Sunday, November 23, 2008 Cruzer asks

Q: The role of estrogen in estrogen + CA

I wonder if there is something I am missing about having hormone positive cancer. It seems to me that since I have ER/PR strongly positive cancer that reducing the amount of estrogren in my body with reduce the amount of risk for recurrence. My diagnosis is IDC, stage one, grade one, 5 negative lymph nodes, clear margins after lumpectomy. My Oncologist suggests 6 wks radiation, no chemotherapy, no tamoxifen (unless if oncotype returns moderate or high risk).

All sounds great, but I want to have my ovaries removed to decrease the amount of estrogen in my body and reduce my risk of ovarian cancer. It just makes sense to me that this would be good preventative medicine.

My logic says "less estrogen will create less risk of estrogen-related cancer." I know that estrogen has good and bad qualities and to remove ovaries foregoes the benefits of estrogen. I am 50 years old and pre-menopausal. Going into menopause would be totally fine to me. I feel like I'm halfway there, anyway.

Is it true - less estrogen means less estrogen available to make estrogen-related cancer?

Can you tell me why women who are post-menopausal GET cancer that is estrogen-related?

Is the removal of ovaries without the use of tamoxifen a reasonable treatment in my situation? Thanks for your help.

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Answers (3)

PJ Hamel, Health Guide

11/23/08 1:32pm

Hi Cruzer: Yes, less estrogen means less estrogen available to feed ER-receptive breast cancer. That doesn't mean NO estrogen; the ovaries aren't the only gland producing estrogen. Your body finds other ways to make it once your ovaries are gone or shut down, mainly by converting androgens manufactured by the adrenal gland to estrogen. (This is what aromatase inhibitors prohibit, if your doctor has discussed those with you.)

I can't stress enough, though, that "going through menopause" isn't all that will happen if you have your ovaries removed. It means permanent loss of estrogen, with all the side effects that entails, including probable bone density loss, which is serious and which we, as women, we hope to put off as long as possible. Hot flashes, sleeplessness, weight gain... it's not easy being without estrogen! You say, "Well, it's better than getting cancer again." My opinion is, having been through it, maybe... maybe not. Your cancer is stage 1, hasn't spread, 99% curable. Is that final 1% reassurance worth having your ovaries removed? I can't guide you one way or the other, but I'm just saying, think hard: this isn't an easy decision.

If you DO have your ovaries removed after all, then you might discuss an aromatase inhibitor with your doctor. If you want to rid your body of as much estrogen as possible, then you might as well go the whole nine yards, eh?

Best of luck with this decision - it's a toughie! PJH

debbie

11/23/08 1:02pm

Helllo Cruzer,

I was diagnosed in August with stage 11(early)and had a lumpectomy. I am ER+ lymph node negative her2- and I had mammosite radiation and now I am having 4 chemo treatments. My oncologist mentioned removing my ovaries in about 6 nmonths. So I firmly agree with you on this. I am 47 and I will have mine removed. Good Luck

Debbie

Tammy

11/29/08 8:28pm

Hello Cruzer,

I had IDC, ER/PR strongly positive cancer with no node involvement and was premenopausal and underwent lumpectomy and then for precaution my oncologist recommend I have 4 chemo treatments and then I underwent the accelerated partial breast radiation and when I was finsished with radiation my oncologist started me on Tamoxifen so that it would block any estrogen from my ovaries getting to my breasts until it puts me into menopause. Once it is determined after several years that I am menospausal I will go on another medical to stop my adrenal glands from producing estrogen. I have had menopausal symptoms such as hot flashes and sleepless nights but taken tylenol pm some nights to help me sleep and the hot flashes have gotten so much better. I will take the menopause over recurrent breast cancer any day.

Q: The role of estrogen in estrogen + CA

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