oophorectomy for breast cancer

[Diane1981]

I have been diagnosed with ILC, 0.4 cm mass, as well as ADH and LCIS.  My breast surgeon has recommended oophorectomy in conjunction with sentinel node biopsy?  I am concerned about cardiovascular risks.  Any feedback is appreciated.  


This discussion is related to oophorectomy after 5 years hormone therapy.

[bluebutterfly2222]

Hi again,

Thanks for the additonal info. In return I have a few additional thoughts:

1. I'm a little puzzled by the breast surgeon's apparent rush to do this, when you don't even know yet if there's lymph node involvement, that's why I suggested also consulting an oncologist and GYN before making your decision. (Yes, it could meant one less exposure to anesthesia, but I'm not sure that should be THE deciding factor.) I'm not clear if you have even gotten to  lumpectomy or mastectomy surgery yet?

2. Since you are ER+/PR+ you will likely be on tamoxifen followed by an AI. These drug
suppress estrogen which might otherwise fuel your type of cancer, and they reduce the risk for recurrence. (They  may also "buy time" in regard to the oophorectomy decision.)

3. Many women wait a while before making the decision about oophorectomy. One factor that often weighs into that decision is genetic testing, to determine whether they are pos. for BRCA1 and/or BRCA2 mutations, since this increases the risk of both breast cancer and ovarian cancer.

4. I hope the article I posted above will be of some help in weighing the decision, in concert with your physicians, in the context of your total health picture and family med. hx.

Best wishes...  

[Diane1981]

In follow-up to:  "You did not give us much information to go on--your age, status re menopause, the hormone receptor status (ER+ or-/PR+or-) of your BC, whether it has been recommended that you take tamoxifen and/or an AI, etc.--so I really can't offer any feedback."

My original inquiry:  I have been diagnosed with ILC, 0.4 cm mass, as well as ADH and LCIS.  My breast surgeon has recommended oophorectomy in conjunction with sentinel node biopsy?  I am concerned about cardiovascular risks.  Any feedback is appreciated.  

I am 49 YOWF, premenopausal, ER and PR 90% positive.  No recommendations yet regarding tamoxifen or an Al.  Still have not undergone node biospy.  Hope this helps.

[bluebutterfly2222]

You did not give us much information to go on--your age, status re menopause, the hormone receptor status (ER+ or-/PR+or-) of your BC, whether it has been recommended that you take tamoxifen and/or an AI, etc.--so I really can't offer any feedback.

However, here is the summary of a relevant article that you might want to review:

REMOVAL OF NORMAL OVARIES DURING DOES NOT LOWER MORTALITY
It has been common practice for decades to remove normal ovaries when a woman undergoes a
hysterectomy for whatever reason. For women between 40 and 44 years old, 50% have their ovaries
removed with hysterectomy. Of those between 45 and 64 years old, 78% have their ovaries removed. It is
estimated that approximately 300,000 women a year in the United States have what is called a
"prophylactic oopherectomy," which means ovary removal with the intent to prevent later illness. The
primary reason is to prevent ovarian cancer. When the ovaries are removed, a woman goes through an
abrupt "surgical menopause." During natural menopause, hormone production stops more gradually. In
addition, the ovaries continue to make significant amounts of testosterone and androstenedione, which are
converted in the body to estrogen. Later menopause is associated with a lower risk of death from
coronary heart disease and stroke. Studies have shown that preserving the ovaries is associated with a
lower risk of heart disease. To keep it in perspective, ovarian cancer kills 14,700 women in the United States
a year. Coronary heart disease causes the death of 326,900 women a year.
Researchers used data from the Nurses' Health Study group, which included 122,700 women ages 30- 55
in 1976. They have been followed from that time, and entered into this study at the time of hysterectomy.
Data was used if the hysterectomy was not for cancer and the participants reported removal of normal
ovaries. 29,380 women had hysterectomies, and of those, 16,345 had ovaries removed. Researchers looked at
the following events: coronary heart disease, stroke, breast cancer, ovarian cancer, lung cancer, colorectal
cancer, hip fracture, pulmonary embolus, and death due to all causes. A lot of additional data was collected
in order to compare similar groups of women in terms of other factors.
The women were similar in terms of baseline risk factors for cardiovascular disease and cancer, although
the women who had their ovaries removed were slightly older and slightly more likely to be using or have
used hormone therapy. Statistical analysis showed that during the 25 years of follow-up, women who
had removal of normal ovaries had a higher all-cause mortality rate, mainly from coronary heart
disease and lung cancer. Although there was a lower incidence of breast cancer, ovarian cancer, and in
fact all cancers in the women who had their ovaries removed, the risk of death from cancer was
higher. At no stage of the study was survival higher for the women whose ovaries were removed.
The increased in cardiovascular risk and mortality has been found in other studies, although none this
large. For women who are not at increased risk of ovarian cancer, prophylactic ovary removal may not
be beneficial, and needs to be reconsidered. Source: OBSTETRICS & GYNECOLOGY (113: 1027, '09).

I would also suggest  that you consult an oncologist and your GYN regarding this decision, rather than just basing it on the recommendation of your breast surgeon.

Best wishes...