Anyone with ER+ considered Oophorectomy?

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Christine1975
Christine1975 Member Posts: 36
edited December 2018 in Surgery - Before, During, and After

I am only about a month into this BC journey and had a BMX on November 12. My tumor was Er+ and Pr+HER2-. My genetic testing came back negative for BRCA1, BRCA2, and no abnormal findings out of 47 genes assessed.

Here is my quandry: my MO said that oophorectomy is an option as part of follow-up treatment, but I would still need to be on tamoxifen or AI's. I am so confused. Aren't the ovaries responsible for producing all the estrogen in a woman's body? If so, wouldn't having the surgery negate the need for future tamoxifen or AI's? I realize that small amounts of estrogen are found in fat cells, but it just seems odd to me that completely removing the ovaries isn't more widely accepted as follow-up treatment alone for ER+ cancers. I'm sure I'm missing something. Anyone that has info, please feel free to educate me on this topic.

I am considering the oophorectomy despite my negative genetic results due to the fact that my maternal grandmother had breast cancer in her 30's and I guess I would just feel better about my recovery if I have them out. Does that sound weird? I know it would throw me into immediate menopause, but that's basically what tamoxifen does anyway, right? Again, feel free to enlighten me because I know I still have a LOT to learn and you ladies are the best group out there! Thank you in advance and I hope everyone is feeling as good as possible today!!!!

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  • SimoneRC
    SimoneRC Member Posts: 419
    edited November 2018

    Adrenal glands also produce estrogen. That is why you would still need to take Tamoxifen or AI after oophorectomy.

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  • DanceSmartly
    DanceSmartly Member Posts: 69
    edited November 2018

    In addition to the adrenal glands, fat cells and brain cells produce estrogen.

    Tamoxifen does not put you into menopause, albeit some of the side effects of Tamoxifen are similar to menopause (e.g. hot flashes). Tamoxifen is a selective estrogen receptor modulator and can either block or stimulate estrogen receptors depending on their location in the body. In fact, I understand that high dose Tamoxifen is sometimes prescribed as a fertility treatment!

    Dance


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  • Spoonie77
    Spoonie77 Member Posts: 925
    edited November 2018

    Hi Christine, sorry you're here but glad you found BCO. I've found this community to be wonderfully supportive and very informative since my diagnosis this past summer.


    As I'm debating about Tamoxifen myself, and for other reasons, I've been doing research on my options. Here are some articles that were helpful to me, maybe they will be helpful to you as well.

    These decisions we face are mind-boggling and confusing to say the least.

    Hope others will continue to chime in and offer their experiences. Wishing you the best.


    Tamoxifen Plus Removing Ovaries Improves Survival for Premenopausal Women

    https://www.breastcancer.org/research-news/20080111b



    Ovarian Shutdown or Removal

    https://www.breastcancer.org/treatment/hormonal/ovary_removal


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    Ovarian Suppression Therapy for Young, Pre-Menopausal Women

    http://stopcancerfund.org/t-breast-cancer/ovarian-suppression-therapy-young-pre-menopausal-women-early-stage-breast-cancer/

    How Effective is Ovarian Suppression Therapy?

    A 2016 study found that 13% of women receiving both tamoxifen and ovarian suppression therapy died within 5 years of breast cancer compared to 15% receiving tamoxifen therapy only. This is a very small difference, but was statistically significant, which means that it did not just happen by chance. For women who also received chemotherapy, 23% of patients receiving tamoxifen only died within 5 years, compared to 19% of women receiving tamoxifen plus ovarian suppression therapy. Since women who undergo chemotherapy are those who are known to have a higher risk of dying from breast cancer, the researchers concluded that "high risk" women should be considered for ovarian suppression therapy.[2]

    Women with stage I breast cancers who do not need chemotherapy and women who have small cancers (1 cm or less) without spread to lymph nodes should not receive ovarian suppression.[2]

    Another study found that combining ovarian suppression with an aromatase inhibitor instead of with tamoxifen can decrease the chances of dying from breast cancer within 5 years, from 13% to 9%.[2]

    Although women taking ovarian suppression therapy with hormone treatment were slightly less likely to die of breast cancer, they did not live longer than women who took hormone therapy alone.[2] In other words, they died of a different cause.


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    Do you need postmenopausal hormone therapy after oophorectomy?


    https://www.mayoclinic.org/tests-procedures/oophorectomy/in-depth/breast-cancer/art-20047337


    Use of low-dose hormone therapy after oophorectomy is controversial. While studies have shown that use of hormone therapy after menopause may increase the risk of breast cancer, other studies suggest early menopause can cause its own serious risks.

    Women who undergo prophylactic oophorectomy and don't use hormone therapy up to age 45 have a higher rate of premature death, heart disease and neurological diseases. For this reason, doctors typically recommend that younger women who have surgically induced menopause should consider taking low-dose hormone therapy for a short time and stop around age 51.

    It isn't entirely clear what effect hormone therapy might have on your cancer risk. Several studies have found that short-term hormone therapy doesn't increase the risk of breast cancer in those with BRCA mutations who have undergone prophylactic oophorectomy. Ask your doctor about your particular situation. If you decide to take low-dose estrogen, plan to discontinue this treatment around age 51.


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    Here's a BCO thread on "Ovary Removal Instead of Tamoxifen" as well...


    https://community.breastcancer.org/forum/78/topics/753924

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  • Lula73
    Lula73 Member Posts: 1,824
    edited November 2018

    Hi Christine1975! Here's a basic rundown of how all this works:

    If your BC is ER+, it means estrogen fuels the growth of the cancer cells. The higher the ER+ % the more dependent on estrogen the cancer cells are. So someone who has ER+ 100%, their cancer cells are pretty much completely dependent on estrogen. For those who have an ER+ % lower than 100%, their cancer cells still utilize estrogen for growth but it's not all they use for growth. So does that mean someone who has <100% ER+ should not take anti-hormonal meds/anti-hormonal meds won't work for them? No that's not the case at all. Think of estrogen like a vitamin for the cancer. We all know that our bodies require certain vitamins and minerals to grow, thrive and survive. Without certain ones, we can die, start to deteriorate, lose our strength, etc. it works very similarly with ER+ BC.

    Now onto estrogen physiology... Before menopause, most of the estrogen in a woman's body is made by the ovaries (approx 80%). The other 20% comes from the androgens released by the adrenal glands.

    After menopause (natural, surgical or thru suppression) the ovaries stop producing estrogen. That means that the 20% that was being made by way of the adrenal glands is the new 100% of our circulating estrogen.

    How do the adrenal glands and fat fit into this puzzle? Androgens are produced by the adrenal glands and are made into estrogen in fat tissue through a process known as aromatization (the aromatase enzyme is the key to the androgens being converted to estrogen by our fat cells). Aromatization is also the process by which other periphery organs like the brain produce estrogen. AIs like aromasin, letrozole, and arimidex inhibit the aromatase action so that the androgens cannot be converted to estrogen.

    So what if I'm skinny or I'm overweight? How does that factor in, does it make a difference? Everyone of us, regardless of BMI, size, weight, etc. has subcutaneous fat (the layer of fat that lies between the skin and muscle) and some level of visceral fat (the fat behind the abdominal muscles that surrounds our organs), so aromatization will happen regardless of how thin or heavy you are. Unless you are taking an AI. If you're on tamoxifen, the aromatization process continues and estrogen is produced, but the tamoxifen blocks it from being able to enter the cells in the target tissue.

    I hope this helps!

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  • PreludeSing
    PreludeSing Member Posts: 102
    edited November 2018

    what a fabulous explanation. thanks Lula 👌🙂

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  • Christine1975
    Christine1975 Member Posts: 36
    edited November 2018

    Wow! You ladies are seriously the BEST!!! I cannot thank you enough for taking the time to answer my questions so thoroughly! Truly, thank you and I appreciate it so much!!!! Hope everyone has a blessed day!

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  • Careninnj
    Careninnj Member Posts: 53
    edited December 2018

    i was diagnosed with stage 1. Grade 1 IDC in june. I had my bilateral mastectomy on aug 16th. I am brca2+, so it was HIGHLY recommended i remove my tubes and ovaries. So i had them removed on nov 26th, 4 days ago. I feel good about my decision.

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