Polite Explanations are Welcome....

i just have to share this pic of my oldest. if I had his eyebrows and lashes I'd be ecstatic.  He was about 5 in the last photo.. now he's 17.  Back to the thread now.. sorry for the hijack.

What stunning eyes! He looks really cool, you've every right to be proud x

Very handsome!

AA... The only thing that you left out is that you are obsessing on a topic that has been respectfully considered. Won't you please move on? Perhaps you might wish to direct your questions towards researchers.

Anyone who happens to come across this thread should understand that all the points that you have made are not being made by a "professional" nor have they been peer reviewed. Researchers are held to that standard. While you are entitled to your opinion of the pros and cons, readers should be VERY AWARE OF YOUR BIAS. And again, it seems very concerning that you continue unabated....

Maybe Apple's last name is Efron!!!!

AA - can you tell me how ovarian ablation kills stray cancer cells?

Susieq... If any of the sisters have the strength and fortitude to read all of AA's points... It might take days afterwards to rebut them.



AA... Perhaps you might consider professional counseling for your obsession. I hope these thoughts aren't paralyzingly you in ordinary life. Do you think of anything else? Or do you think because you found this site, expressing these ideas are therapeutic? While you express that this is a learning process for you to justify your posts, it is very clear that this is NOT your motivation. You are motivated by your previous treatment which you think was poorly explained to you. You BELIEVE it is magnanimous of you to post your ideas, so what happened to you doesn't happen to others. However, most of us have been pleased with our care and are well informed with our options. Is enough, enough already? Or must we need to continue to question what you write, word by word, line by line? Move on please.

Hillck... Yes. But keep in mind that the NCCN guidelines pretty much say the same thing. The footnote in the NCCN guidelines point out that O/S hasn't been proven yet to be equal or superior to chemo for some women, but can be considered an alternative. That's why, here in the US they are doing the SOFT and TEXT trials. So, in the meanwhile, you have these kind of recommendations to bridge the gap. My MO said that in Europe O/S is more widely recommended for some women. I think that's also why they aren't advocating permanent sterility.

hillck...I sent you a PM

This article appeared in the ASCO newsletter in 2007.  It is as relevant today as it was in 2007.  The results of the SOFT trial are STILL unknown...making this subject for PREmenopausal still controversial. HOWEVER,  I AM POSTING THIS ARTICLE FOR SISTERS WHO WISH TO UNDERSTAND THE TOPIC and CONTROVERSY BECAUSE IT IS DISCUSSED BY PROFESSIONALS.  Home > Past Issues > January 2007 Current Controversies in OncologyOvarian Suppression in Patients with Hormone-receptor Positive Breast CancerEric P. Winer, MDDirector, Breast Oncology CenterAssociate Professor of Medicine,Harvard Medical SchoolDana-Farber Cancer Institute The treatment of women with early-stage breast cancer has changed dramatically during the past three decades. As a result of both early detection and improved treatment, we have seen a decline in mortality despite an overall increase in the incidence of breast cancer. In parallel, huge strides have been made in our understanding of the molecular biology of breast cancer. We no longer think of breast cancer as a single disease process, but instead as a family of related diseases. For women with hormone receptor-positive breast cancer, hormonal therapy plays a central role in reducing the risk of disease recurrence, and improvements in such therapy will be key to reducing mortality from breast cancer in the years ahead. A 5-year course of tamoxifen was long considered the standard approach for women of all ages with breast cancer. In postmenopausal women, the widespread use of aromatase inhibitors - either in place of or in addition to tamoxifen - has improved disease-related outcomes. In contrast, for premenopausal women, the road beyond a 5-year course of tamoxifen has not been clearly defined. Ovarian suppression, a treatment that holds great promise for premenopausal women, was one of the first adjuvant treatments to be evaluated in randomized clinical trials. Unfortunately, these early trials were inconclusive because of a constellation of design flaws that could not have been anticipated at the time. More than a decade ago, the Early Breast Cancer Trialists Collaborative Group (EBCTCG) demonstrated that ovarian ablation was an effective treatment, but these findings were largely ignored by the medical oncology community. Throughout the 1990s, our collective attention was focused on intensifying chemotherapy regimens, not on reducing disease recurrence in premenopausal women through the use of better hormonal therapy. Some investigators (more so in Europe than in the United States) designed prospective trials to re-evaluate the role of ovarian suppression/ablation. Based on the results of these studies, there is renewed interest in ovarian suppression/ablation and improving hormonal therapy options for premenopausal women. In the pages that follow, Joyce O'Shaughnessy, MD, and Antonio C. Wolff, MD, engage in a point-counterpoint discussion about the use of ovarian suppression in women with hormone receptor-positive breast cancer. They share thoughtful insights and their own views about the role that ovarian suppression can play. Dr. O'Shaughnessy and Dr. Wolff both support the ongoing clinical trials - Suppression of Ovarian Function Trial (SOFT) and Tamoxifen and Exemestane Trial (TEXT) - that address hormonal therapy questions in premenopausal women. However, they recognize the need to make difficult treatment choices when participation in a clinical trial is either not feasible or not chosen by a patient. Unlike a new experimental therapy that may not be available to patients outside of a clinical trial, ovarian suppression can be prescribed and administered by any physician. Outside of a clinical trial, physicians must weigh the available data and provide a recommendation to their patients at a time when the medical community still has insufficient data. As health care providers, we want to maximize benefit from treatment and minimize both short- and long-term toxicity. However, until we have clearer answers, breast cancer clinicians will continue to struggle with these vexing questions for the thousands of women who do not participate in clinical trials. I hope that the perspectives expressed by Dr. O'Shaughnessy and Dr. Wolff will arm you with additional information you need as you confront this difficult clinical choice in your daily practice.An Argument for Ovarian Ablation in Premenopausal Patients with Breast CancerJoyce O'Shaughnessy, MDCharles A. Sammons Cancer Center,Baylor University Medical CenterTexas Oncology PAUS Oncology Premenopausal patients younger than age 35 have a worse prognosis than older premenopausal patients, even with appropriate adjuvant chemotherapy and tamoxifen therapy (Colleoni M, et al. Ann Oncol. 2006;17:1497-1503). The International Breast Cancer Study Group (IBCSG) Trial VIII showed that patients younger than age 40 tend to recover ovarian function after adjuvant chemotherapy and to benefit from the addition of goserelin to cyclophosphamide, methotrexate, and fluorouracil (CMF) compared with those who receive goserelin or CMF alone, suggesting that prolonged suppression of ovarian function may benefit premenopausal women with hormone receptor-positive breast cancer (Castiglione-Gertsch M, et al. J Natl Cancer Inst. 2003;95:1833-1846). To this point, IBCSG 13-93 recently demonstrated that chemotherapy-induced amenorrhea significantly improved disease-free survival in premenopausal patients with estrogen receptor-positive cancer who were treated with either chemotherapy alone or chemotherapy plus tamoxifen (hazard ratio [HR] for amenorrhea versus no amenorrhea = 0.61; 95% CI, 0.44-0.86; p = 0.004) (Colleoni M, et al. J Clin Oncol. 2006;24:1332-1341). However, several studies have shown no benefit to the addition of goserelin to chemotherapy in premenopausal women (EBCTCG. Lancet. 2005;365:1687-1717; Arriagada R, et al. Ann Oncol. 2005; 16:389-396), likely because adjuvant chemotherapy-induced ovarian suppression or ovarian ablation makes the addition of goserelin unnecessary (Petrek JA, et al. J Clin Oncol. 2006;24:1045-1051). In contrast, the phase III Randomized Comparison of Adjuvant Therapies in Premenopausal Women with Resected Node-positive Hormone Receptor-positive Adenocarcinoma of the Breast (INT0101) trial showed that the addition of goserelin to cyclophosphamide, doxorubicin, and fluorouracil (CAF) improved 9-year diseasefree survival in women younger than age 40, and did not benefit those older than age 40, the majority of whom had postmenopausal estradiol levels at the completion of CAF (Davidson NE, et al. J Clin Oncol. 2005;23:5973-5982). Therefore, because most premenopausal patients receive adjuvant chemotherapy, the benefit of ovarian ablation or ovarian suppression after adjuvant chemotherapy must be analyzed specifically in patients younger than age 40, who generally retain ovarian function following completion of adjuvant chemotherapy. Klijn and colleagues demonstrated an overall survival benefit for premenopausal patients with hormone receptor-positive metastatic breast cancer who were treated with first-line buserelin - a luteinizing hormonereleasing hormone (LHRH) agonist - in combination with tamoxifen, compared with patients treated with buserelin or tamoxifen alone (Klijn JG, et al. J Natl Cancer Inst. 2000;92:903-911). An underpowered adjuvant trial that evaluated 345 premenopausal patients with hormone receptor-positive breast cancer showed a nonsignificant 5-year disease-free survival advantage for those who received tamoxifen plus ovarian ablation (either by oophorectomy or goserelin-induced) compared with those who received tamoxifen alone (90.3% versus 87.8%, respectively), as well as a trend toward improved survival (97% versus 95%, respectively, HR = 0.65) (Robert NJ, et al. Proc Am Soc Clin Oncol. 2003;22 [abstract 16]). Results of the INT0101 trial indicated that disease-free survival rates were highest in women younger than age 40 who were treated with tamoxifen plus goserelin following CAF (CAF plus tamoxifen alone was not evaluated) (Davidson NE, et al. J Clin Oncol. 2005;23:5973-5982). Thus, although we await definitive data from SOFT, the available data that focus on patients younger than age 40 who have a high chance of retained ovarian function after chemotherapy, although imperfect, suggest that the addition of ovarian ablation or ovarian suppression to tamoxifen improves breast cancer outcome. Analyses of the heterogeneous natural history of estrogen receptor-positive breast cancer reveal that some patients relapse during the first 5 years after diagnosis (luminal B, high grade, high recurrence score) while others relapse later, between years 6 through 15 and beyond post-diagnosis (luminal A, low/intermediate recurrence score, low grade) (Saphner T, et al. J Clin Oncol. 1996;14:2738-2746). In this biologic context, we can ask whether young, premenopausal patients with indolent but high-risk breast cancer require the long-duration endocrine therapy that oophorectomy provides. In postmenopausal patients with hormone receptor-positive cancer, recent data have shown that treatment with an aromatase inhibitor following 5 years of adjuvant tamoxifen provides substantial benefit in reducing recurrence rates, even if 3 to 5 years of no intervening therapy occurred before initiation of the aromatase inhibitor (Goss PE, et al. Breast Cancer Res Treat. 2005;[abstract 16]). The 15-year overview from the Early Breast Cancer Trialists Collaborative Group (EBCTCG) showed a lower annual rate of recurrence with ovarian ablation indirectly compared with ovarian suppression with 2 to 5 years of an LHRH agonist, suggesting that longer duration endocrine therapy may provide benefit to premenopausal women (in patients age 40 and younger: 0.7 ovarian ablation versus 0.79 ovarian suppression; in patients age 40 to 49: 0.67 ovarian ablation versus 0.77 ovarian suppression) (EBCTCG. Lancet. 2005;365:1687-1717). For premenopausal women with virulent, high-grade breast cancer, several studies have suggested decreased effectiveness for adjuvant tamoxifen therapy, especially in the face of a high recurrence score, progesterone receptor-negative breast cancer, or expression of HER-1 or HER-2 (Paik S, et al. N Engl J Med. 2004;351:2817-2826; Arpino G, et al. J Natl Cancer Inst. 2005;97:1254- 1261). Adjuvant studies of postmenopausal patients suggest superior benefit for aromatase inhibitor therapy compared with tamoxifen in the high-risk estrogen receptorpositive subsets (Dowsett M, et al. J Clin Oncol. 2005;23:7512-7517; Thurlimann B, et al. N Engl J Med. 2005;353:2747-2757). Treatment of premenopausal patients with high-grade, virulent, estrogen receptorpositive/ progesterone receptor-negative or HER-2-positive breast cancer with an aromatase inhibitor requires the addition of ovarian ablation or ovarian suppression. Although we await results from both SOFT and TEXT to provide definitive data about the role of aromatase inhibitor therapy with either ovarian ablation or ovarian suppression compared with tamoxifen alone or tamoxifen plus ovarian ablation or ovarian suppression, given the available data for postmenopausal patients showing superiority of the aromatase inhibitors over tamoxifen in breast cancers with more virulent biology, it is reasonable to consider ovarian ablation and aromatase inhibitor therapy for premenopausal patients with virulent breast cancers who are at high risk.Ovarian Ablation Should Not Be Routinely Offered to All Premenopausal Women with Estrogen Receptor-positive Breast CancerAntonio C. Wolff, MDThe Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins Although breast cancer is primarily a disease of older women, up to a quarter of all new patients diagnosed with invasive disease are age 50 and younger; half of them are expected to have estrogen receptorpositive disease (Jemal A, et al. CA Cancer J Clin. 2006;56:106-130). Adjuvant endocrine therapy is arguably the most effective targeted therapy for women with early-stage, estrogen receptor-positive breast cancer, and data from the most recent Oxford Overview show an unequivocal survival benefit from 5 years of tamoxifen that extends through 15 years and possibly beyond (EBCTCG. Lancet. 2005;365:1687- 1717). It is therefore of historical interest (and some concern) that it took until the 1995 Oxford Overview for tamoxifen to be recognized as effective in reducing the annual odds of recurrence and death regardless of age (Lancet. 1998;351: 1451-1467). However, it is increasingly understood that not all patients with estrogen receptor-positive disease benefit equally from endocrine therapy (Paik S, et al. N Engl J Med. 2004;351:2817-2826), as gene expression profiling appears to identify patients with specific tumor subtypes at higher risk of recurrence who can derive substantial benefit from adjuvant chemotherapy (Paik S, et al. J Clin Oncol. 2006; 24:3726-3734). Several factors have confounded therapeutic decisions for younger women. These include an inverse correlation between age and estrogen receptor-positive disease, a pervasive misconception that chemotherapy was more important than endocrine therapy in these patients, and age-related effects of chemotherapy on ovarian function and the resulting indirect endocrine effects. Retrospective data from several trials have shown that premenopausal women younger than age 35 do worse than older premenopausal women when treated with chemotherapy alone (Aebi S, et al. Lancet. 2000;355:1869-1874), which may be because of the greater likelihood of patients in this subset to regain menstrual function after chemotherapy (Goldhirsch A, et al. J Natl Cancer Inst Monogr. 2001; 44-51; Petrek JA, et al. J Clin Oncol. 2006;24:1045-1051). This may explain why the survival benefit offered by chemotherapy in the absence of endocrine therapy may be limited to older premenopausal women (Goldhirsch A, et al. J Natl Cancer Inst Monogr. 2001;44-51), as well as why tamoxifen therapy of a longer duration is necessary for premenopausal women (EBCTCG. Lancet. 2005;365:1687-1717). To further complicate matters, the emotional concerns and needs of younger patients regarding family planning may negatively influence the decision to pursue endocrine therapy for younger premenopausal women (Partridge AH, et al. J Clin Oncol. 2004;22: 4174-4183). Ovarian ablation/suppression strategies have been shown to be effective when compared with no therapy among women younger than age 50, but the benefit from the addition of ovarian ablation/ suppression to chemotherapy in the Oxford Overview is less clear (EBCTCG. Lancet. 2005;365:1687-1717). Strategies to examine the role of ovarian ablation/suppression in the form of oophorectomy (Thomson CS, et al. Breast. 2002;11:419-429), irradiation (Ejlertsen B, et al. J Clin Oncol. in press 2006), or an LH-RH agonist (Jonat W, et al. J Clin Oncol. 2002;20:4628-4635; Castiglione-Gertsch M, et al. J Natl Cancer Inst. 2003;95:1833-1846; Schmid P, et al. Anticancer Res. 2002;22:2325-2332) versus CMF chemotherapy and the role of ovarian ablation/suppression plus tamoxifen versus chemotherapy (Boccardo F, et al. J Clin Oncol. 2000;18:2718-2727; Jakesz R, et al. J Clin Oncol. 2002;20:4621-4627; Roche H, et al. Ann Oncol. 2006;17:1221- 1227) have yielded similar clinical outcomes. Transient ovarian suppression with an LHRH agonist also leads to a lower rate of permanent amenorrhea (Jonat W, et al. J Clin Oncol. 2002;20:4628-4635) and is likely to result in fewer of the complications associated with premature menopause. However, there are no data to suggest that ovarian suppression can effectively replace more contemporary chemotherapy regimens containing anthracyclines and taxanes. Evidence of clinical benefit derived from the use of ovarian ablation/suppression after chemotherapy among young premenopausal women has been observed in several studies (Castiglione-Gertsch M, et al. J Natl Cancer Inst. 2003;95:1833-1846; Arriagada R, et al. Ann Oncol. 2005;16: 389-396; Davidson NE, et al. J Clin Oncol. 2005;23:5973-5982; Baum M, et al. Eur J Cancer. 2006;42:895-904), but the additional benefit offered by ovarian ablation/suppression in women also treated with tamoxifen remains unclear. The IBCSG trial 13-93 recently showed improved disease-free survival in patients treated with tamoxifen plus chemotherapy, and indirect evidence suggests that some benefit from chemotherapy-induced amenorrhea might exist even when tamoxifen is also administered (International Breast Cancer Study Group. J Clin Oncol. 2006;24:1332-1341). This study showed that patients with chemotherapy-induced amenorrhea, which was defined as at least one report of no menses during the first 15 months after randomization, had an improved outcome compared with those patients who continued to menstruate, regardless of whether they received tamoxifen. Several ongoing prospective randomized trials are now examining various questions in premenopausal women. One such trial is SOFT, which is evaluating approximately 3,000 premenopausal patients with estrogen receptor-positive disease treated with tamoxifen alone or who remain premenopausal after chemotherapy, and who are then randomly assigned to receive 5 years of therapy with tamoxifen alone, tamoxifen with ovarian suppression, or an aromatase inhibitor exemestane with ovarian suppression. It has been 111 years since the first report by Sir George Beatson on the role of oophorectomy as a therapeutic option in breast cancer (Beatson G. Lancet. 1896; 2:104-107), and yet so much uncertainty remains compared with what oncologists have learned about the use of aromatase inhibitors in older women in barely a decade. Ovarian ablation/suppression may be considered as an alternative to CMF in premenopausal women also treated with tamoxifen (Jakesz R, et al. J Clin Oncol. 2002;20:4621-4627), and studies such as SOFT will help close the gap in addressing some of the most critical questions regarding the optimal endocrine treatment for premenopausal women (Wolff AC, et al. J Clin Oncol. in press, 2006). Until then, ovarian ablation/suppression should not be routinely offered to all premenopausal women with estrogen receptor-positive breast cancer."Current Controversies in Oncology" is a forum for the exchange of views on topical issues in the field of oncology. The views and opinions expressed therein are those of the authors alone. They do not necessarily reflect the views or positions of the editor or of the American Society of Clinical Oncology.

I had a complete hysterectomy 20 years ago, ovaries and all, because I had fibroid tumors and the gyn thought it would be best to remove the ovaries since they could be a problem with cancer.

That was the beginning of my problems with thyroid, low libido, and probably bc as well.  If I had it to do over, I would not have let this happen.  I failed to do my research until after I began having problems and then it was too late.  

Always do your own research! 

I don't think my bc was caused by removal of the ovaries, but rather the unbalanced hormones in my system.  I was given HRT premarin only, after, and when finally tested, 20 years later, I had zero progestrone in my system, and nine months later bc.