Hi,
I so remember the anxiety I had about the same decision-- what more can I do to prevent the bc's return? I saw other young women doing things to shut-down their ovaries and wondered if I should do the same.
I went to three different Oncs about my anti-hormonal treatment...and should I get my ovaries out to prevent a recurrence of BC. I couldn't get one Onc to recommend it. One even called it 'surgical castration' which is, in a sense, what it is. It is equivalent to removing a man's testicles.
My age was a big factor-- I was 34 when diagnosed.
The more I researched the issue, the more it became clear that there isn't any medical evidence that clearly stated that it would reduce my risk of having the bc return, which was my main concern. (I don't have a family history of either ovarian or breast, and I tested brca negative). It would have made it possible to take a drug like Arimidex, but that drug has only a modest advantage in absolute numbers over Tamoxifen and I didn't feel that it would make much of a difference in my case because I had a high degree of both er and pr. (Some studies have suggested that Arimidex and like drugs have a greater benefit where only one hormone receptor is positive)
There are trials ongoing now for premeno women confronting the decision of the optimal anti-hormonal treatment. I'm sure your Onc has mentioned them to you-- the TEXT and SOFT-- both incorporate ovarian shut-down.
Here's an article on ovarian shut-down's role in adjuvent treatment for bc (attached)
You'll find some good info/interviews on this site:
http://www.breastcancerupdate.com/
Here's a thread from when I was trying to make a similar decision:
http://her2support.org/vbulletin/showthread.php?t=23729
There was a recent
Wall Street Journal article that summarized large observational studies that measured the health consequences of removing woman's ovaries. This is data from the general population, not a population of early-stage breast cancer patients.
Two recent papers published in two major medical journals examined the long-term risks and benefits of removing a woman's ovaries. A report last fall in the Lancet by Mayo Clinic researchers found that removing ovaries before the age of 45 raises a woman's risk of dying during the next 30 years by 70% if she doesn't use hormone-replacement drugs. An earlier study in Obstetrics & Gynecology showed that removing a woman's ovaries later in life, which is the more common practice, still increases her risk of premature death. In that study, ovarian removal before the age of 65 increased a woman's overall risk of death before the age of 80 by 8.5%.
What's surprising about the data is that it directly contradicts the widely held belief in the medical community that removing a woman's ovaries typically will prolong her life. "We were all shocked when we saw the [data] showing that there was such an advantage to leaving her ovaries in for long-term health," says William H. Parker, clinical professor of obstetrics and gynecology at University of California-Los Angeles School of Medicine and the lead author of the Obstetrics study.
To be sure, the data aren't conclusive. Both reports are based on observational studies, which means the women weren't randomized to different treatment groups and other factors may be influencing the results. In the Mayo Clinic study, young women who had ovaries removed but then took estrogen drugs were just as healthy as women who kept their ovaries. But doctors say many women are frightened about the risk of hormone drugs and often don't take them after losing their ovaries.
Most doctors practicing today were taught that the ovaries don't serve any real purpose after menopause. If a woman is going to undergo a hysterectomy (surgical removal of her uterus) anyway, doctors typically advise women to go ahead and have their ovaries removed as well.
While there is no question that the procedure eliminates ovarian-cancer risk, the fact is most women are at extremely low risk for the disease. Ovarian cancer accounts for 6% of female cancer deaths. But the issue of ovarian cancer is emotionally charged because there is no way to screen for it, and it's usually fatal because it is often detected at its late stages.
The problem is that removing a woman's ovaries to prevent ovarian cancer appears to take a toll on other parts of her body. The ovaries after menopause still produce androgens that the body converts to estrogen. The continuing hormone production of post-menopausal ovaries not only affects a woman's sex drive and mood, but it also appears to offer added protection to her bones and heart.
Based on the Obstetrics & Gynecology report, the benefit of keeping the ovaries far exceeds the risk. The researchers calculated the risks and benefits among 10,000 women between the ages of 50 and 54 who kept their ovaries compared with a similar group of women who opted to have their ovaries removed. By the time they reach 80, an additional 838 women in the no-ovary group will have died of heart attacks and another 158 will have died from hip fracture compared with women who keep their ovaries. However, only 47 women in the no-ovary group would be saved from ovarian cancer.
Women with a strong family history of ovarian cancer obviously have more to gain from ovary removal than women with a strong family history of heart disease or osteoporosis. Dr. Parker says the study isn't perfect, but it should at least prompt doctors to have a more meaningful discussion with patients about the full risks and benefits involved in removing healthy ovaries from a woman's body. "This is at least a subject for conversation between patient and doctor," says Dr. Parker. "But that conversation often does not happen."
Also-- I seem to remember that there is some reason that keeping your uterus would be beneficial for sexual functioning.
I encourage you to visit youngsurvival.org-- there are women your (our) age who have had their ovaries out and they can give you a better idea of what it is like to be in menopause at a relatively young age.
I know this is a lot of info at once-- I hope you find it helpful. I used to second guess my decision to 'just' take Tamoxifen. I'm really glad that I stayed this course and didn't give-up any more of my quality of life than needed to this blasted disease.
I hope you can also find a decision that is right for you.
My best,
Jen