Ovarian Suppression vs. Ovary Removal?

Hi johnsmith. I have the same type of BC as you. However as I am 53 the doctors refused to take my ovaries out. They said I must be close to menopause so I have monthly Zoladex injections to stop my ovaries functioning. I refused Tamoxifen due to a family history of thrombosis and uterine cancer. So I am on Femara. Apparently Femara or AI's are better for Lobular? If I was younger and having finished my family I would have had my ovaries out. I think this is a question for your Oncologist or some other expert to answer. Good luck

As of now, there is no survival advantage using either method.  However, it was recently announced that using an aromatase inhibitor with ovarian suppression reduced recurrence over tamoxifen and ovarian suppression.  BUT, as of now, it is too early to know if survival is better using the AI.  Later this year, we should learn more about these studies (TEXT and SOFT).

Since your partner is 45, she might wish to begin chemical o/s and see how she feels. A year or more of it might push her into natural menopause.

Furthermore, if she does do o/s, she might discuss with her physician adding Zometa to her treatment. Early data seems promising for women over 40 who are in a low estrogen state to include the bone building drug in their plan as well.

John...I'm sorry for confusing you.  First off, when we discuss recurrence, there are TWO meanings....local and distant.  Local is contained in the breast area and distant refers to metastasis.  So, the latest research coming from preliminary data from the TEXT and SOFT trials tells us that, so far, there are fewer local recurrences.  Now what does it mean that neither has effected survival?  Well, the study is "young" and it may take many more years of observation to see if there is a statistical difference effecting survival between those who took the AI and O/S vs. the Tamoxifen along with O/S.

Furthermore, not to confuse you even more, we are waiting for more data later this year to hopefully tell us if adding Ovarian Suppression to either an AI or Tamoxifen improves survival.  We don't know yet.  

One of the reasons why these studies are taking a long time to unfold is because any type of recurrence for ER positive, HER 2 negative disease often takes many more years to occur.  Unlike more aggressive tumors that recur within a year or two of active treatment, ER positive tumors are GENERALLY less aggressive AND respond well to treatment.  So, that means, the chance of recurrence is less likely, but can occur way down the road.

Regarding the body making estrogen after ovary removal.....the body still manufactures small amounts of estrogen.....

Systemic therapy, that is ovarian suppression and/ or Tamoxifen or an AI are given to prevent a distant recurrence.  That is, once the tumor is removed, there might have been cancer cells that floated away from the original tumor....systemic therapy should mop up those remaining cells PREVENTING metastasis.

Finally....systemic therapy should also prevent a new primary from occurring in the other breast.

John....first off, I see she is BRCA negative, so ovary removal is not imperative.

Regarding shutting down ovaries whether through surgery or chemically, does not come without side effects.  Estrogen helps our bones.  So, removing as much estrogen might compromise bone health.  I realize both of you want to reduce the chance as much as possible to never again revisit this disease....we all feel the same way.  However, keep in mind that you can be very aggressive in treating this disease and still metastasize.  Likewise, for most patients, breast cancer is a very treatable disease.

Good luck.

john....on annicemd's thread stage 1 grade 1.....premenopausal....thread....there are a whole bunch of sisters doing o/s ...along with Tamoxifen.....you might want to read that thread.  Don't forget to inquire about Zometa.

John Smith, ovaries serve other purposes than just helping to bear children. They also produce other hormones besides estrogen, which all combined, help many functions in our bodies such as sleep, cardiovascular health, bone density, and enjoyment of sex life. Some oncologists don't believe in removing them at all, some women just take tamoxifen,  which functions by blocking estrogen from getting into the breast cancer cells. This is what I took and without doing anything to my ovaries. And six years later I have had no further problems. Even without ovaries functioning, the adrenal glands and fat cells make estrogen in small amts, so then a drug would still be prescribed to either block or stop that estrogen from being produced. Should your fiancee decide to go that route of doing more than just taking tamoxifen, ovarian suppression is probably a better option because it is reversible, should the menopause be too difficult to handle. Removing ovaries, and possibly suffering with the results of surgical menopause is something that obviously cannot be reversed.

I am 54 and finishing up my rads soon...then deciding on what hormone blocker to go on...I was also deciding on ovary removal...this thread has enlightened me on some things...my MO did not thing ovary removal was necessary...if I go on tamoxifen my gynocologist thought I should get a total hysterectomy...now I am not sure what to do so I will research more on this.  Rosie 

I think the tipping point with your girlfriends history is the grandmothers sister with the uterine cancer and the questionable esophageal/Ovarian. If they are suspicious that it was ovarian, and coupled with the uterine ( even though she was a smoker and could have been influenced by that) thats why they are offering removal. I have somewhat of a similar situation wherein I am 50. Have a sister with ovarian (also a smoker) but also have a history of other cancers with my parents at fairly younger ages that share  space on certain genes. Even though I am Braca - all of the physcians and genetics agreed that there may be a subgene type that could be affected so they recommended I have my ovaries removed. Given that I was already perimenopausal, I chose to do it and to take an AI have had no immediate side effects so far. In your girlfriends situation, she falls into that same hairy hx situation with the cancers not even being related as directly as mine.  However she is probably not as far into menopause so being conservative may be the better way to go until she reaches her early fifties and then she can rethink it if she wants. At that point she may just switch to an AI and call it a day. If I didn't have a sister with ovarian I prob wouldn't have done it in spite of the other cancer hx. When it's necessary I say do it but I'm  not sure in her case it's necessary.

I'm getting my hysterectomy next month because of Fibroids. I'm having insurance issues concerning the BRCA testing but I hope that it's resolved by next month. Nonetheless, I'm on the fence for removing my ovaries because of the increase possibility of heart disease. My mother died of a heart attack at age 53, my father just dead of congestive heart failure this year. My mother's father died of a heart attack and my father's mother died of congestive heart failure. 

That being said, I'm choosing between increase ovarian cancer or increase heart disease. Both parents, a grandparent on both sides. I don't know what to do. Oh and now my sister is having heart issues. She's 48..All very close relatives. I mean you can't get any closer than parents, sister and grandparents. But my Oncologist seems to think I decrease my chances of a recurrence if I remove my ovaries. I'm so confused. I think if I spoke with a Cardiologist he'd oppose it. 

Ann 

Ann - I would definitely seek a second opinion.  Unless you are BRCA + or have a high oncotype, removing your ovaries is a drastic move.  For many reasons, I wish I never would have had to have mine removed.  You have had chemo, and looks like you are tolerating Tamoxifen.  Both those steps are huge.  Ovaries are also responsible for producing your body's testosterone, which is important for sex drive.  Mine took a nose dive and it sucks.  No doctor told me this, but with being BRCA +, it would still have been my choice, just would have been nice to have been informed and a little more prepared.  

http://www.clinicaloncology.com/ViewArticle.aspx?d=Solid%2bTumors&d_id=148&i=August+2014&i_id=1093&a_id=27959

Premenopausal Breast Cancer: Potential New Treatment Standard Is Emerging

(If this link goes to the wrong place - simply copy/paste this article title into the search box.)

http://www.medscape.com/viewarticle/826021