Awareness of the Causes Leading to Surgical Ablation of Ovarian Function in Premenopausal Breast Cancer—A Single-Center Analysis
<i>Background and Objectives</i>: Ovarian surgical ablation (OSA) in estrogen receptor-positive (ER+) breast cancer is usually performed to halt ovarian function in premenopausal patients. Since alternative pharmacological therapy exists and few studies have investigated why surgery is s...
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| Language: | English |
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MDPI AG
2021-04-01
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| Series: | Medicina |
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| Online Access: | https://www.mdpi.com/1648-9144/57/4/385 |
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| author | Joana Correia Oliveira Filipa Costa Sousa Inês Gante Margarida Figueiredo Dias |
| author_facet | Joana Correia Oliveira Filipa Costa Sousa Inês Gante Margarida Figueiredo Dias |
| author_sort | Joana Correia Oliveira |
| collection | DOAJ |
| description | <i>Background and Objectives</i>: Ovarian surgical ablation (OSA) in estrogen receptor-positive (ER+) breast cancer is usually performed to halt ovarian function in premenopausal patients. Since alternative pharmacological therapy exists and few studies have investigated why surgery is still performed, we aimed to analyze the reasons for the use of OSA despite the remaining controversy. <i>Materials and Methods</i>: Premenopausal ER+ breast cancer patients treated at a tertiary center (2005–2011) were selected, and patients with germline mutations were excluded. <i>Results</i>: Seventy-nine patients met the inclusion criteria. Globally, the main reasons for OSA included: continued menstruation despite hormone therapy with or without ovarian medical ablation (OMA) (34.2%), patient informed choice (31.6%), disease progression (16.5%), gynecological disease requiring surgery (13.9%), and tamoxifen intolerance/contraindication (3.8%). In women aged ≥45 years, patient choice was significantly more frequently the reason for OSA (47.4% versus 17.1% (<i>p</i> = 0.004)). For those aged <45 years, salvation attempts were significantly more frequent as compared to older women (26.8% versus 5.3% (<i>p</i> = 0.01)). In 77.8% of women undergoing OSA with menstrual cycle maintenance, surgery was performed 1–5 years after diagnosis, while surgery was performed earlier (0–3 months after diagnosis) in patients undergoing OSA as an informed choice (56.0%), as a salvation attempt (53.8%), or due to gynecological disease (63.6%). The leading reason for OSA in women previously undergoing OMA was continued menstruation (60.0%). <i>Conclusions</i>: This study suggests a possible failure of pharmacological ovarian suppression and reinforces the need for shared decision-making with patients when discussing treatment strategies, although validation by further studies is warranted due to our limited sample size. |
| first_indexed | 2024-03-10T12:16:57Z |
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| language | English |
| last_indexed | 2024-03-10T12:16:57Z |
| publishDate | 2021-04-01 |
| publisher | MDPI AG |
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| series | Medicina |
| spelling | doaj.art-fd073404c7234c909b17836eabd75df22023-11-21T15:49:30ZengMDPI AGMedicina1010-660X1648-91442021-04-0157438510.3390/medicina57040385Awareness of the Causes Leading to Surgical Ablation of Ovarian Function in Premenopausal Breast Cancer—A Single-Center AnalysisJoana Correia Oliveira0Filipa Costa Sousa1Inês Gante2Margarida Figueiredo Dias3Gynecology Department, Centro Hospitalar e Universitário de Coimbra, Praceta Prof. Mota Pinto, 3004-561 Coimbra, PortugalGynecology Department, Centro Hospitalar e Universitário de Coimbra, Praceta Prof. Mota Pinto, 3004-561 Coimbra, PortugalGynecology Department, Centro Hospitalar e Universitário de Coimbra, Praceta Prof. Mota Pinto, 3004-561 Coimbra, PortugalGynecology Department, Centro Hospitalar e Universitário de Coimbra, Praceta Prof. Mota Pinto, 3004-561 Coimbra, Portugal<i>Background and Objectives</i>: Ovarian surgical ablation (OSA) in estrogen receptor-positive (ER+) breast cancer is usually performed to halt ovarian function in premenopausal patients. Since alternative pharmacological therapy exists and few studies have investigated why surgery is still performed, we aimed to analyze the reasons for the use of OSA despite the remaining controversy. <i>Materials and Methods</i>: Premenopausal ER+ breast cancer patients treated at a tertiary center (2005–2011) were selected, and patients with germline mutations were excluded. <i>Results</i>: Seventy-nine patients met the inclusion criteria. Globally, the main reasons for OSA included: continued menstruation despite hormone therapy with or without ovarian medical ablation (OMA) (34.2%), patient informed choice (31.6%), disease progression (16.5%), gynecological disease requiring surgery (13.9%), and tamoxifen intolerance/contraindication (3.8%). In women aged ≥45 years, patient choice was significantly more frequently the reason for OSA (47.4% versus 17.1% (<i>p</i> = 0.004)). For those aged <45 years, salvation attempts were significantly more frequent as compared to older women (26.8% versus 5.3% (<i>p</i> = 0.01)). In 77.8% of women undergoing OSA with menstrual cycle maintenance, surgery was performed 1–5 years after diagnosis, while surgery was performed earlier (0–3 months after diagnosis) in patients undergoing OSA as an informed choice (56.0%), as a salvation attempt (53.8%), or due to gynecological disease (63.6%). The leading reason for OSA in women previously undergoing OMA was continued menstruation (60.0%). <i>Conclusions</i>: This study suggests a possible failure of pharmacological ovarian suppression and reinforces the need for shared decision-making with patients when discussing treatment strategies, although validation by further studies is warranted due to our limited sample size.https://www.mdpi.com/1648-9144/57/4/385breast cancerreceptorestrogensalpingo-oophorectomyantineoplastic agentshormonal |
| spellingShingle | Joana Correia Oliveira Filipa Costa Sousa Inês Gante Margarida Figueiredo Dias Awareness of the Causes Leading to Surgical Ablation of Ovarian Function in Premenopausal Breast Cancer—A Single-Center Analysis Medicina breast cancer receptor estrogen salpingo-oophorectomy antineoplastic agents hormonal |
| title | Awareness of the Causes Leading to Surgical Ablation of Ovarian Function in Premenopausal Breast Cancer—A Single-Center Analysis |
| title_full | Awareness of the Causes Leading to Surgical Ablation of Ovarian Function in Premenopausal Breast Cancer—A Single-Center Analysis |
| title_fullStr | Awareness of the Causes Leading to Surgical Ablation of Ovarian Function in Premenopausal Breast Cancer—A Single-Center Analysis |
| title_full_unstemmed | Awareness of the Causes Leading to Surgical Ablation of Ovarian Function in Premenopausal Breast Cancer—A Single-Center Analysis |
| title_short | Awareness of the Causes Leading to Surgical Ablation of Ovarian Function in Premenopausal Breast Cancer—A Single-Center Analysis |
| title_sort | awareness of the causes leading to surgical ablation of ovarian function in premenopausal breast cancer a single center analysis |
| topic | breast cancer receptor estrogen salpingo-oophorectomy antineoplastic agents hormonal |
| url | https://www.mdpi.com/1648-9144/57/4/385 |
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