How necessary is hormonal therapy/ovary removal?

Hi Mama_green-

Welcome to BCO! We're sorry you find yourself here, but we hope you find this community to be a source of support.

We have an article on our main site that you might find informative: http://www.breastcancer.org/research-news/20080111.... Research has shown that ovary removal plus hormone therapy may increase survival rates. In women with an abnormal BRCA1 mutation, that increase is even more pronounced: http://www.breastcancer.org/research-news/2-studie.... We know it's a tough decision to make. We hope you have a clearer idea once your BRCA test comes back.

Please keep us posted!

The Mods

hi to both of you

Many factors at play with your diagnosis..mainly due to IDC size and grade and nodes involvement so mastectomy was recC

Hormone positive cancer is estrogen driven produced in ovaries and in our body fat cells

the best treatment aim is to reduce estrogen production ..drug therapy now recc for 10 years.

to prevent the possible development of metastatic cancer.

So its recommended that ovaries get switched off and or removed or you are already in menopause

All the best B

Hi mama_green:

When recommended, ovarian suppression drugs or oophorectomy are typically accompanied by Tamoxifen or an Aromatase Inhibitor. This is a relatively intensive approach to endocrine therapy.

Recommended approaches to endocrine therapy depend on a variety of factors, and is within the area of expertise of Medical Oncologists.

In post-menopausal women, including those who have received a bilateral oophorectomy, tissues other than the ovary produce clinically significant amounts of estrogen. Aromatase Inhibitors ("AI") block the synthesis of estrogen by such non-ovarian tissues.

In contrast, Tamoxifen can be used in those who are either pre-menopausal or post-menopausal. This is because it works by blocking the action of estrogen at the level of the estrogen receptor in breast cells (e.g., in any remaining breast tissue or in rogue breast cells at distant sites), regardless of the source of the estrogen (be it the ovary or other tissues).

In general, initial adjuvant (post-surgical) endocrine therapy options may include one or more of the following, depending on various factors, such as type of cancer (e.g., DCIS, IDC), recurrence risk profile, and co-morbidities:

Pre-menopausal:

(a) Tamoxifen alone; or

(b) Tamoxifen plus Ovarian Suppression (a second drug to suppress/shut down ovarian function); or

(c) Ovarian Suppression ("OS") plus an Aromatase Inhibitor ("AI") (in pre-menopausal women, use of an AI requires added OS to shut down ovarian function; using both is intended to stop estrogen production from all sources)

=> If oophorectomy is received, see post-menopausal options

Post-menopausal (this includes patients whose ovaries have been removed by bilateral oophorectomy):

(a) Tamoxifen; or

(b) Aromatase inhibitor

Tamoxifen, Aromatase Inhibitors, and the drugs used to induce ovarian suppression have different side effect profiles.

Oophorectomy (usually bilateral salpingo-oophorectomy) has different health impacts, which should be discussed.

In pre-menopausal women, the choice between tamoxifen alone and other more intensive approaches entails a personalized risk/benefit analysis.

Such decisions should be made in consultation with a Medical Oncologist in light of one's risks of loco-regional and distant recurrence, risk of new disease, menopausal status, and overall health and presentation, including medical history or co-morbidities that may be potentially relevant to the particular side effect profiles of a specific drug or intervention. To understand risk/benefit in your case, once the results of the surgical pathology, lymph node biopsy, and related testing are available, be sure to request an explanation of those various recurrence risks after all other treatments, with or without the recommended endocrine therapy.

Very generally, adding ovarian suppression tends to be used in situations where more intensive treatment is warranted by distant recurrence risk. For example, a diagnosis of 4 mm IDC (ER+PR+HER2-) that is determined by sentinel node biopsy to be node-nedgative (pN0) would not be the type of diagnosis that generally leads to a recommendation for intensive endocrine therapy under current clinical guidelines (See ASCO Guideline Update in next post). However, clinical guidelines address the typical case, and there may be appropriate exceptions. Perhaps age, co-morbidities (e.g., a contraindication for Tamoxifen in a pre-menopausal woman), or some other considerations are in play? Do not hesitate to ask why ovarian suppression and oophorectomy are being recommended in your particular case.

Of course, the results of the surgical pathology and lymph node biopsy could alter understanding of your risk profile, and systemic treatment recommendations. At that point, you should revisit the question and you may find a second opinion with another medical oncologist at an independent institution to be helpful.

By the way, in light of recent clinical trial results, the question of whether to continue endocrine therapy beyond five years is also a case-specific determination based on a variety of factors.

BarredOwl