Breast Cancer and Hysterectomy

[GMM]

I am a 41 year breast cancer survivor and my doctor is recommending a hysterectomy.  My cancer was estrogen and progesterone negative, yet my doctor says I am at a higher risk or ovarian, uterine and colon cancer.  I have a uterine fibroid that is causing menstrual problems and she recommends a full hysterectomy.  I have some concerns and wonder if it is necessary.

[CCF-RN,MSN-rf]

Dear GMM:  While it is true that a personal history of breast cancer does slightly increase a person's risk or a second breast cancer and some other cancers, it seems that you are really facing two questions.  First, the hysterectomy, which is a surgical procedure to remove the uterus.   If the fibroid is causing problems, many times a hysterectomy is done to treat this.  However a hysterectomy does nothing to reduce the risk of ovarian cancer unless the ovaries are also removed with the uterus. The next question is whether to remove the ovaries or not.  Often, if a person is post menopausal and a hysterectomy is being done for some other reason, a surgeon will elect to remove the ovaries - in theory, to reduce the chances of ovarian cancer.  Ovaries are sometimes removed in women with estrogen positive cancers.  As yours is a hormone negative cancer, you may benefit from a thorough discussion of risks and benefits, as they relate to you, with your oncologist.  Ultimately, the decision is yours and reviewing the pros and cons as they pertain to your specific situation may help you to make this decision.

[Yvonne1348]

I had my ovaries removed at the recommendation of both my onco and breast surgeon. I developed breast cancer in both breasts (I think she said the odds of that were only 3 percent), and they felt it would reduce my chances of a recurrence by 50 percent or more, since I was determined to be strongly estrogen positive. I'm comfortable with my decision to have my ovaries removed due to my particular circumstances, but it's not a decision to be made lightly.

If you go to your internet search engine and enter "ovaries and health risks," you will find literally thousands of websites that say that removing ovaries is a bad idea, and you increase your risk of Parkinson's, heart disease, and osteoporosis (depending on your age at the time your ovaries are removed). Some websites said you increase your odds of dying before 80yo by as much as 9 percent if you have your ovaries removed. If you enter "ovary removal and breast cancer," you will find nearly as many websites that support the idea that ovary removal significantly reduces your breast cancer risk (not to mention ovarian cancer).

Since the ovaries also produce testosterone (which is converted to estrogen), your testosterone level will drop by about 50% if your ovaries are removed (I guess your body still produces some testosterone without the ovaries, just not as much).  What this means is that it could kill your sex drive.

I guess that you just need to weigh the risks against the benefits, and have a heart to heart talk with your doctor.  It's important to know ALL the facts so you can make an informed decision. Another possibility is to have all your other plumbing removed, but leave the ovaries (along with the hormones they produce).  

Yvonne