Do I Need a Hysterectomy?
I recently had breast cancer surgery and have been advised to follow up with a hysterectomy because of my family history. Would it be advisable for me to have this surgery? I'm having difficulty taking the chemo and will require radiation, according to my physician. I'm 50 years old.
Whenever a doctor recommends surgery, it's best to get a second opinion. In this case, I'd advise you to seek out a female doctor, who would probably suggest a less radical solution than removing all your reproductive organs.
Hysterectomy has long been thought of and touted as the ultimate solution for all recurrent or persistent gynecological problems. It's probably done more often than necessary, especially in the United States, where one third of all women have no uterus by the time they reach 60. This is doubly upsetting because there are many alternatives to hysterectomy. When one says "complete hysterectomy," that means removing the uterus, ovaries, and fallopian tubes. There's no reason to take your uterus out in order to lessen your risk of cancer. Your doctor is likely suggesting an oophorectomy, which means removal of the ovaries. When I was in medical school, this was a very common surgery in breast cancer cases because the ovaries make estrogen, which can increase the risk of cancer recurrence.
Or, your doctor may be concerned about the potential for developing cancer in your ovaries. You mention a family history, which could include both breast and ovarian cancer. Before assuming you are at unusually high risk for both cancers, however, it would be wise to consult a genetic counselor or cancer geneticist. The breast cancer genes BRCA1 and BRCA2 are linked to early onset breast cancer, not usually cancer that occurs at middle age or later.
It's very important to recognize that removing your ovaries (or your breasts) won't eliminate the possibility of developing cancer in that area. There are cells that remain in the lining of the pelvic cavity (or beneath the breast tissue) after surgery, and these are not protected. Even though they make less estrogen after menopause, the ovaries continue to make hormones important to the rhythms and processes in your body throughout your life. And some women report depression, decreased libido, and weakened sexual response if the uterus is removed.
We do have pharmacological means to counter the production of estrogen far less invasively than cutting out the ovaries. Tamoxifen is an estrogen antagonist, meaning it works to reduce the influence of estrogen on breast tissue. It has significant side effects and increases the risk of uterine cancer, but is much less toxic than chemotherapy. A promising alternative is estriol, which is produced in the ovary and is also derived from plant sources. It may protect against the development and growth of breast cancer. At 50, however, you are close to menopause, when your ovaries will stop producing estrogen.
I'm not trying to tell you to rule out an oophorectomy. That operation could provide tremendous relief to a woman deeply concerned about ovarian cancer. I would only suggest that you consult with at least one other doctor and think carefully about your decision.