Assignment: Prophylactic Hysterectomy

Assignment: Prophylactic Hysterectomy

Assignment: Prophylactic Hysterectomy

For this assignment, you will review and reflect on the Prophylactic Hysterectomy article. This article can be applied to healthcare providers in the primary care and specialty settings. Discussion of the article is based on the course objectives and weekly content, which emphasize the core learning objectives for an evidence-based primary care curriculum. Throughout your nurse practitioner program, discussions are used to promote the development of clinical reasoning through the use of ongoing assessments and diagnostic skills, and to develop patient care plans that are grounded in the latest clinical guidelines and evidence-based practice.

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Discuss any “take-away” thoughts from the article.

What are the ethical dilemmas to consider with prophylactic surgeries?

Discuss the screenings/interventions/options/education that you would provide to a patient that has a strong family history of ovarian cancer. What if the patient has no health insurance? What resources could you offer to assist the patient?

Role of prophylactic hysterectomy in patients at high risk for hereditary cancers
Jeannine A. Villella a, Madhu Parmar a, Kathleen Donohue b,
Cathy Fahey c, M. Steven Piver c, Kerry Rodabaugh a,⁎
a Department of Gynecologic Oncology, Buffalo, NY 14263, USA
b Department of Health Behavior, Roswell Park Cancer Institute, Buffalo, NY 14263, USA
c Gilda Radner Familial Ovarian Cancer Registry, Roswell Park Cancer Institute, Buffalo, NY 14263, USA
Received 23 September 2005
Available online 13 February 2006

Abstract

Background. Current surgical recommendations for ovarian cancer prophylaxis in women at high risk of developing ovarian cancer include bilateral salpingo-oophorectomy (risk-reducing salpingo-oophorectomy (RRSO)). The role of hysterectomy is unclear. We sought to determine
outcomes following prophylactic surgery in high-risk women.

Methods. We surveyed unaffected members of the Gilda Radner Familial Ovarian Cancer Registry who had undergone oophorectomy from 1981 to 2002. Data were collected and analyzed for statistical significance by the Fisher’s Exact Test.

Results. Two hundred eighty women were surveyed, and 154 (55%) responded; 97% were Caucasian and 14% reported being Jewish. The median age of the respondents was 51 years (range 29–79); median age at oophorectomy was 41 years (range 15–68). Fifty-eight patients (38%) reported a laparoscopic procedure. One hundred five patients (68%) had a simultaneous hysterectomy, and 4 (3%) had a prior hysterectomy. Fortyfour patients (29%) underwent BSO only. Of these 44 patients, 40 (91%) did not require a subsequent hysterectomy. Of the 4 who did, 2 were for leiomyomas, one for menorrhagia and the other was unknown. While not statistically significant, of the 3 patients who developed a subsequent
gynecologic malignancy, all had undergone a hysterectomy. There was a statistically significant difference in whether or not the uterus was removed as part of the procedure by time period, whereby women treated prior to 1990 had a higher likelihood of having a hysterectomy (P = 0.03).

Conclusion. The women in our study did not require hysterectomy for prevention of malignancy. We conclude that one should screen for benign gynecological indications for hysterectomy when planning a prophylactic BSO for prevention of ovarian cancer. Other potential risk factors for endometrial cancer, including the role of UPSC in HBOC, remain to be elucidated.
© 2006 Elsevier Inc. All rights reserved.

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