prophytactic TAH-BSO

Dear Doctor:

I am 60 and have gone through chemo, lumpectomy and radiation treatment due to breast cancer ( stage 2 )
4 years ago in 2005.  The biopsy result of my sentinel nodes are all right.  I have been faithly taking the necessary blood test and followe up appointment with my oncologist and gynocologist.    Year 2010 marks the beginning of my 5th year of being diagnosized as having breast cancer but have survived and doing fine.

My sister who is 4 years yougner has had masectomy by choice 3 years before my breast cancer at 48 in 2002.  In 1007, she suddenly had recurrence just 5 years later at 53.  This time, she has taken chemo, surgery and radiation therapy.  This new development has prompted my action of taking the genetic testing in early 2008 folowing the advice of all my doctors.  The genetic testing shows I have inconclusive BRCA-1 and negative BRCA-2.  I have failed to convince my sister taking the genetic testing and that will remains a mystery to me unfortunately.  

I just found out few days ago that the pelvic ultrasound I have taken in early 2008 have indicated that  I have had 2 leiomyomas ( I don't know what's that ) & the measurement are:   1.0 x 0.6 x 0.9 cm and 1.8 x 1.5 x 1.4 cm.  This test was done 2 years ago but I was not aware of this result at all at that time.  At my latest discussion with my gynologist,  my gynologist said these are " very small "  cyst? or tumors? and " that's nothing " since it's " pretty common " with women over 50 or older.

Today, I also found out my grand mom died of uterine cancer around 80.  These two new discovery has made me more concerned as my risk of having both uterine and ovarian cancer is much higher than I thought.  I have consulted a surgeon who is a gynocologist and oncologist 2 years ago in 2008 after knowing  my undesirable genetic result.  He was not eager to have me take any surgery at that time and wanted me to find the result of my sister's genetic testing result.   Due to the lack of cooperation from my sister and unaware of the uterine leiomyomas,  I have slowed down to tackle the problem.  Now,  I am seriously consider to have TAH-BSO instead just a BSO.  My questions are:

Do you think I should just take BSO first and wait for the biopsy result for another possible hysterectomy?  If so,
how soon I can have another hysterectomy if the biopsy of the ovary is malignant?

Do you think it's prudent to have TAH-BSO in 1 operation and drastically cut down my risk to both uterine and ovarine cancer in just one surgery?  If so, what's the benefit vesus the risk and side-effect?

Do you think I should ask the help from a surgeon who specialized in minimumly invasive laparoscopically operation for either TAH-BSO or BSO?  What about the alternative of having the help of a surgeon who is both a gynocologist and oncologist?  Will he/she be more competent to handle my case if the biopsy is malignant?

I really do not want to have recurrence of breast cancer and want to avoid ovarine and uterine cancer but my family and personal history is against me even with the inclusive BRCA-1.   Would you give me your advice?   I am grateful for your kindest help.  Thanks a million for your prompt reply.

Berlinda

[Elaine Brown, MD]

Hi!
If I were in your position, I would undergo a LAVH BSO. For breast cancer survivors, regardless of their BRCA status, having the ovaries removed reduces the possibility of a recurrence of breast cancer.  It also (obviously) reduces the risk of uterine cancer.
Fibroids or leiomyomata are completely benign, and are nothing to worry about, but I don't see an obvious reason not to remove your uterus given the possibility that you are at increased risk for a familial cancer syndrome.
If you are concerned about incontinece issues, or pelvic relaxation issues, you could have only the upper part of the uterus ( the fundus ) removed.  This is a pretty simple and straight forward operation.  Removal of the cervix further reduces your risk of cancers, but also adds slightly more risk surgically.
I don't see a downside to having a gyn/oncologist perform or assist at your surgery if it is possible for you to do so.  It is probably not totally necessary if it is difficult to arrange.
Be certain to ask all of your questions to your surgeon--it is usually a good idea to write them down before you go in so you remember them.  Then write down the answers to go over them again later.
Remember, there are going to be lots of opinions on what is best in your situation, and what I have given you here is my own opinion.
I hope it helps!
Good luck!
Dr B