Tamoxifen instead of ovarectomy

The drug Tamoxifen inhibits so-called estrogen receptors and simultaneously stimulates progesterone receptors. It is a selective estrogen receptor modulator, which is used preferentially in the therapy of hormone-sensitive breast cancer (breast cancer therapy). Among other things, the hormone estrogen is produced in the ovaries.

In hormone-sensitive forms of breast cancer, the aim is to prevent the estrogen from binding to the tumor, as this can affect growth. Tamoxifen can be used for this purpose or the ovaries can be removed. Which of the two procedures is the most appropriate should be discussed with the treating physician. It should be noted that pregnancy can no longer be achieved after a bilateral ovariectomy. In addition, after removal of the ovaries, menopausal symptoms may occur.

Ovarectomy after breast cancer

More than half of malignant breast tumors grow dependent on female sex hormones. Especially the estrogen produced in the ovaries is essential for some types of breast cancer. When this connection was discovered, many women who had breast cancer had their ovaries removed.

This slowed or stopped the growth of breast cancer due to the subsequent hormone deficiency. However, the resulting infertility was very problematic, especially for young women, and the immediate onset of menopause with its typical symptoms was also critically evaluated. Since the 1970s, ovarectomy after breast cancer has no longer been performed as a standard procedure because anti-hormone therapies have been available since then, with which tumor growth can be influenced in a drug-induced manner.

In most cases, menstruation resumes after treatment and fertility is maintained. Even if certain gene variants are found in a woman with breast cancer, the risk of developing ovarian cancer may also be increased. As part of this increased risk, an ovarectomy may be considered in women who have completed family planning.

So far, two hereditary gene mutations have been identified that lead to breast cancer and often also ovarian cancer in a high percentage of those affected. These are the genes BRCA1 and BRCA2 (BRCA = Breast Cancer). These two genes can be reliably detected by complex genetic tests, and are probably responsible for less than half (about 25-50 percent) of hereditarily caused breast cancer cases. However, genome research into hereditary diseases is still in its “infancy”. Many questions regarding a possible increase in the risk of the occurrence of certain diseases through the effect of gene variants are still open.