Oophorectomy in Premenopausal Patients with Estrogen Receptor-Positive Breast Cancer: New Insights into Long-Term Effects
Approximately 80% of breast cancers are estrogen receptor-positive (ER+), and 68–80% of those occur in premenopausal or perimenopausal women. Since the introduction of tamoxifen for adjuvant endocrine therapy in women with non-metastatic ER+ breast cancer, subsequent trials have demonstrated an onco...
| Main Authors: | , , , |
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| Format: | Article |
| Language: | English |
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MDPI AG
2023-02-01
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| Series: | Current Oncology |
| Subjects: | |
| Online Access: | https://www.mdpi.com/1718-7729/30/2/139 |
| _version_ | 1797621588276805632 |
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| author | Fatima Khan Kristin Rojas Matthew Schlumbrecht Patricia Jeudin |
| author_facet | Fatima Khan Kristin Rojas Matthew Schlumbrecht Patricia Jeudin |
| author_sort | Fatima Khan |
| collection | DOAJ |
| description | Approximately 80% of breast cancers are estrogen receptor-positive (ER+), and 68–80% of those occur in premenopausal or perimenopausal women. Since the introduction of tamoxifen for adjuvant endocrine therapy in women with non-metastatic ER+ breast cancer, subsequent trials have demonstrated an oncologic benefit with the addition of ovarian function suppression (OFS) to adjuvant endocrine therapy. Subsequently, therapies to either suppress or ablate ovarian function may be included in the treatment plan for patients that remain premenopausal or perimenopausal after upfront or adjuvant chemotherapy and primary surgery. One strategy for OFS, bilateral salpingo-oophorectomy (BSO), has lasting implications, and the routine recommendation for this strategy warrants a critical analysis in this population. The following is a narrative review of the utility of ovarian suppression or ablation (through either bilateral oophorectomy or radiation) in the context of adjuvant endocrine therapy, including selective estrogen receptor modulators (SERMs) and aromatase inhibitors (AIs). The long-term sequelae of bilateral oophorectomy include cardiovascular and bone density morbidity along with sexual dysfunction, negatively impacting overall quality of life. As gynecologists are the providers consulted to perform bilateral oophorectomies in this population, careful consideration of each patient’s oncologic prognosis, cardiovascular risk, and psychosocial factors should be included in the preoperative assessment to assist in shared decision-making and prevent the lifelong adverse effects that may result from overtreatment. |
| first_indexed | 2024-03-11T08:58:07Z |
| format | Article |
| id | doaj.art-9f507757acda43348f6698b3e12bdc85 |
| institution | Directory Open Access Journal |
| issn | 1198-0052 1718-7729 |
| language | English |
| last_indexed | 2024-03-11T08:58:07Z |
| publishDate | 2023-02-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Current Oncology |
| spelling | doaj.art-9f507757acda43348f6698b3e12bdc852023-11-16T19:57:51ZengMDPI AGCurrent Oncology1198-00521718-77292023-02-013021794180410.3390/curroncol30020139Oophorectomy in Premenopausal Patients with Estrogen Receptor-Positive Breast Cancer: New Insights into Long-Term EffectsFatima Khan0Kristin Rojas1Matthew Schlumbrecht2Patricia Jeudin3Departments of Medicine, Leonard M. Miller School of Medicine, University of Miami, 1120 N.W. 14th Street, Miami, FL 33136, USADepartments of Medicine, Leonard M. Miller School of Medicine, University of Miami, 1120 N.W. 14th Street, Miami, FL 33136, USADepartments of Medicine, Leonard M. Miller School of Medicine, University of Miami, 1120 N.W. 14th Street, Miami, FL 33136, USADepartments of Medicine, Leonard M. Miller School of Medicine, University of Miami, 1120 N.W. 14th Street, Miami, FL 33136, USAApproximately 80% of breast cancers are estrogen receptor-positive (ER+), and 68–80% of those occur in premenopausal or perimenopausal women. Since the introduction of tamoxifen for adjuvant endocrine therapy in women with non-metastatic ER+ breast cancer, subsequent trials have demonstrated an oncologic benefit with the addition of ovarian function suppression (OFS) to adjuvant endocrine therapy. Subsequently, therapies to either suppress or ablate ovarian function may be included in the treatment plan for patients that remain premenopausal or perimenopausal after upfront or adjuvant chemotherapy and primary surgery. One strategy for OFS, bilateral salpingo-oophorectomy (BSO), has lasting implications, and the routine recommendation for this strategy warrants a critical analysis in this population. The following is a narrative review of the utility of ovarian suppression or ablation (through either bilateral oophorectomy or radiation) in the context of adjuvant endocrine therapy, including selective estrogen receptor modulators (SERMs) and aromatase inhibitors (AIs). The long-term sequelae of bilateral oophorectomy include cardiovascular and bone density morbidity along with sexual dysfunction, negatively impacting overall quality of life. As gynecologists are the providers consulted to perform bilateral oophorectomies in this population, careful consideration of each patient’s oncologic prognosis, cardiovascular risk, and psychosocial factors should be included in the preoperative assessment to assist in shared decision-making and prevent the lifelong adverse effects that may result from overtreatment.https://www.mdpi.com/1718-7729/30/2/139bilateral salpingo-oophorectomybreast cancerER+tamoxifenaromatase inhibitorendocrine therapy |
| spellingShingle | Fatima Khan Kristin Rojas Matthew Schlumbrecht Patricia Jeudin Oophorectomy in Premenopausal Patients with Estrogen Receptor-Positive Breast Cancer: New Insights into Long-Term Effects Current Oncology bilateral salpingo-oophorectomy breast cancer ER+ tamoxifen aromatase inhibitor endocrine therapy |
| title | Oophorectomy in Premenopausal Patients with Estrogen Receptor-Positive Breast Cancer: New Insights into Long-Term Effects |
| title_full | Oophorectomy in Premenopausal Patients with Estrogen Receptor-Positive Breast Cancer: New Insights into Long-Term Effects |
| title_fullStr | Oophorectomy in Premenopausal Patients with Estrogen Receptor-Positive Breast Cancer: New Insights into Long-Term Effects |
| title_full_unstemmed | Oophorectomy in Premenopausal Patients with Estrogen Receptor-Positive Breast Cancer: New Insights into Long-Term Effects |
| title_short | Oophorectomy in Premenopausal Patients with Estrogen Receptor-Positive Breast Cancer: New Insights into Long-Term Effects |
| title_sort | oophorectomy in premenopausal patients with estrogen receptor positive breast cancer new insights into long term effects |
| topic | bilateral salpingo-oophorectomy breast cancer ER+ tamoxifen aromatase inhibitor endocrine therapy |
| url | https://www.mdpi.com/1718-7729/30/2/139 |
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