Does retention of the ovaries improve long-term survival after hysterectomy? The validity of the epidemiological evidence

Based on a decision analysis of multiple epidemiological studies, it has been claimed that, among women hysterectomized for benign disease, removal of the ovaries before the age of 65 years decreases long-term survival, and that the benefit conferred by retaining the ovaries outweighs any reduction in ovarian cancer mortality among oophorectomized women who are at average risk of ovarian cancer. The decision analysis failed to allow for the inevitable complexity involved in an overarching quantitative analysis of multiple outcomes, and to do so would not have been feasible; it made multiple assumptions, some of which could not be defended; a definition of 'average risk' of ovarian cancer was not provided, and the validity of the concept of 'average risk' was not considered; sensitivity analyses designed to test the robustness of the data were inadequate. The findings from decision analysis cannot be used as evidence to determine whether bilateral oophorectomy poses a public health problem in terms of long-term survival.