Ovary removal ups breast cancer survival for some
NEW YORK (Reuters Health) - Removal of the ovaries (oophorectomy) plus tamoxifen, as adjuvant, or "add-on" therapy, significantly improves survival in premenopausal women with operable breast cancer, a study indicates.
This finding is particularly relevant for women in resource-poor countries where, unlike in Western countries, the breast cancer case burden mostly affects premenopausal women. Moreover, in contrast to their Western peers, patients from resource-poor countries often have limited access to chemotherapy.
The study, conducted by Dr. Richard R. Love at The Ohio State University in Columbus and colleagues, involved 709 premenopausal women with operable breast cancer from Vietnam and China who were randomized to receive adjuvant oophorectomy and tamoxifen for 5 years or to observation only. The median follow-up period was 7.0 years.
The overall and "disease-free" 5-year survival rates in the adjuvant therapy group were 78 percent and 74 percent, respectively. The corresponding rates in the observation group were significantly lower -- 71 percent and 61 percent. Moreover, similar differences were still apparent at 10 years.
The survival benefit achieved with adjuvant therapy was most pronounced for women with estrogen receptor (ER)-positive breast cancer. Among these women, at 5 years, the overall and disease-free survival rates in the adjuvant therapy group were 88 percent and 83 percent, respectively, while the corresponding rates in the observation group were 74 percent and 61 percent. Once again, the differences persisted at 10 years.
The current findings support the use of adjuvant oophorectomy and tamoxifen in premenopausal women, particularly those with ER-positive tumors, the investigators conclude.
SOURCE: Journal of Clinical Oncology, January 2008.
What breastcancer.org says about this article…
Ovary removal ups breast cancer survival for some
The study reviewed here showed that pre-menopausal women who had their ovaries removed (called oophorectomy) and took tamoxifen, a hormonal therapy, for 5 years after breast cancer surgery had a lower risk of the breast cancer coming back and better survival rates compared to pre-menopausal women who didn't have their ovaries removed and take tamoxifen after breast cancer surgery.
Cancers that were estrogen-receptor-positive responded the best to the ovary removal and tamoxifen.
The women in this study were from Vietnam and China, where more pre-menopausal women are diagnosed with breast cancer than in the United States. The women in the study were diagnosed early, so surgery was an effective treatment. Removing the ovaries of women diagnosed with operable breast cancer is considered an aggressive step.
The ovaries of pre-menopausal women produce estrogen. Estrogen can encourage breast cancer growth and increase the risk of the cancer progressing or coming back. This is why doctors want to stop the ovaries from producing estrogen as part of the overall breast cancer treatment plan in many pre-menopausal women.
Removing the ovaries is one way to permanently stop the ovaries from producing estrogen. Medicines also can be used to temporarily stop the ovaries from making estrogen (called medical shutdown). The medicines include Zoladex (chemical name: goserelin) and Lupron (chemical name: leuprolide).
For many pre-menopausal women, medical shutdown can be a good treatment option. Women who want to have children after breast cancer treatment may prefer this option over ovary removal.
Still, removing the ovaries may be a better option for some women when the risk of the cancer coming back or progressing is high. Other women may choose to have their ovaries removed because they're concerned about their risk of ovarian cancer. Having breast cancer increases ovarian cancer risk, especially in women who have a breast cancer gene abnormality.
If you're a pre-menopausal woman, removing your ovaries as part of breast cancer treatment is an aggressive step and may be able to lower your risk of the cancer coming back and increase your survival. Still, it also means that you will be permanently in menopause. Talk to your doctor about whether this type of aggressive treatment makes sense for you. Together, you and your doctor can weigh the side effects against the protective effects and decided on a treatment approach that is right for YOU and your unique situation.
