Female Health Issues After Breast Cancer
Janet: But it is very rare?
Dr. Elena Kamel: Right. The only other way that an ovarian cancer could recur if one had one’s ovaries removed is if a portion of the ovary was left behind; or if at the time of removal, it wasn’t, it wasn’t known that there were seedlings, microscopic seedlings of ovarian cancer. So typically when a breast cancer patient comes to us and wants to have her ovaries removed, since we know she’s at high risk at the time of the surgery, we do washings. We actually wash the peritoneal cavity and send that fluid to cytology to make sure that there’s no evidence of any even microscopic early ovarian cancer cells.
Janet: Right, you said something about hot flashes, that they get worse after breast cancer. Is that what you said?
Dr. Elena Kamel: No, after treatment.
Dr. Elena Kamel: After chemotherapy for breast cancer…because of the cytotoxic medications to the ovaries and women become amenorrheic, meaning they lose their periods, the hot flashes often intensify.
Janet: But when do they go away, after the chemo is…
Dr. Elena Kamel: Everybody’s different. Unfortunately sometimes hot flashes never go away…
Dr. Elena Kamel: …and sometimes they abate very slowly.
Janet: Oh, because I stopped about five years ago and I still have them.
Dr. Elena Kamel: Right, then you answered my question that sometimes they don’t always go away. That really has nothing to do with whether someone’s a breast cancer patient or not; in menopause, every person’s menopause is different and there are some women who are plagued for 20 years with hot flashes and there are others who have the blessing of either…
Janet: Yeah, it just seems that it got worse after my chemo.
Dr. Elena Kamel: The chemo will, and think about why, because the chemo truly oblates the ovarian functions. Think about it, it knocks them out. Whereas if you’re in your own menopause, the ovaries still make a little bit of estrogen and they make a little bit of testosterone that helps hot flashes. But after chemotherapy, there really, in the menopausal patient, there really is very little ovarian function left.
Janet: The ovaries do help though somewhat...
Dr. Elena Kamel: A little bit.
Operator: Ellen from California is online. Please go ahead.
Ellen: Thank you. I have a couple questions actually. I was wondering, do you recommend then after breast cancer that the ovaries should be removed? Is that something that you would recommend or?
Dr. Elena Kamel: No, I wouldn’t make a blanket statement that anybody who has breast cancer needs to have their ovaries removed. I think that that has to be part of the package of evaluation of the individual afterwards and so that often involves genetic testing, seeing if someone’s BRCA-1 or -2 positive. In those patients, and if they’re also of Ashkenazi decent, they have an increased risk of over 30% of having ovarian cancer. So in that population, I would very much advocate removing the ovaries. If someone has breast cancer and also has a family history of ovarian cancer, that person would be someone I would certainly recommend to have the ovaries removed. In certain institutions there’s screening programs. For example, at Northwestern we have a program where women who’ve had breast cancer can be enrolled in a program where we watch their ovaries with Doppler ultrasound every six months and we follow their CA-125 to see if any changes occur. But those would be the options that I would offer women.
Ellen: You said something about chemotherapy being toxic to the ovaries, is that why it increases the risk after breast cancer that you could get ovarian cancer?
Dr. Elena Kamel: No, it just… What it does when I say “toxic to the ovaries”, it basically, it annihilates their function, but it doesn’t increase your mutagenesis of cancer cells. There is a link, there is a link between breast cancer, ovarian, and colon and there is an increased risk in someone who’s had any of those of having the other.
Ellen: So then you probably need to get screened more often than say for colonoscopy?
Dr. Elena Kamel: Correct and so in fact most breast cancer patients are advised to have colonoscopies every five years.
Ellen: Five years, okay. Thank you.
Operator: Maryann from Virginia’s online. Please go ahead.
Maryann: Hi. Thank you for taking my question. I would like you to talk a little bit about aromatase inhibitors and the side effects of them as well as the long-term effects of aromatase inhibitors please.
Dr. Elena Kamel: The aromatase inhibitors are a form of adjuvant that we use in the postmenopausal patient to help decrease the potential for recurrence of breast cancer. In particular, the major side effect or the major ill that they can often cause is loss of bones. So the majority of patients who are on the most commonly used inhibitor is Arimidex, those patients need a baseline bone density before the medicine started and then they are followed yearly with bone density. Many patients are put on prophylactic Fosamax or Actonel or Boniva, which are drugs to help build bones just to counteract the effects of bone loss that this medication has. I would say that is the really number one side effect that we are concerned about.
Maryann: What about joint pain?
Dr. Elena Kamel: That also can happen in certain individuals, but it’s much less, much, much less.
Maryann: Thank you.
Operator: Felice from Florida’s online. Please go ahead.
Felice: Yes, I had a question regarding the vaginal dryness you were discussing earlier. You were talking about using I guess estrogen supplements.
Dr. Elena Kamel: Correct.
Felice: What is the situation with that regarding someone who is estrogen receptor positive with their cancer?
