The ACOG's October 2015 response to July 2015 letter and research

The American College of Obstetricians and Gynecologists
Vice President, Practice Activities
Christopher M. Zahn, MD, FACOG
Telephone: 202/863-2529

October 1, 2015

Dear Ms. ******:

Thank you for writing to the American College of Obstetricians and Gynecologists (ACOG) regarding the issue of oophorectomy performed at the time of hysterectomy. Your letter and the concerns you have raised were discussed by the ACOG leadership and with members of the Committee on Practice Bulletins-Gynecology at its September 2015 meeting. This committee oversees development of clinical practice recommendations, including those related to oophorectomy, and wanted to share the following information with you.

At the outset, it is important to distinguish elective oophorectomy from prophylactic or risk-reducing oophorectomy. In elective oophorectomy, normal-appearing ovaries are removed at the time of another surgery, most commonly hysterectomy. Prophylactic or risk-reducing oophorectomy occurs when the ovaries are removed due to a high risk of ovarian cancer, such as in the setting of hereditary cancer. It is also important to distinguish "normal-appearing" ovaries from those identified with a potential lesion at the time of surgery, such as cysts or other abnormalities, in which case they no longer constitute "normal-appearing" ovaries. We understand your concern to be about elective oophorectomy.

ACOG's clinical guidelines are based on current medical evidence and are revised as medical evidence evolves. As a result of the data that has been amassed over time, the risk-benefit evaluation of elective oophorectomy has changed. ACOG's current clinical guidance reflect this newer data. In fact, our current guidance recommends that "strong consideration" be given to retaining normal-appearing ovaries in women not at increased risk of ovarian cancer. ACOG will continue to evaluate the medical evidence and to update our guidelines as new data becomes available.

As for other medical interventions, the informed consent process is essential for women considering oophorectomy. Patient autonomy is critical in this process; indeed ACOG provides ethical guidance to its members on elective surgery and patient choice, and the issues of counseling, informed consent, and patient autonomy. For some patients, the threat of potential ovarian cancer may outweigh the potential risks of menopausal symptoms or even cardiovascular disease, and those women may decide to have the oophorectomy performed. For other women, the risks of menopausal symptoms, osteoporosis, and cardiovascular disease may outweigh the risk of ovarian cancer, and result in her decision to retain her ovaries. It is ACOG's position that the woman is the one to make this very important decision, with the assistance of her physician and medically accurate and balanced information.

Again, we appreciate the opportunity to review your letter and to provide a response. Thank you for your inquiry, and we hope that we have addressed your concerns.

Respectfully,
Christopher M. Zahn Vice President, Practice Activities

cc: The Hon. Patty Murray, U.S. Senator

CMZ:ch