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Margulies“My friend Jenny’s a nurse and she told me I needed my ovaries removed.”

Jenny’s friend, Laura, was just diagnosed with breast cancer and before even seeing the breast surgical oncologist, Jenny told Laura to have her ovaries removed.

So, not only was Laura facing the possibility of losing her breasts, now she might need to remove her ovaries as well. Oh, my!

Why would someone with breast cancer need her ovaries removed? Two reasons: (1) if she has a BRCA mutation, a.k.a. the “Angelina Jolie” or breast cancer gene; or (2) she needs to shut down any estrogen production.

What is the Breast Cancer gene? For a more thorough discussion, please read my blog: BRCA – The Breast Cancer Gene and Angelina Jolie. In short, women who have a known genetic mutation of the BRCA gene are at risk for breast and/or ovarian cancer.

In this case, removing the ovaries will reduce the risk of developing ovarian cancer and if she were to have the breast cancer gene, Laura would be wise to have her ovaries removed once her breast cancer treatments have been completed.

What is estrogen and why should Laura stop the production of estrogen?

Estrogen is a female sex hormone that is primarily produced in the ovaries. When a woman goes through menopause, the ovaries stop producing estrogen, but the liver, muscle, and fat will still produce very small amounts of estrogen.

Breast cancers can quite often be “estrogen fed,” meaning that estrogen can stimulate the breast cancer to grow. These breast cancers will express the estrogen receptor (ER). You will often hear of a breast cancer as ER+. In ER+ breast cancers, we do want to shut down the production of estrogen.

In premenopausal women, that is, women whose ovaries are still producing estrogen, it can be very difficult to shut down all estrogen production. Instead we use a drug like tamoxifen which, instead of shutting down estrogen production, actually blocks the estrogen receptor on the breast cancer. This prevents the breast cancer from receiving a growth signal and thus the breast cancer will die.

A recent study suggested that shutting down the ovaries in a premenopausal woman, in addition to treatment with tamoxifen, may in fact be beneficial and lead to a more durable response.

This study still needs to go through the peer review process, whereby physicians and scientists review the research and ensure that the results are real and meaningful.

Medicinal ablation, i.e. shutting down the ovaries with medicine, is the preferable way to shut down estrogen production from the ovaries, because the ovaries can be restarted after the 5-10 years of treatment with tamoxifen.

This return of ovarian function may be important if a woman is interested in having more children and may be important for a woman’s overall health. Maybe.

In the postmenopausal woman, there is no need to remove or ablate the ovaries unless the woman has the breast cancer gene.

We are forever increasing our knowledge and improving our treatments. Hopefully, one day, we will have found the cure.