Prophylactic ovary removal?

[peekawho]

I had invasive ductal ca at age 35, negative nodes, ER/PR pos, and tried Tamoxifen at the time but had to d/c because of side effects.  At the time, no furthur therapy was offered after my mastectomies. Chemo was not indicated at the time.  No mention of ovary removal was ever made to me. No hx of breast or ovarian ca in the family at all.

FF to current age of 49.  I've done well, but am becoming uncomfortable with how often my current doctors are suggesting prophylactic removal of my ovaries.  I feel like I've done very well for 12 years, but it is unnerving to have this repeatedly suggested by both my gyn and family doctors.  They seem unconcerned with the fact that I will not be able to take HRT.  I have no wish for an early menopause or the issues that can accompany it.  I do have female relatives with osteoporosis and early cardiac disease.  I have hypertension controlled with an Ace/diuretic combo.  

I do not have an oncologist at this time, as I've been so healthy for so long.  I know you can't make a specific recommendation, but is proph. removal the standard of care now for someone my age?  Again, no family hx of breast/ovarian ca.  I'd prefer to keep my ovaries but am being made to feel like I'm at risk for a recurrance if I do, even after all this time, due to the ER/PR status.  

Thanks.

[H3ath0r]

A related discussion, Prophylactic ovary removal was started.

[peekawho]

It was less than 1cm, that's all I remember.  It was a long time ago!  How old are you?  I suppose I'm near enough menopause that I should be agreeable with this, but I like to keep as many of my original parts as possible, if you know what I mean!

[boninclyde]

It was nice to read your story about how long you have done well. It gives others encouragement.  Can I ask how large your invasive cancer was?  I was diagnosised last July 06, masectomy in August 06 my er and pr status the same as yours, no node involvement with 0.09mm invasion. No rads or chemo. My doctors are trying to push me to have a complete hyterectomy also and I am not liking the idea. Again thanks for sharing. I am sure the doctor will answer your question soon.

[peekawho]

I seem to have no indication that natural menopause is coming anytime soon.  My older sister is still cycling regularly at age 54!  I've had an endometrial ablation last year, so I have no idea about my own cycle, but certainly don't seem to have the slightest other symptom of perimenopause.  
(The endometrial ablation was for the heavy periods that have plagued me all my life, and it's worked wonderfully.  I got flack for not just having a TAH-BSO at the time, though.)  

[peekawho]

Well, I guess we have our info now.  Sigh.

I suppose I should get tested for the genes.  Then I can have a discussion about the removing my ovaries.  I just fear the cardiovascular risks and other effects so much.  

I'll get the input of my docs, and thank you so much for the article--it was enlightening, although I feel it may not apply completely to my situation with 13 years past now after the original cancer diagnosis.  We really have such a strong family history of female heart attacks and strokes.  I would think my risk of that would be greater than the risk of a long term recurrance.

Lots of thinking to do!  Many thanks for your help.

[Annekathryn Goodman, M.D.]

Hi there,
Thank you for your important question.  There is a wealth of information about the risk reduction of both ovarian and breast cancers in women who have the BRCA1 or 2 gene mutations.  For women without gene mutations, there is less information. I have definitely seen a recent trend among medical oncologists to refer premenopausal women with high risk breast cancer for risk reducing surgery (removal of the fallopian tubes and ovaries) regardless of their gene status. Looking at the literature, there is an article from 2001 in JNCI that states that there is a 25 % reduction in recurrence of breast cancer in women who have had 'ovarian ablation' (meaning the removal of their ovaries). These were women without BRCA mutations. I have pasted part of the conclusions below.

I completely understand your concerns. Ultimately, you need to decide what is right for your. Their ovary benefits to ovarian hormones as well. I might suggest than you consider undergoing genetic testing of BRCA 1and 2 even though you have no family history.  The majority of breast and ovarina cancers occur in women with no family history. The gene mutation could be a new one. If you turn out to have BRCA mutation, that may help you to  decide on surgery.
best wishes.

  ROLE OF OVARIAN ABLATION  
JNCI Monographs 2001 2001(30):67-71

The largest body of data regarding the use of ovarian ablation for adjuvant therapy is the EBCTG meta-analysis. Results for the 15-year analysis were collected in 1995 and published in 1996 (2). Updated data from the 2000 EBCTG meta-analysis have been presented in a preliminary fashion, but analysis is still incomplete. The 1995 overview summarized results from 12 of the 13 randomized studies that assessed ovarian ablation by surgery or irradiation. These trials began before 1980. They enrolled 2102 women under age 50 years and 1354 women greater than or equal to 50 years old at randomization. Analysis was focused on the younger women, since no statistically significant impact of ovarian ablation on outcome for the older women (who were presumably mostly postmenopausal) was observed. Five of the trials included routine use of adjuvant chemotherapy, whereas the other trials did not.

Selected results from the 1995 EBCTG overview analysis are presented in Table 1. Ovarian ablation led to a 25%