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Oophorectomy and Breast Cancer

By Jonas Wilson, Ing. Med.

Oophorectomy is a surgical operation in which the ovaries are removed. The removal of these sex organs has been practiced for over a century as part of the treatment of breast cancer. It causes a significant reduction in the production and circulation of estrogen and progesterone, the primary female sex hormones.

Oophorectomy derives its clinical benefits from the fact that some breast cancers require these hormones to grow. Thus, reducing the production of hormones in the body may lead to a halting or slowing in the progression of these hormone-dependent breast cancers.  

The history behind the procedure

The relationship between breast cancer and the presence of functional ovaries was first observed by a British doctor, Thomas William Nunn. He reported breast cancer regression in a woman 6 months after she had reached menopause. Based on Mr. Nunn’s observation, a German surgeon, Albert Schinzinger, was the first to propose removal of the ovaries as a potential therapy for breast cancer. This procedure was subsequently done for the first time in 1895 by a British physician, George Thomas Beatson. While some success was reported, it was largely unpopular at first, because it was associated with a high degree of morbidity.

It was not until the mid 20th century that large oophorectomy trials focusing on its role in breast cancer were studied and reintroduced into the mainstream of breast cancer treatment. Studies by reputable bodies, such as the Early Breast Cancer Trialist’s Collaborative Group, showed compelling evidence for the procedure. These studies suggested that the removal of the ovaries had a large positive effect on disease-free survival as well as on the overall survival of patients with early breast cancer. Advancements in medicine, and our understanding of breast cancer, however, has affected the practice of oophorectomy. These advancements include using chemotherapy, targeting hormone receptors and alternative ways to suppress ovarian function without the removal of these key organs.

Indications for oophorectomy, and risk factors

Women who possess BRCA1 and BRCA2 genetic mutations have a greater risk of developing ovarian and breast cancer.

Those who have completed their families and have a genetic predisposition to the development of these malignant conditions are prime candidates for the procedure.

It may also be performed prophylactically in those who have a strong family history of ovarian and breast cancer.

Studies show that the risk of developing breast cancer in women with a BRCA mutation may be halved by bilateral oophorectomy. The chances of developing ovarian cancer in such women may be reduced by up to 90% by this procedure.

Important to note that is that the total risk varies depending on several factors, such as the lifestyle choices of the women (including their weight management and alcohol consumption), and their family history. Hence, oophorectomy may be of immense benefit in some women, but not in others. In the latter, the risks associated with the procedure and the possible side effects outweigh the benefit due to the reduction in cancer propensity.

While the surgical procedure is generally safe, the associated risks include injury to internal organs, intestinal blockage and infection. Moreover, the premature reduction of sex hormones may lead to problems, such as osteoporosis (or bone thinning) and an increased risk of heart disease.

Reviewed by Dr. Liji Thomas, MD.

References

Further Reading

Last Updated: Aug 22, 2016

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