The CDC used to publish what they referred to as a surveillance of hysterectomy in the U.S. every 5 or so years. Since 2005, they've stopped, or at least stopped publishing them online, and have even taken down the 2000-2004 report.
Apart from surveys that are done only very infrequently, the last one being in 1996, the CDC has only ever published the number of inpatient hysterectomies. This is the basis for the number we see cited so commonly in studies and literature, 600,000. However, this is increasingly inaccurate as the level of outpatient, or ambulatory, hysterectomies rises.
A well-corroborated number from the AHRQ indicates that at least 40%-50% of all hysterectomies are now done on an outpatient basis. This doesn't mean that the patient goes home the same day. An outpatient patient can actually end up spending several nights in the hospital but the doctor never admits her. Her insurance likes this because they pay less for an outpatient procedure.
Anyhow, if we use the 40% figure, we know that the last-reported CDC inpatient number was 498,000. That means that, if inpatient is 60%, that's about a 830,000 total of U.S. hysterectomies.
To arrive at the number of elective hysterectomies, let's be really conservative and take out every woman diagnosed with uterine (55,000), ovarian (22,000), and cervical (13,000) cancer, based on SEER stats (e.g., http://seer.cancer.gov/statfacts/html/cervix.html).
That leaves 740,000 elective (voluntary) hysterectomies.
If we stick with the accepted "55% of elective hysterectomies include bilateral ovary removals" estimate, that's about 407,000 women a year whose ovaries are removed during elective hysterectomy.
However, the number of healthy ovary removals may increase to ~700,000 a year if Dr. Rocca is right in his write-up that there are 300,000 additional BSOs when women present with benign cysts.
Potentially, we are talking about ~1,900 women a day to remove an organ that only develops cancer in 22,000 women a year.
But are all these random ovary removals the reason the number is so low?
No. The ovarian cancer diagnosis and mortality rate was the same in 1965 when the ovarian removal rate was only 25%.
With such a low risk, removing the ovaries of a woman at risk is like shooting fish in a barrel. Taking out hundreds of thousands to address the risk in ~20,000 is like using a boulder to crush an ant. It's also not a surgical approach taken in any other cancer prevention surgery.
The ACOG argues that this should ultimately be up to the woman. Unless the woman does not have a demonstrated (via a certified genetic counselor) risk of ovarian cancer, this is not true. Once the doctor says "cancer risk" to the patient, she will agree to anything. If they couple that with their 2011 brochure that says that the ovaries cease functioning at the time of menopause, which we've known for 100 years since the endocrine system because well-understood is not true, then you are setting up enough misinformation for us to stay where we are: hundreds of thousands of women made ill to address a microscopic risk. This is NOT about informed consent, but about bad medicine. The statistics are staggering.
Apart from surveys that are done only very infrequently, the last one being in 1996, the CDC has only ever published the number of inpatient hysterectomies. This is the basis for the number we see cited so commonly in studies and literature, 600,000. However, this is increasingly inaccurate as the level of outpatient, or ambulatory, hysterectomies rises.
A well-corroborated number from the AHRQ indicates that at least 40%-50% of all hysterectomies are now done on an outpatient basis. This doesn't mean that the patient goes home the same day. An outpatient patient can actually end up spending several nights in the hospital but the doctor never admits her. Her insurance likes this because they pay less for an outpatient procedure.
Anyhow, if we use the 40% figure, we know that the last-reported CDC inpatient number was 498,000. That means that, if inpatient is 60%, that's about a 830,000 total of U.S. hysterectomies.
To arrive at the number of elective hysterectomies, let's be really conservative and take out every woman diagnosed with uterine (55,000), ovarian (22,000), and cervical (13,000) cancer, based on SEER stats (e.g., http://seer.cancer.gov/statfacts/html/cervix.html).
That leaves 740,000 elective (voluntary) hysterectomies.
If we stick with the accepted "55% of elective hysterectomies include bilateral ovary removals" estimate, that's about 407,000 women a year whose ovaries are removed during elective hysterectomy.
However, the number of healthy ovary removals may increase to ~700,000 a year if Dr. Rocca is right in his write-up that there are 300,000 additional BSOs when women present with benign cysts.
Potentially, we are talking about ~1,900 women a day to remove an organ that only develops cancer in 22,000 women a year.
But are all these random ovary removals the reason the number is so low?
No. The ovarian cancer diagnosis and mortality rate was the same in 1965 when the ovarian removal rate was only 25%.
With such a low risk, removing the ovaries of a woman at risk is like shooting fish in a barrel. Taking out hundreds of thousands to address the risk in ~20,000 is like using a boulder to crush an ant. It's also not a surgical approach taken in any other cancer prevention surgery.
The ACOG argues that this should ultimately be up to the woman. Unless the woman does not have a demonstrated (via a certified genetic counselor) risk of ovarian cancer, this is not true. Once the doctor says "cancer risk" to the patient, she will agree to anything. If they couple that with their 2011 brochure that says that the ovaries cease functioning at the time of menopause, which we've known for 100 years since the endocrine system because well-understood is not true, then you are setting up enough misinformation for us to stay where we are: hundreds of thousands of women made ill to address a microscopic risk. This is NOT about informed consent, but about bad medicine. The statistics are staggering.