Ovary removal - no impact on cancer recurrence?

PandoraX

I had a lumpectomy last Janurary for DCIS. In September, for completely unrelated reasons (hyperplasia atypia of the endometrial lining), I had a total hysterectomy plus oopherectomy (which fortunately went smoothly). I was technically not in menopause at the time despite being 57. One would think that ovary removal would reduce the risk of DCIS recurrence in those of us who have estrogen positive versions. Yet, my nurse oncologist said there is no evidence and no studies and that she is asked this question all the time. How can this be so? Why don't risk assessment tools include oopherectomy?

Related to the estrogen question....why are there no studies about body fat and DCIS recurrence? Ironically, many of the things that reduce estrogen production (menopause, oopherectomy, tamoxifen) appear to increase body fat production - so I wonder if the possible benefits associated with estrogen reduction versus the estrogen production associated with fat production might cancel each other out. Despite healthy diet, regular intense exercise, I have gained about 10 pounds. It's not a big deal but it's clear to me that my body has decided that it MUST produce more fat (I would have to be hungry all the time or exercise 15 hours a day in order to lose those pounds). A little infuriating when the literature points to a gain of 10 pounds in a year as a general breast cancer risk factor. Then again, weight increase or decrease and oopherectomy or presence of ovaries do not appear to be listed as risk factor in any of the models that calculate DCIS recurrence. This is all very puzzling! Thoughts?

runor

I don't think I have anything to add but seem to be coming up against similar questions. I had a big bleed after 4 years of no bleeding. I was NOT menopausal when I started tamoxifen at 53 and tamox instantly and completely stopped my periods. Now at 57 and a blood test shows I am indeed postmenopausal. I guess that happened and I didn't notice it because tamox makes me feel generally crappy and hot flashy and fat like a hog and all that good stuff.

My uterus was suspected of hyperplasia,   with a very thick endometrium but a D&C seems to reveal a uterus that is in pretty good shape aside from a big polyp, which was removed. The gynecologist is willing to take it out anyway, just because we know that tamoxifen has a negative effect on the uterus and my uterus has fired one warning shot already. Obviously something went wrong to trigger that flood of blood. But I have questions.

If I remove my ovaries and the smidge of hormones they produce even after menopause, can I quit tamoxifen? 
If I can't quit tamoxifen, what is the bloody point of removing my ovaries?
The hot flashes I have now are miserable but tolerable. What if I remove my ovaries and they become nuclear? I will have made my life worse. 
We know that ER/PR positive breast cancers come back even years later, will removing my ovaries prevent that?
We are learning that removal of ovaries brings an increased risk of heart disease, bone problems and dementia.
So. What choice is the best choice for me? Take out my ovaries, keep taking tamoxifen and hope the damn cancer doesn't come back? Having taken the ovaries out and crossed my fingers against breast cancer, what do I do to ward off increasing fat, heart problems and going bonkers?

It seems no matter how I look at this there is no good decision. Women need hormones. That's how we are made. My hormones are feeding my 100% ER/PR positive breast cancer. If I take out my ovaries, keep taking tamoxifen, I might live a long life, but it might be a miserable life with other issues I have inflicted on myself. Many people tell me get it out, get it all out! It's looking like maybe it's not so simple. I wish you luck, PandoraX.

 

PandoraX

Hi Runer - I hear you about the complexity of making decisions. I was terrified of having my ovaries removed - partly because I read too much stuff on-line. Be wary for example of the stie "Hormone Matters" that seems to pop up instantly when you google - not to mention one crazy OBG who has written many terrible books, imploring women not to get rid of their ovaries - but rather get in touch with 'their inner goddess women" (or something like that). I did notice a few mor hot flashes after I got my hysterectomy (but I had technically been pre-menopausal) and probably put on a couple of pounds, still have some muscle soreness - but otherwise, my life is pretty much back to normal. At our age, I don't think the side effects of having ovaries removed is particularly significant. I've also heard this anecdotally from other women. Probably more important to exercise and eat right, etc. I'm taking low does Tamixifen - so I honestly can't tell if I'm getting side effects from that or not. MAYBE - I'm having a couple more hot flashes than I normally would, MAYBE it's responsible for 2-3 pound weight gain? Hard to tell if it's that or the hysterectomy or just menopause that would have been inevitable anyway. One thing I've had trouble with since getting the hysterectomy is adjusting my thyroid meds (had thyroid out due to cancer 13 years ago).Did you OBG or ONC say anything about reducing your risk of breast cancer return by removing your ovaries?

LillyIsHere

PandoraX, after removing the ovaries, I assume body fat does increase the estrogen levels and that's why we get anti-estrogen medications. I asked to have my ovaries removed and pathology showed that they were very healthy and pink, etc. but I have no regrets. I feel cancer diagnose is way scarier than removing body parts I can live without. I had a family friend who had removed her uterus and ovaries when she was very young. She lived over 90 yr old and I remember since I was a child, that means she had her surgery over 100 years ago (in Europe). I know that data are not on one person only and everybody is different. I also know several women with dementia who had all their uterus and ovaries in place. We are all different and I feel I belong in the 3% group .

My question is how come the average age of women with BC, ER+ is 63 yr old, way over their menopause stage when ovaries have finished their job of producing estrogen. Is the tinny estrogen that is created from the skin and a bit of body fat that creates and feeds cancer cells?

AliceBastable

I had a thorough hysterectomy at age 58 due to endometrial cancer. Ten years later I had breast cancer with a very high estrogen percentage. I guess I'm one of those people who keeps cranking it out like an estrogen factory. I took tamoxifen for a year, but then one of my CTs (follow-up for kidney cancer 🙄) showed fatty liver, and I found a report tying tamoxifen to fatty liver. Since I'm restricted to Tylenol for my arthritis, I don't need any more stress on my liver (Tylenol is processed through the liver; NSAIDs are processed through the kidneys, and with only one trying to stay functional, and a history of kidney cancer, I can't take them now). So I guess I'm still producing estrogen at 71. I think my Mom had some hormonal overload problems, too - she had a D&C at around my age, and breast cancer at 85. I wonder if I should have asked my urologist to remove the adrenal gland closest to the bad kidney when he was pulling thing out? But I don't know what other problems that might have caused. My oncologist nags me about the tamoxifen; in December she said I kind of blew it because I've been off it too long to restart, but this month she indicated I'd still get some benefit if I took it again. Grrr. I have my regular CT next week so I'll see how my greasy old liver is looking. I've lost weight so the fatty deposits may have shrunk. I hope.

exbrnxgrl

Don’t forget that your adrenal glands produce small amounts of estrogen too

moth

Just a point of info:

estrogen is made by other tissues as well - liver, brain "One of the most widely used mechanisms for controlling estrogen synthesis in the body is regulation of the enzyme aromatase." <------ which is why in post menopausal women with er+ cancer we use aromatase inhibitors

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC35953...

PandoraX

Yes - it seems are bodies are bound to produce estrogen one way or another. But if they can measure the percentage that hormone therapies reduce your risks, then I wonder why there hasn't been a numerical percentage applied to ovary removal, weight loss, etc. Weight loss is probably more difficult to study (too many factors to consider) - but with a oopherectomy, your ovaries are either in or out, so it seems it would be easier to study.

flashlight

Estrogen is produced also by fat cells and the adrenal gland after menopause. I was told my ovaries shrunk to about 0.5cm. Normal healthy ovaries are 3-4cm. My daughter's MIL passed last October from Ovarian cancer. She was a year older than me with no family history. She had gone to the ED with severe lower back pain. My UroGyn said it usually starts in the fallopian tubes, where the most aggressive cancer appears to grow. Even though I don't have any family history and my MO wasn't concerned I'm glad I had them out.