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Ovary Removal May Not Be Needed in Endometrial Cancer
Date:1/26/2009

In women 45 and younger, study finds no survival difference when ovaries left intact

MONDAY, Jan. 26 (HealthDay News) -- Younger women with early-stage endometrial cancer need not lose their ovaries when undergoing treatment for the cancer, a new study contends.

The largest study to date has found no difference in five-year survival rates among women who kept their ovaries and those who did not. Removal of the ovaries, called an oophorectomy, has long been a standard part of therapy for endometrial cancer.

However, "it appears that this is a safe thing if a woman wants to go ahead and keep her ovaries," said Dr. Jay Brooks, chairman of hematology/oncology at Ochsner Health System in Baton Rouge, La.

As always, though, no one decision is right for all women all the time.

"This is a retrospective study, so it's hard to say for sure that we should change practice based on this," said Dr. Jason D. Wright, assistant professor of obstetrics and gynecology at Columbia University College of Physicians & Surgeons in New York City and lead author of the study. "But it's definitely a provocative finding, and it does appear that ovarian preservation is safe."

"This is something that needs to be discussed with young women -- that this is available," he added. "Ideally, this would be tested in a prospective study."

The benefits of preserving the ovaries would be considerable. Young women would be spared the discomfort of hot flashes, vaginal dryness and other symptoms of induced menopause before their time. Also, avoiding the procedure would reduce the risk of cardiac disease and bone loss and would probably result in a longer life span.

The findings were published online Jan. 26 in the Journal of Clinical Oncology.

About 5 percent of endometrial cancer cases occur in women younger than 40. The average age is 60, and removing the ovaries is not really an issue for women after about age 50 because they have already undergone natural menopause, said Dr. Jeffrey Fowler, director of gynecologic oncology at the James Cancer Hospital and Solove Research Institute at Ohio State University in Columbus.

A hysterectomy (surgical removal of the uterus), and often an oophorectomy as well, has been standard with this type of cancer, largely because of concerns that the cancer might also affect the ovaries and that continued production of estrogen could fuel tumor growth.

The study spanned the years 1988 to 2004 and ultimately involved 3,269 women age 45 or younger who had stage I endometrial cancer. All of the women were registered in a national cancer database.

All women had a hysterectomy, and the 12 percent who kept their ovaries tended to be younger, to have been diagnosed later in the span of the study, to have a low tumor grade and to live in the eastern United States.

Removing the ovaries had virtually no effect on five-year survival rates, the study found. Among women who underwent the procedure, 98 percent of those with stage IA cancer, 96 percent who had stage IB disease and 89 percent with stage IC disease lived at least five years, compared with 98, 100 and 86 percent, respectively, of women who did not have their ovaries removed.

But even with oophorectomy dominating treatment for this type of cancer, individualization of treatment has been and should continue to be the standard, Fowler said.

Family history of cancer, stage and grade of the tumor and how aggressive the cancer is should all factor into treatment decisions, he said. So should the person's genetic vulnerability: Women carrying the BRCA cancer gene, for instance, probably have increased survival after undergoing ovary removal, he said.

"We need to individualize and discuss the risks and benefits," Fowler said.

More information

The U.S. National Cancer Institute has more on endometrial cancer.



SOURCES: Jason D. Wright, M.D., assistant professor, obstetrics and gynecology, Columbia University College of Physicians and Surgeons, New York City; Jeffrey Fowler, M.D., director, gynecologic oncology, James Cancer Hospital and Solove Research Institute, Ohio State University, Columbus, Ohio; Jay Brooks, chairman, hematology/oncology, Ochsner Health System, Baton Rouge, La.; Jan. 26, 2009, Journal of Clinical Oncology


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