Do I need hysterectomy - will it prevent breast cancer

I am a 48 year old premenopausal woman scheduled to have a hysterectomy next week.  I have had problems with ovarian cysts for years.  I currently have an extremely painful 4cm complex cyst on my right ovary.  I have a small uterine fibroid and polyps.  I completed treatment for stage 1 invasive ductal carcinoma in august. (estrogen & progesterone positive tumor)  I am scheduled to start tamoxifen soon.  My doc feels it is best to remove my ovaries and put in in menopause to prevent breast cancer and avoid the tamoxifen.  As long as she is in there she said she may as well remove the uterus.  I am really worried and feel it is overkill and that I should just suffer with the cysts  and take the tamoxifen.  Your thoughts??

[Elaine Brown, MD]

HI!
There is definitely a reduction in the recurrence rate of breast cancer when the ovaries are removed.  This has been shown in several fairly good, well done studies.  A couple of other things to consider--the complex cyst needs to be removed anyway if it is persistent. If it goes away, I might consider watching and waiting.
Some other important information to consider is that Tamoxifen increases the risk of uterine polyps and endometrial cancer 8 times the baseline rate.  You already have polyps, and probably don't want to risk another cancer.  
You could theoretically leave the left ovary, and derive some benefit from it after the Tamoxifen therapy is over (usually 5 years).  But if you were my patient, I think I would want to talk you out of AT LEAST the cystic ovary( if persistent)  and the uterus.
By the way, if the cyst is benign, you could be a candidate for a supracervical laparoscopic hysterectomy, or a laparoscopic assisted vaginal hysterectomy with removal of ovary(s).
I'm sure that you don't want more surgery, but you even more don't want more cancer!
Good luck!
Dr B

[geog272]

You should get at least one second opinion at a major hospital of high regard like Brigham and Women's!