Ovary removal or suppression

Hi I had a 8mm grade 2 invasive breast cancer removed with clear margins and no node involvement. Post rads I was found to have 1.5cm lump, a surgical biopsy confirmed B9. I missed out on a clinical trial for ovary suppression because of time delay. I am now feeling really anxious about what to do should I have my ovaries suppressed to increase my chance of no reaccurance? I have started Tamoxifen post rads as well. I do believe I have a 12% chance of reaccurance does this mean in the breast or can this be anywhere in the body. I forgot to mention I am 40 years old and my cancer was 90%+pr and 60%er+. Is it common for women to feel completely stressed and and anxious after treatment finishes. Also no lympathic invasion was found.
Thank you for this service cancer is a really stressful time and been able to ask questions sometimes puts ones overactive stressed minds at ease. Looking forward to your reply

[Fernando Roque, MD]

Hi.  The 10th St. Gallen Consensus meeting on the management of early breast cancer recommends EITHER tamoxifen alone or tamoxifen plus ovarian suppression (with a gonadotropin releasing hormone [GnRH] agonist) as appropriate treatment for pre-menopausal women with early breast cancer after surgery.  Ovarian suppression plus Tamoxifen has been found to be superior to Tamoxifen alone in terms of survival rates, but the study was done on pre-menopausal women with metastatic, not early, breast cancer (see http://jnci.oxfordjournals.org/cgi/content/full/92/11/903).  The combination of ovarian suppression plus Tamoxifen has already been found to be superior to ovarian suppression alone (see http://jco.ascopubs.org/cgi/content/abstract/19/2/343).

For your case, you will probably benefit from a treatment of ovarian suppression.  But it would be better for you to continue using Tamoxifen as well, as the outcome is better than if you are treated with ovarian suppression alone.

[ANNETTE200]

What would you class my chances of reaccurance after I have ovary suppression and continue Tamoxifen.

[Fernando Roque, MD]

Hi.  The St. Gallen recommendation for using tamoxifen plus ovarian suppression as treatment for pre-menopausal women with early breast cancer was based more on expert opinion than actual trial results.  As I have mentioned in my earlier post, the clinical trials showing superiority of combined Tamoxifen plus ovarian suppression over either Tamoxifen alone, or ovarian suppression alone, studied populations of pre-menopausal women with ADVANCED breast cancer.  Strictly speaking, the results of these trials may be inappropriate for your situation, since you have early stage, node negative disease.

We still do not have solid data regarding the reduction in risk of recurrence in pre-menopausal women with early breast cancer receiving combined Tamoxifen and ovarian suppression.  There is an ongoing clinical trial which addresses this question - the Suppression of Ovarian Function (SOFT) Trial, but the results would only become available in a year or two.  The reduction of recurrence risk from combined tamoxifen/ ovarian suppression should at the very least, be at par with the risk reduction from using tamoxifen alone.