Does having ovaries removed reduce reoccurrence?

PandoraX

At 57 (technically pre-menopausal), I had a complete hysterectomy - due to suspicious cells in my endometrial lining. I also had a higher than normal amount of estrogen in my body for someone my age. I had the hysterectomy about a half year after my breast surgery. Fortunately it went well - nor was it related to taking Tamoxifen because I had only tried it for 2 weeks prior to the diagnosis.

I know some women have their ovaries removed for prophylactic benefits of estrogen reduction if their DCIS is Estrogen Positive, which mine is. When I asked my nurse oncologist if that made any difference on my reoccurrence risk, she kind of shook her head and said that every one asks her that. It seemed to make no difference as far as her strongly pushing me to take Tamoxifen. I really had to argue my case for trying the low dose Tamoxifen, which I've been on for 5 months now. Of course I'd love to not take it at all - and am searching for any justification not to take it - so hence the question. If your DCIS is ER/PR positive, how can removing your ovaries not reduce your risk significantly? Why do there appear to be no studies about this? Why don't the risk calculators include this factor?

Moderators

Hi PandoraX,

You're sure to get some helpful responses here soon, but we wanted to point you to a couple of articles from the main Breastcancer.org site that might be informative:

Tamoxifen Plus Removing Ovaries Improves Survival for Premenopausal Women

Is Prophylactic Ovary Removal Right for You?

We hope this helps get some answers!

--The Mods

PandoraX

Thanks moderators for posting these articles. They do suggest that ovary removal does reduce risk -- if done before menopause. At the time of my oopherectomy, I hadn't had a period for well over a half year...so I guess you could say my status was uncertain. So does it follow that the benefits are uncertain? I do recall the surgeon saying - as long as you have breasts, your body is making estrogen - and again, suggesting that an oopherectomy wasn't a 'solution'. Well I'd love to hear others weigh in here.

PandoraX

I did find one study - but it seems mostly limited to women with the BRACA gene. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC35932...

Moderators

Yes, correct, those studies are focused on premenopausal women.

We also found these articles, but they also focus on BRCA positive patients. Though you may find some helpful information within:

Breast Cancer Risk Drops Within 5 Years of Prophylactic Ovary and Fallopian Tube Removal in Women With BRCA Mutations

Women With Abnormal BRCA1 Gene Benefit From Having Ovaries and Fallopian Tubes Removed; Quality of Life Affected

We hope others stop by to weigh in soon!

--The Mods

AliceBastable

I had a thorough hysterectomy due to endometrial cancer in 2008 when I was 58. According to my lab work and tampon consumption, I was nowhere near menopause yet. Ten years later, I got breast cancer and the ER/PR were both very high, in the 90s. I must have an overflowing reserve of estrogen somewhere.

PandoraX

AliceBastable - Wow - I'm sorry you have been through so much. Clearly a hysterectomy doesn't guarantee you won't get breast cancer. Did any of your doctors comment that this ER/PR breast cancer was unusual after a hysterectomy - or did it seem like something they see all the time?

exbrnxgrl

Pandorax

Nothing is a guarantee that you won't get breast cancer, not even a bilateral mastectomy. Breasts are not the major estrogen “maker" in your body so I am not sure of what that nurse was saying. Take care.

Beesie

Pandora, I can't answer for what AliceBastable's doctor told her, but I can tell you that ER+ breast cancer remains very common after menopause, representing approx. 80% of post-menopausal breast cancers. In fact I believe that post-menopausal women are more likely than younger women to have ER/PR positive cancers. Many ER+/PR+ cancers are strongly positive.

I was more than 10 years into menopause when I was diagnosed with cancer that was PR- but highly ER+. My mother was diagnosed at age 80 and her cancer was the same as mine, PR- but strongly ER+.

PandoraX

I guess as long as there's estrogen in the body, that's enough to cause a breast cancer cell to mutate. So true - there's no way to guarantee you won't get breast cancers - so I guess my question really is - how much does ovary removal reduce the risk of a return of DCIS or a brand new cancer - as say, compared to taking Tamoxifen or equivalent? No doubt the answer is a nuanced "it depends" - but I do find it perplexing that the benefits radiation and drugs are offered u[ in very specific percentage risk reduction terms - whereas there seems little mention of hysterectomy as a specific risk reduction factor.

kathabus

I mean, I think that's a fair question, Pandora. Hopefully we can have data on that one day.

I didn't have DCIS, but I had an oopherectomy so that I could take an Aromatase Inhibitor (AI). There was a trial called the SOFT Trial that concluded that AIs were a little more effective at preventing metastasis than Tamoxifen in premenopausal women. So that's why I did it. So that might be a trial you might be interested in researching. Of course it's related to the drugs, but nonetheless it is kind of tied to going into menopause when you're premenopausal.

It sounds like you want to trade in Tamoxifen for an oopherectomy. Would an oopheretomy be better than nothing? Probably. Is an oopherectomy better than tamoxifen? Probably not. I have to think it's somewhere in the middle. I wish there was more data on this for us. Best wishes.

Each_day_2018

Hi Pandora - I had small areas of DCIS and LCIS when I was diagnosed...so I can't give details specific to your situation, but close LOL!

I was told I would take Tamoxifen once I finished my active treatment. I read so many reviews and heard so many stories about side effects that I asked my doctor about alternatives I could consider. I was 31 when I was diagnosed, and I work full time with 3 kids....so I didn't want to take something that was just going to bring me down more! He actually provided me medical journal studies on women who used Tamoxifen vs. those who had their ovaries removed and took Arimidex. Anyways, it wasn't a big difference in the 5-10 year survival and recurrence rates. Because of this, I opted to have my ovaries removed instead. I think the way Tamoxifen works is that it blocks cells from binding with cancer cells and Arimidex blocks the estrogen produced in the adrenal glands. So with Tamoxifen, you will still have estrogen in your body, but it won't be able to bind with anything. When you remove the ovaries, you're removing the hormone sources completely when paired with the Arimidex.

That's my very basic understanding of how they work, someone please correct me if I am wrong!

I know some people that that have no issues with Tamoxifen and some who do... I just feel like doing the research will help you feel better about your decision, or just make it feel like you had a choice in the matter. I get so tired of doctors suggesting ONE thing and making it seem like there is no other alternatives, so just do your research and ask lots of questions!

Best of Luck to you!! Keep us posted.

PandoraX

Thank you for your explanation. From your description of how the different hormone therapy works, you would think Tamoxifen would have less in the way of side effect, since the estrogen is still in your body. How has your body reacted to the Arimidex?