Chemotherapy or ovary ablation

[logan8]

I am a 46 year old female, premenopausal. I had a lumpectomy for an intraductal and incasive moderately well-differentiated ductal adenocarcinoma - clean lymph nodes, clean margins, ER+, PR+, Her2neu negative, family history of breast cancer (sister, aunt, cousin). My oncologist suggests just radiation and tamoxafen OR radiation, ovary ablation, and tamoxafen. The second opinon oncologist said chemo, radiation, tamoxafen. The reason for not suggesting ovary ablation was that "we usually don't do it in this country". Is one better than the other? I can't find much on the side effects of the ablation - is it different from natural menopause? Are there articles to read  about this strategy?

[azzcat]

I am in much the same spot--44 yrs. old and premenopausal. Infiltrating ductal carcinoma, 1cm, sentinel node biopsy negative, margins clean, ER+, PR+, well-differentiated, Her2 negative, grade I histiological, low MIB, mother and aunt BC history. I understand I'll need radiation and Tamoxifen, but I can't find enough information to support the need for chemotherapy as an adjuvant treatment. I have found evidence that ovarian ablation is equivalent in effectiveness to CMF chemo. As I'm done having children, ovarian ablation seems a much preferable choice to chemo. But is either chemo or ovarian ablation in combination with Tamoxifen really necessary? How would the additional adjuvant treatment improve my odds?

[CCF-RN,MSN-JS]

Dear Logan8,   There has been some question as to what role ovarian ablation (drying up the ovaries) has in the treatment of early stage breast cancers.  This treatment has shown benefit in the treatment of metastatic breast cancer, so they are now studying it in terms of adjuvant treatment for early cancers.  The reason for doing it would be to further decrease the estrogen available to estrogen-receptive tumors.  

The National Institute of Health had a panel of experts review the available data as of December 2000 regarding adjuvant treatment of breast cancer.  This panel provided a consensus statement regarding the various aspects of adjuvant therapy for breast cancer.  Concerning adjuvant hormone therapy should be offered to women whose tumors express hormone receptor protein (yours does).  At present five years of tamoxifen is standard adjuvant hormone therapy; ovarian ablation represents an alternative option for selected premenopausal women.  

Ovarian ablation is used far less frequently in the United States.  Methods to accomplish ablation are surgical (oopherectomy), radiation therapy to the ovaries, or chemical suppression of ovarian function.  Ovarian ablation appears to produce a similar benefit to some chemotherapy regimens.  Combining ovarian ablation with chemotherapy has not been shown to provide an additional advantage to date.  The value of combining hormonal therapies has not yet been adequately explored.  

Side effects to ablation are those experienced with natural menopause.   In your search for additional reading material regarding ovarian ablation you could look in terms of the different methods.  Oopherectomy (removal of the ovaries) is the name of the surgical procedure.   Some names of common medications used to produce ablation are goserelin (also known as Zoladex), or leuprolide (Lupron).