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Younger women who have both ovaries removed in the hope of avoiding cancer and who do not receive adequate hormone replacement therapy run a higher risk of premature death, a study says.
Hundreds of thousands of pre-menopausal women each year undergo preventive removal of both ovaries with the aim of avoiding ovarian cancer.
Some of these women have variants of two genes, BRCA1 and BRCA2, which are notoriously linked to female cancer, and studies have showed the removal of the ovaries does, for this specific group, seem to have a protective effect.
But for the majority of women who do not have such high-risk gene variants, little is known as to whether ovary removal -- which for some can have lasting emotional effects -- is worthwhile.
In the first detailed research into this question, US doctors followed up 1,293 American women who had had one ovary removed and 1,097 who had had both ovaries removed.
They then compared the data with those for 2,390 women, matched for age and background, who had not undergone any such operation.
The surgery was carried out before the onset of menopause. The women were followed up until their deaths or the end of the study.
Overall, the risk of death was the same, for all groups.
But, within the double-ovary group, there was a risk for women who had the operation when they were younger than 45 and the risk rose significantly for under-45s who had not received oestrogen therapy.
When matched against counterparts in the "control" group, these women were 1.6 times likely to die prematurely.
The principal causes were cancer, cardiovascular problems and neurological disease, such as dementia and Parkinson's disease. The risk was 6.3 times for death from neurological disorder.
The paper appears in the October issue of The Lancet Oncology, a specialist journal on cancer published by The Lancet in London.
The researchers, led by Walter Rocca, a neurologist and epidemiologist at the Mayo Clinic in Rochester, New York, said it was unclear whether double ovarian removal before the age of 45 was a cause of the worrying mortality or simply an indicator of some other underlying health risk.
In any case, if a woman younger than 45 has cancer of the ovaries or a benign disease that requires ovarian removal, the argument for surgery is compelling, said Rocca.
Removal should also be considered in older women and in women with a very high risk of ovarian cancer, he added.
Ovarian cancer has been dubbed a "silent killer" of women because its symptoms are often ignored or mistaken for other problems and so it is diagnosed too late.
It is the fifth leading cause of cancer death in women, according to Medline Plus (http://www.nlm.nih.gov/medlineplus/), a website run by the US National Library of Medicine and National Institutes of Health.
Older women are at highest risk, it says. More than half of the deaths from ovarian cancer occur in women between 55 and 74 years of age. About a quarter occur in women aged between 35 and 54.
AFP 291742 GMT 09 06
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