The grades of evidence (I-III) and levels of recommendations (A-C) are defined at the end of "Major Recommendations" field.
The following conclusion is based on good and consistent scientific evidence (Level A):
- In women ages 50 to 79 years who have had a hysterectomy, use of estrogen therapy has shown no increased risk of breast cancer or heart disease with up to 7.2 years of use.
The following recommendation is based on limited or inconsistent scientific evidence (Level B):
- Bilateral salpingo-oophorectomy should be offered to women with BRCA1 and BRCA2 mutations after completion of childbearing.
The following recommendations are based primarily on consensus and expert opinion (Level C):
- Women with family histories suggestive of BRCA1 and BRCA2 mutations should be referred for genetic counseling and evaluation for BRCA testing.
- For women with an increased risk of ovarian cancer, risk-reducing salpingo-oophorectomy should include careful inspection of the peritoneal cavity, pelvic washings, removal of the fallopian tubes, and ligation of the ovarian vessels at the pelvic brim.
- Strong consideration should be made for retaining normal ovaries in premenopausal women who are not at increased genetic risk of ovarian cancer.
- Given the risk of ovarian cancer in postmenopausal women, ovarian removal at the time of hysterectomy should be considered for these women.
- Women with endometriosis, pelvic inflammatory disease, and chronic pelvic pain are at higher risk of reoperation; consequently, the risk of subsequent ovarian surgery if the ovaries are retained should be weighed against the benefit of ovarian retention in these patients.
Definitions:
Grades of Evidence
I Evidence obtained from at least one properly designed randomized controlled trial
II-1 Evidence obtained from well-designed controlled trials without randomization
II-2 Evidence obtained from well-designed cohort or case-control analytic studies, preferably from more than one center or research group
II-3 Evidence obtained from multiple time series with or without the intervention. Dramatic results in uncontrolled experiments could also be regarded as this type of evidence.
III Opinions of respected authorities, based on clinical experience, descriptive studies, or reports of expert committees
Levels of Recommendations
- The recommendations are based on good and consistent scientific evidence.
- The recommendations are based on limited or inconsistent scientific evidence.
- The recommendations are based primarily on consensus and expert opinion.
