Breast Cancer and Ovaries

[louisat1111]

I am 48 yrs. old and was diagnosed with b/c in July of 2008.  I have undergone a lumpectomy, chemotherepy -AC/T and radiation.  I finished this course last spring.  I was also on tamoxifen until about two weeks ago.  I will be undergoing an ooferectomy as a precaution, as my mother died of ovarian cancer at the age of 59. The plan is to put me on a aromatase inhibitor about 1 week after my surgery. My question is:  is the oopherectomy a good plan for me, considering my background?  And also, is an aromatase inhibitor necessary given the fact that my ovaries will be removed? I was diagnosed with a 2.5 cm tumor with calcification totally 4.5cm. Stage 2A/grade 2 with LVI-lymphatic vascular invasion.

[katarina777]

If it was me in your situation, I would feel fine about the decision. My oncologist brought up the same idea but then dropped it. yet, I do not have a mother who died of ovarian cancer, and sometime these cancers happen in clusters and you can get both, even a third cancer.

One less thing to worry about?

Katrin

[Strike3]

Hi, Louisa, sounds like you have some questions that your medical team isn't addressing. You bring up a lot of great questions. If I were in your situation I would ask the following questions of my oncologist (the doctor - not the nurse):

1. What is my personal risk of recurrence given my diagnosis if I do no further therapy? (this provides a baseline from which to make a decision) There is a computer program that the oncologist has that computes this. It doesn't give you any guarantees  - it computes the odds - the risk - of recurrence.

2. What is the effect on my personal risk of recurrence if I elect to have the oophorectomy?

3. What is the effect on my personal risk of recurrence if after the oophorectomy I continue with the recommended course of aromotase inhibitors?

Understanding your own personal risk of recurrence and how the recommended therapies effect that risk is the key to making the right decision for you.

For example, in my case given my diagnosis and personal medical history (which is different from yours) I decided to not take tamoxifen or any of the AI's. The risk of recurrence in my case (which was already relatively low at 10%) was reduced by 3% (to 7%) - not enough, in  my opinion, to endure the significant side effects associated with these therapies. Your case is different from mine and will need to be evaluated on its own merits.

It's also important to understand that risk of recurrence is different from risk of death. Not all recurrences of breast cancer will be deadly.

Given your family history of ovarian cancer, did you have genetic testing? If so, did your results show the mutation on the BRCA 1 and/or 2 gene? If you do have either one or both of these mutations then your risk of breast cancer and ovarian cancer are increased significantly. It's important to be genetically tested in order to aid you in your decision process. It can also help other members of your family to understand their own risks of these cancers.

If you haven't had the genetic test and the decision to have the oophorectomy is based solely on your mother's history, then I, personally, would insist on the genetic testing before deciding to have the oophorectomy. Just for reference, I had ovarian cancer at age 40, resulting in oophorectomy/hysterectomy - breast cancer at age 42 - and I did not have the BRCA 1 or 2 mutations. So, it doesn't mean that the BRCA 1 & 2 genes not having mutations means you aren't at risk of ovarian cancer. Understanding the genome and all the effects of the variations and mutations is only just beginning. There's so much more that isn't known than is at this time.

You didn't say, but if your doctor is recommending the oophorectomy and the AI's then I assume your cancer is Estrogen Receptor positive (ER+). The ovaries produce estrogen and removing them will reduce the risk of recurrence. The body also produces estrogen on its own - through fat cells, actually.

So that's my 2 cents. Good luck to you.

[japdip]

I'm sure the surgery recommended was done so as your best treatment and the Aromatase inhibitors are always prescribed to women who are post-menopausal which is what you will be following your ovary removal. There are other sources of Hormones besides the ovaries so this is the standard treatment. Best wishes for a speedy recovery .......