Surgical oophorectomy: a primary option in adjuvant treatment of premenopausal breast cancer

Main Article Content

Richard R. Love

Abstract

Globally, there are 500,000 annual new cases of hormone-sensitive breast cancer in premenopausal women; 400,000 of these occur in women in low and middle income countries (LMIC). With optimal adjuvant therapy, fully one third more than the half of women who might survive with primary surgery alone-more than 80%, could survive 10 years. Affordability and practicality of treatment profoundly affect global practice and these do not characterize the current standards of care – LHRH agonist plus tamoxifen or an aromatase inhibitor.

Surgical oophorectomy plus tamoxifen is a safe, efficient and affordable, patient-centered and equitable adjuvant treatment, long considered equivalent to that from LHRH agonist plus tamoxifen treatment. New data additionally suggest that women, who are in extended follicular phase of their cycles at the time of surgery, benefit much less from this treatment, and women who are in normal progesterone-confirmed follicular or luteal phases, benefit more than unselected or LHRH-treated women. New data also show that surgical oophorectomy plus tamoxifen is associated with no loss of bone mineral density at the hip, and loss for only a year in the lumbar spine.

The dominance of a business model for medicine, the narrow perspective and single metric-efficacy focus of guideline creation, and limited understanding of the practice of medicine for poor women worldwide, appear to be contributing to the social injustice of not offering women the option of surgical oophorectomy instead of LHRH treatment. 100,000 women a year could be saved. Further research investigating outcomes associated with the timing of surgical oophorectomy is strongly justified.

Article Details

How to Cite
LOVE, Richard R.. Surgical oophorectomy: a primary option in adjuvant treatment of premenopausal breast cancer. Medical Research Archives, [S.l.], v. 5, n. 7, july 2017. ISSN 2375-1924. Available at: <https://esmed.org/MRA/mra/article/view/1396>. Date accessed: 30 jan. 2023.
Keywords
medical, medicine,research,pharmacology
Section
Research Articles

References

References

1. Love, R.R., Van Dinh, N., Quy, T.T., et al.: Survival after adjuvant oophorectomy and tamoxifen in operable breast cancer in premenopausal women. J Clin Oncol. 2008.26:253-7.
2. Early Breast Cancer Trialists’ Collaborative group: Systemic treatment of early breast cancer by hormonal, cytotoxic or immune therapy. Lancet 1992. 339:72-85.
3. Burstein, H.J., Lacchetti, C., Anderson, H. et al: Adjuvant endocrine therapy for women with hormone receptor-positive breast cancer: American Society of Clinical Oncology Clinical Practice Guideline update on Ovarian suppression. J Clin Oncol 2016. 34:1689-1701.
4. Love, R.R., Laudico, A.V., Dinh, N.V., et al.: Timing of adjuvant surgical oophorectomy in the menstrual cycle and disease-free and overall survival in premenopausal women with operable breast cancer. J Nat Cancer Inst 2015 107 (3): djv064 doi: 10.1093/jnci/djv064.
5. Love, R.R., Hossain, S.M., Hussain, M., et al.: Luteal versus follicular phase surgical oophorectomy plus tamoxifen in premenopausal women with metastatic hormone receptor positive breast cancer. Europ J Cancer 2016. 60:107-116. http://dx.doi.org/10.1016/j.ejca.2016.03.011.
6. Love, R.R.: Adjuvant surgical oophorectomy plus tamoxifen in premenopausal women with operable breast cancer: a global treatment option. Clin Breast Cancer 2016.16: 233-7. http://dx.doi.org/10.1016/j.clbc.2016.03.003.
7. Badwe R, Hawaldar R, Parmar V, et al: Single-injection depot progesterone before surgery and survival in women with operable breast cancer: a randomized controlled trial. J Clin Oncol 2011; 29:2845-51.
8. Baum M, Chaplain MA, Anderson AR, Douek M, Vaidya JS. Does breast cancer exist in a state of chaos? Eur J Cancer. 1999;35(6):886-91.
9. Love, R.R., Young, G.S., Laudico, A.V., et al: Bone mineral density changes following surgical oophorectomy and tamoxifen adjuvant therapy for breast cancer. Cancer 2013; 119:3746-52.
10. Tevaarwerk, A.J., Wang, M., Zhaon, F. et al.: Phase III Comparison tamoxifen versus tamoxifen plus ovarian function supresssion in premenopausal women with node negative, hormone receptor positive breast cancer (E-3193, INT-0142): A trial of the Eastern Cooperative Oncology Group. J Clin Oncol 2014. 32:3948-3958.
11. Farmer, P.: Pathologies of power Health human rights and the new war on the poor. University of California Press, Berkley and Los Angeles, 2005.
12. Love, R.R. Love, S.M.: Peri-operative biology in primary breast cancer: A credible therapeutic target. Breast Cancer Res Treat 2016. 156:411-413.

Similar Articles

1 2 3 4 > >> 

You may also start an advanced similarity search for this article.