SIDEBAR: Expect Questions from Your Patients and Colleagues


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Patients of the Women’s Cancer Center at Fox Chase Cancer Center in Philadelphia often ask about ovarian cancer risk, the center’s Director, Robert A. Burger, MD, told The ASCO Post. Moreover, the recent study showing that bilateral salpingo-oophorectomy reduced that risk generated discussion among colleagues about how to advise patients.

“Up to this point, we have counseled them that having their ovaries and tubes removed is probably the operation that makes most sense, because it is the only operation that well-done studies have shown a risk reduction for, even though we know that hysterectomy may also be an independent protective factor against ovarian cancer,” Dr. Burger said.

Prevention, Treatment, and Survivorship

“In our population of women who are at high risk of ovarian cancer, about half of them elect to have a hysterectomy at the time of their bilateral salpingo-oophorectomy and the other half elect just to have their ovaries and tubes removed,” Dr Burger said. But women who have a bilateral salpingo-oophorectomy and want to have hormone replacement therapy because of menopausal symptoms will need to receive progestins as well as estrogen, he explained. “So based on this large population study, the issue becomes this: If they have preventive surgery, should we be counseling them to have their uterus removed if there is a good chance they are going to need to be on hormone replacement? Because if the uterus is removed, we can simplify the hormone replacement regimen and not include progestin and also not expose them to a potential risk of endometrial cancer if they need to be on a medication like tamoxifen to reduce the risk of breast cancer,” Dr. Burger said.

“We are as actively involved in prevention as we are in treatment,” Dr. Burger stated. “We believe that the cancer centers of this millennium basically should be involved in all the points of care that deal with cancer, from primary prevention though survivorship.” He noted that the Women’s Cancer Center staff works closely with an ovarian and breast cancer advocacy group called Facing Our Risk of Cancer Empowered (www.facingourrisk.org). ■


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Hormone Replacement and Ovarian Cancer: Competing Risks in Decisions about Bilateral Salpingo-oophorectomy

Recently reported findings that bilateral salpingo-oophorectomy and hysterectomy decreased the risk of ovarian cancer compared to ovarian conservation and hysterectomy, without increasing cardiovascular, fracture, and other cancer risks, should “challenge” current thinking about bilateral...


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