewhat, but you don't have a lot of medical professionals out there helping you find anecdotes.

[DemBones DemBones]

10. Don't you feel, though, that those

who voluntarily give a writer an anecdotal account tend to be at one extreme or another? Either they have an axe to grind or they view the doctor as God and their treatment as miraculous, with a good probability that neither is true, IMO.

Beyond the use of anecdotes, which is standard in such reporting, my larger complaint about the article is that we're not informed about the methodology of the study. I'm very curious to see that article . . .

[Celebration]

12. Oh I agree!!

Anyone who would want their medical history in print seems a little off to me, at the very least. Or there could be some sort of motive to agree to an interview. An ordinary response from someone might have been "Well, I had my ovaries out and no problems so far. Had I known this I may have decided to leave them in." However, nobody with that type of response would probably want to be quoted on the record.

I *think* most readers understand that.

You are right about all the different issues that come up for women,though. I thought the article made an excellent point about HRT not being used as much now (for good reason).