Ovarian Ablation

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Ovarian ablation is among the oldest treatments for metastatic breast cancer. Beatson first described the method in 1896 when he reported the dramatic shrinkage of tumor in three women with locally advanced disease.

Surgical oophorectomy was used extensively for the treatment of advanced disease in premenopausal women, and in 1922 radiation-induced ovarian ablation was also introduced. The EBCTCG reported the results of a meta-analysis of 12 trials of adjuvant ovarian ablation, published exactly 100 years after Beatson’s original report.

For women under the age of 50 (most of whom were premenopausal at the time of diagnosis), ovarian ablation (either surgical or radiation-induced) was found to improve disease-free and overall survival significantly.

For women who received ovarian ablation as their only adjuvant therapy, there was a 25% (SD 7) reduction in the risk of recurrence. For women who received adjuvant chemotherapy in addition to ovarian ablation, the benefits were much less (10%, SD 9). By contrast, there was no significant benefit of ovarian ablation in older women, as would be expected based on their perimenopausal/postmenopausal status.

Although the numbers of patients were small, there was no difference in the incidence of contralateral breast cancer in these women.

Maura N. Dickler
American Cancer Society Guidelines for the Early Detection of Breast Cancer: Update 2003. CA Cancer J Clin 2003

References

1. Early Breast Cancer Trialists' Collaborative Group. Tamoxifen for early breast cancer: An overview of the randomized trials. Lancet 1998; 351:1451-1467.
2. Early Breast Cancer Trialists' Collaborative Group. Polychemotherapy for early breast cancer: An overview of the randomized trials. Lancet 1998; 352:930-942.
3. Early Breast Cancer Trialists' Collaborative Group. Ovarian ablation in early breast cancer: Overview of the randomized trials. Lancet 1996; 348:1189-1196.
4. Fisher B, Costantino JP, Wickerham DL et al. Tamoxifen for the prevention of breast cancer: Report of the National Surgical Adjuvant Breast and Bowel Project P-1 study. J Natl Cancer Inst, 1998; 90:1371-1388.
5. Gianni Bonadonna, Guest Editor. Breast Cancer. Seminars in Oncology 1996; 23:413-532.

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