Early Oophorectomy Research Articles

Prophylactic Radical Fimbriectomy with Delayed Oophorectomy in Women with a High Risk of Developing an Ovarian Carcinoma: Results of a Prospective National Pilot Study.

Risk-reducing salpingo-oophorectomy is the gold standard for the prophylaxis of ovarian cancer in high-risk women. Due to significant adverse effects, 20-30% of women delay or refuse early oophorectomy. This prospective pilot study (NCT01608074) aimed to assess the efficacy of radical fimbriectomy followed by a delayed oophorectomy in preventing ovarian and pelvic invasive cancer (the primary endpoint) and to evaluate the safety of both procedures. The key eligibility criteria were pre-menopausal women ≥35 years with a high risk of ovarian cancer who refused a risk-reducing salpingo-oophorectomy. All the surgical specimens were subjected to the SEE-FIM protocol. From January 2012 to October 2014, 121 patients underwent RF, with 51 in an ambulatory setting. Occult neoplasia was found in two cases, with one tubal high-grade serous ovarian carcinoma. Two patients experienced grade 1 intraoperative complications. No early or delayed grade ≥3 post-operative complications occurred. After 7.3 years of median follow-up, no cases of pelvic invasive cancer have been noted. Three of the fifty-two patients developed de novo breast cancer. One BRCA1-mutated woman delivered twins safely. Twenty-five patients underwent menopause, including fifteen who had received chemotherapy for breast cancer, and twenty-three underwent menopause before the delayed oophorectomy, while two did not undergo a delayed oophorectomy at all. Overall, 46 women underwent a delayed oophorectomy. No abnormalities were found in any delayed oophorectomy specimens. Radical fimbriectomy followed by delayed oophorectomy appears to be a safe and well-tolerated risk-reducing approach, which avoids early menopause for patients with a high risk of breast and ovarian cancer.

Results of a prospective phase II national study: Prophylactic radical fimbriectomy (NCT01608074), in women with a documented high risk of breast/ovarian cancer—Final pathological results and outcomes.

1594 Background: Risk-reducing salpingo-oophorectomy (RRSO) is the gold standard in surgical prophylaxis of pelvic high-grade serous carcinoma (HGSC) for women at risk of breast/ovarian cancer. Due to significant adverse effects of early oophorectomy, 20-30% of women delay or deny performing this operation. Recent data highlight the fallopian origin of most pelvic HGSC, especially its fimbrial part. Thus, we suggested a new two-step risk-reducing procedure: the radical fimbriectomy (RF) with delayed oophorectomy (DO) (Leblanc et al Gyn Oncol 2011), leading to the current RF/DO Phase 2 study. We present the definitive results on primary and secondary objectives of this trial. Methods: BRCA1/2 carriers or any women with a documented familial risk of breast/ovarian cancer were first counseled to perform a classical laparoscopic RRSO. If they denied, they were offered to enter the RF/DO study. All specimens were submitted to the SEE-FIM pathological protocol. Pathological data along with all intra- and 30-day and beyond post-operative adverse events were prospectively recorded. Follow-up consisted in an annual clinical breast and gynecological examination, with tumor markers and hormonal status assessment. Primary endpoint was the rate of pelvic serous carcinoma. Secondary endpoints were procedure morbidity, rates of tubal abnormalities, breast cancer, secondary oophorectomy. Results: From January 2012 to October 2014, 121 RF were performed: 120 by laparoscopy, 1 laparotomy (concurrent myomectomy). An occult neoplasia was found in 3 cases with 1 invasive HGSC. Intraoperative complications were two grade1 bleedings without transfusion with no grade ≥3 early post-operative or delayed complication. With a median follow-up of 5.3 years (0.2 -7.6), no patient developed any pelvic HGSC, 21 patients developed a breast cancer (3 de novo, 18 recurrences/contralateral.). 1 cancer-free BRCA1-mutated lady delivered safe twins, after an uneventful post-RF pregnancy obtained with assisted reproductive technology (ART). Overall, 29 women underwent DO (by choice: 12 or menopause: 17) resulting in grade 3b complication in 1 case, but no pathological abnormality. Conclusions: RF/DO appears as a safe, well tolerated and effective procedure in terms of occult neoplasia detection. A successful pregnancy with ART was possible after radical fimbriectomy. Longer follow-up and larger cohort are necessary to confirm its efficacy in terms of ovarian cancer prophylaxis. Clinical trial information: NCT01608074.

Cognitive markers of dementia risk in middle-aged women with bilateral salpingo-oophorectomy prior to menopause

Oophorectomy prior to menopause is associated with late-life dementia. Memory decline may start within 6 months after oophorectomy in middle-aged women, suggested by lower verbal and working memory performance. Unknown is whether such changes persist beyond 6 months, and whether they are reversed by estradiol. Short-term benefits of estradiol on verbal memory following oophorectomy were observed in one study, but longer term effects remain unknown. In the present study, middle-aged BRCA1/2 mutation carriers with early oophorectomy at least 1 year prior to study onset were tested on verbal and working memory with results stratified by (1) current estradiol use (n = 22) or (2) no history of estradiol use (n = 24), and compared to age-matched premenopausal controls (n = 25). Both memory abilities were adversely affected by oophorectomy, but only working memory was maintained by estradiol. Estrogen metabolite levels correlated with working memory, suggesting a role for estradiol in preserving this ability. Memory decline appears to persist after early oophorectomy, particularly for women who do not take estradiol.

Risk of cardiovascular disease after preventive salpingo-oophorectomy

IntroductionBreast cancer susceptibility gene (BRCA) mutation carriers are recommended to undergo early oophorectomy to prevent ovarian cancer. Premature loss of ovarian hormones may increase the risk of cardiovascular disease. Because...

Abstract P6-08-12: Understanding the etiology of osteopenia and osteoporosis in young breast cancer survivors compared to cancer-free women

Abstract Background: Our group previously reported that young breast cancer (BC) survivors have a higher risk of osteopenia/osteoporosis compared to their cancer-free peers. In order to develop successful interventions we need to understand the major contributing factors. Therefore, we investigated bone loss in young BC survivors by age at diagnosis, tumor characteristics and BC treatment compared to their cancer-free peers. Methods: We studied 775 women (211 BC survivors, 564 cancer-free) with familial risk of breast and/or ovarian cancer in the Breast and Ovarian Surveillance Service (BOSS) cohort at Johns Hopkins. Survivors were diagnosed with stage 0-III BC <5 years prior to enrollment. The comparison group was cancer-free women at enrollment. Osteopenia and osteoporosis were ascertained based on self-reported physician diagnosis in baseline and follow-up questionnaires. Prevalent cases of osteopenia or osteoporosis were excluded. Multivariable (MV)-adjusted Cox proportional hazard models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) of osteopenia and/or osteoporosis among BC survivors compared to cancer-free women. BC survivors were stratified by age at diagnosis, estrogen-receptor (ER) tumor status, and BC treatment. MV models were adjusted for age, menopausal status, body mass index, physical activity, smoking, alcohol use, hormone replacement therapy and early oophorectomy. Results: Mean time from BC diagnosis to enrollment was 1.4 years for survivors and mean age at BC diagnosis was 47 years. At baseline, BC survivors were more likely to be slightly older, postmenopausal, and current vitamin D users and less likely to have had an early bilateral oophorectomy compared to cancer-free women. During a mean follow-up time of 5.7 years, 66% of BC survivors and 54% of cancer-free women reported having ≥1 bone density exam and 112 incident cases of osteopenia/osteoporosis were identified (75% osteopenia only). BC survivors diagnosed at age ≤50 years had a 2-fold increased risk of osteopenia/osteoporosis compared to cancer-free women (HR=2.05, 95% CI=1.24-3.40). Risk of bone loss was similar among survivors with ER-positive tumors compared to cancer-free women (HR=2.04, 95% CI=1.30-3.22). No association was observed for BC survivors treated with tamoxifen only or chemotherapy only. BC survivors treated with aromatase inhibitors (AIs) only had almost 3-fold increased risk of osteopenia/osteoporosis compared to cancer-free women (HR=2.92, 95% CI=1.38-6.17). BC survivors treated with chemotherapy + tamoxifen and chemotherapy + AIs had over 2- and 4-fold increased risk of osteopenia/osteoporosis compared to cancer-free women (HR=2.28, 95% CI=1.04-5.00; HR=4.09, 95% CI=1.99-8.42, respectively). Results suggest that risk of bone loss was highest within 5 years after BC diagnosis. Conclusion: Our results demonstrate that osteopenia/osteoporosis incidence is higher in BC survivors compared to cancer-free women and risk varies by age at diagnosis, ER-status and BC treatment. Our findings provide support for a baseline evaluation of bone density close to diagnosis in BC survivors with familial risk. Future studies are needed to address the frequency of monitoring among specific age and treatment groups. Citation Format: Ramin CA, May BJ, Roden RBS, McCullough M, Armstrong DK, Visvanathan K. Understanding the etiology of osteopenia and osteoporosis in young breast cancer survivors compared to cancer-free women [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P6-08-12.

Abstract 3271: Evaluation of bone health in breast cancer survivors compared to cancer-free women: A prospective study within a young familial risk cohort

Abstract Background: Bone loss has been consistently reported among long-term older breast cancer (BC) survivors. However, it remains unclear how early and to what degree BC survivors experience bone loss compared to their cancer-free peers and to what extent this can be attributed to age and premature menopause. Methods: We studied 796 women (210 BC survivors, 586 cancer-free) with familial risk of breast and/or ovarian cancer in the Breast and Ovarian Surveillance Service (BOSS) cohort at Johns Hopkins Hospital. Survivors were diagnosed with stage I-III BC <5 years prior to baseline (mean time from diagnosis to enrollment=1.4 years; mean age at diagnosis=47 years). Osteopenia and osteoporosis were ascertained based on self-reported physician diagnosis in baseline and follow-up questionnaires. Prevalent cases of osteopenia or osteoporosis were excluded. Multivariable (MV)-adjusted Cox proportional hazard models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) of osteopenia and osteoporosis incidence among BC survivors compared to cancer-free women. MV models were adjusted for age, race, menopause status, body mass index, physical activity, smoking, hormone replacement therapy and early oophorectomy. Results: BC survivors were slightly older (mean age 48 vs. 45 years), more likely to be post-menopausal (51% vs. 29%) and had higher current vitamin D use (21% vs. 8%) compared to cancer-free women. During a mean follow-up time of 6.2 years, 77% of BC survivors and 60% of cancer-free women reported having ≥1 bone density exam and 115 incident osteopenia and/or osteoporosis cases were identified (75% osteopenia only). In MV-adjusted models, BC survivors had 66% higher risk of being diagnosed with osteopenia and/or osteoporosis compared to cancer-free women (HR=1.66, 95% CI=1.11-2.47). BC survivors with no current vitamin D or calcium use had 76% and 93% higher osteopenia and/or osteoporosis risk compared to cancer-free women, respectively (MV HR=1.76, 95% CI=1.14-2.72; MV HR=1.93, 95% CI=1.15-3.24). BC survivors ever treated with chemotherapy or hormone therapy had higher osteopenia and/or osteoporosis risk compared to cancer-free women (MV HR=2.00, 95% CI=1.14-3.50; MV HR=1.79, 95% CI=1.14-2.82, respectively). Analyses restricted to women with no change in menopause status during follow-up were only slightly attenuated (MV HR=1.58, 95% CI=0.96-2.59). Conclusion: Our results demonstrate that bone loss is significantly greater than and occurs early in young BC survivors compared to cancer-free women even after taking into consideration increasing age and premature menopause. Our findings also provide support for a baseline evaluation of bone density at diagnosis with subsequent monitoring in young BC survivors with familial risk. Further analyses are ongoing to evaluate the effect of specific BC treatments on bone health in this cohort. Citation Format: Cody A. Ramin, Betty J. May, Richard B. Roden, Dana Petry, Deborah K. Armstrong, Kala Visvanathan. Evaluation of bone health in breast cancer survivors compared to cancer-free women: A prospective study within a young familial risk cohort [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 3271. doi:10.1158/1538-7445.AM2017-3271

Adiposity post prophylactic oophorectomy in young women at high risk for breast and ovarian cancer.

1572 Background: Bilateral prophylactic salpingo-oophorectomy (BPSO) is the current standard of care for BRCA1/2 mutation carriers and women with a strong family history of ovarian cancer. We have previously demonstrated an association between early oophorectomy, adiposity and mortality in the general population. Methods: A cross sectional study was conducted between November 2009 and January 2013 in 87 women with a family history of breast and ovarian cancer and/or BRCA1/2 mutation to identify the effect of early BPSO on multiple health outcomes. Twenty-two women who underwent BPSO within 1 to 5 years of enrollment while premenopausal and not on hormone therapy were compared to 44 premenopausal women with intact ovaries and the same age distribution and 21 postmenopausal women with intact ovaries and not on hormone therapy. Multiple anthropometric measures were taken and % body fat assessed by DEXA scan. Linear regression was used to estimate differences in these measures between the three groups. Results: The mean ages were 47, 47, and 54 years in the BPSO, premenopausal and postmenopausal groups respectively. Parity, alcohol intake, smoking and race did not significantly differ between groups. Fewer BPSO women had ever used oral contraceptives (OCP) compared to the premenopausal group (p =0.05). The BPSO group had lower mean physical activity (p = 0.05) compared to the two other groups. BMI was increased in the BPSO group but was not statistically different across groups. However, mean waist and abdominal circumference and trunk % body fat were significantly higher among women who underwent BPSO compared to both groups. In multivariate analyses adjusting for age, physical activity, and OCP use, the average waist circumference was 7.92 cm (95% CI 1.46, 14.37) higher and 8.98 cm (95% CI 0.40, 17.46) higher in the BPSO group compared to the postmenopausal and premenopausal groups, respectively. A similar pattern was seen for abdominal circumference. Association with % body fat were not statistically significant. Conclusions: This pilot study suggests that increased central adiposity, is a sequelae of BPSO in young women. Longitudinal studies are needed to confirm results and evaluate the efficacy of interventions.

Association of bilateral oophorectomy and body fatness in a representative sample of US women

ObjectivePreclinical studies suggest that abrupt hormone deprivation caused by oophorectomy, leads to obesity and its metabolic sequelae. The purpose of the current study was to examine the association between oophorectomy and body fatness in a nationally representative sample of women. MethodsThe association between prior oophorectomy and nine adiposity measures was examined using data from the Third National Health and Nutrition Examination Survey (NHANES III, 1988–1994). The analytic population included cancer-free women age 40 or older (N=3549) who underwent standardized body measurements and reported on whether or not they had a bilateral oophorectomy. Multivariate linear and polytomous logistic regressions were used to evaluate the association of oophorectomy with multiple measures of adiposity. ResultsMean percent body fat, skinfold thickness, waist circumference and body mass index were significantly higher in women with oophorectomy before age 40 compared to those with intact ovaries, but no difference was observed in women with oophorectomy at an older age. Women who underwent an early oophorectomy were nearly three times more likely than women with intact ovaries to have percent body fat in the highest tertile compared to the lowest tertile (OR=2.82, 95% CI 1.39–5.75). Excluding hormone therapy (HT) users yielded stronger associations. ConclusionBilateral oophorectomy in young women is strongly associated with an increase in percent body fat, a well-established risk factor for cancer and other chronic diseases. Measuring body fat in addition to BMI may provide a more comprehensive assessment of adiposity in these women.

Bilateral oophorectomy, body mass index, and mortality in U.S. women aged 40 years and older.

Bilateral oophorectomy is used as a risk reduction strategy in BRCA1/2 mutation carriers, although data on long-term side effects are not yet available. In the general population, oophorectomy, particularly at a young age, has been associated with increased overall and cardiovascular disease (CVD) mortality. The mechanisms for this association are not well understood. We examined the association between prior bilateral oophorectomy, obesity, and all-cause, cancer, and CVD mortality. Our study population included women ages 40 and above from the Third National Health and Nutrition Examination Survey (NHANES III), a nationally representative survey with enrollment from 1988 to 1994 and prospective mortality follow-up through December 31, 2006. We excluded women with a history of reproductive cancer or missing oophorectomy status, yielding a study population of 4,040. Cox proportional hazards modeling was used to estimate HR for all-cause and cause-specific mortality. In multivariate analyses, body mass index (BMI) significantly modified the association between oophorectomy and mortality (P(interaction) = 0.04). Women who were obese at the time of interview and who had an oophorectomy at less than 40 years were more than twice as likely to die [HR, 2.23; 95% confidence interval (CI), 1.25-3.98], particularly of CVD (HR, 2.77; 95% CI, 0.91-8.41), than nonobese women with intact ovaries. These associations persisted after excluding women who used estrogen therapy and women who had oophorectomy before 35 years of age. The joint effect of obesity and early oophorectomy on mortality was significantly greater than expected, given the independent effects of both exposures. Our results suggest that minimizing weight gain after oophorectomy and addressing cardiovascular risk factors could beneficially impact mortality.

Risk Factors for Dementia with Lewy Bodies (S24.005)

Objective: To determine the risk factors associated with Dementia with Lewy Bodies (DLB) in a population-based case-control study. Background DLB is the second most common form of dementia and shares features with Alzheimer9s Disease (AD) and Parkinson9s disease with dementia (PDD). No prior studies have comprehensively assessed risk factors for DLB. Design/Methods: We identified 147 subjects with incident DLB and without a concomitant diagnosis of AD. Each DLB subject was matched for sex and age (+/- 5 years) with two cognitively-normal control (NC) subjects, and compared to 221 subjects with AD. We asked subjects and carers about known AD and PDD risk factors during enrollment and follow-up. We also reviewed their complete medical records to verify exposure information. Results: For DLB compared to NCs, the nominal odds ratio (OR) for a history of depression was 11.9 (p Conclusions: Like PD, DLB was associated with male preponderance, pre-existing anxiety and depression and early oophorectomy in females. Like AD it was associated with shorter life-span, stroke and the APOEe4 allele. It differed from AD in regard to gender and education. Supported by: Grants P50 AG16574 and P01 AG07216 from the National Institute on Aging, by the Robert H. and Clarice Smith and Abigail Van Buren Alzheimer9s Disease Research Program and R01 AG15866. Disclosure: Dr. Boot has nothing to disclose. Dr. Orr has nothing to disclose. Dr. Ferman has nothing to disclose. Dr. Roberts has received research support from Abbott Laboratories. Dr. Pankratz has received research support from Abbott Laboratories, Inc. Dr. Dickson has nothing to disclose. Dr. Ahlskog has nothing to disclose. Dr. Knopman has received personal compensation for activities with Lilly Pharmaceuticals as a data safety monitoring board member. Dr. Knopman has received personal compensation in an editorial capacity for Neurology. Dr. Knopman has received research support from Elan, Forest, and Baxter. Dr. Petersen has received personal compensation for activities with Pfizer, Inc., Janssen Alzheimer9s Immunotherapy, Elan Pharmaceuticals, and GE Healthcare. Dr. Boeve has nothing to disclose.

Early Oophorectomy May Hasten Osteoporosis

Early Oophorectomy May Hasten Osteoporosis

Early Oophorectomy Linked to Osteoporosis, Arthritis

Early Oophorectomy Linked to Osteoporosis, Arthritis

Premature ovarian failure

Over the last 40 years or so, there has been a significant rise in the number of women in the western world who have had their ovaries surgically removed prior to the age of natural menopause. The vast majority of these women were undergoing hysterectomy at the time, usually for a benign gynaecological condition such as menstrual dysfunction. Gynaecologists advised women to have their ovaries removed contemporaneously to eliminate the risk of future ovarian cancer. Many of these women received no counselling about the implications of having their ovaries prematurely removed and how they might feel thereafter. Many subsequently wished they could set the clock back as they experienced a very abrupt onset of vasomotor symptoms, mood change, lack of energy and loss of libido. There were instances of litigation in the UK as women realized that they had not given their informed consent to have this procedure performed. Data from the Mayo Clinic Cohort Study on Oophorectomy and Ageing add a new dimension to this debate. This study has demonstrated trends of increased mortality, cardiovascular disease, cognitive impairment, Parkinsonism and osteoporosis in women following bilateral oophorectomy prior to the age of natural menopause compared with a referent group from the same population in Minnesota. While the data lack the robustness of a randomized trial, they strongly suggest that premature lack of estrogen is detrimental to long-term health and estrogen replacement is beneficial. The study encompassed a 38-year follow-up of women from a population-based sample and as stated by Shuster et al. 1 in the review in this edition of Menopause International, has the potential ‘to guide decision-making for or against prophylactic bilateral oophorectomy before the age of natural menopause’. Women with a personal history of breast cancer or with a strong family history of breast or ovarian cancer are a small but increasing group who may clearly benefit from early oophorectomy to improve their prognosis. They may or may not be the carriers of known genetic mutations and will receive expert guidance from familial cancer specialists. However, it is likely that they will have very little counselling to prepare themselves for life following premature removal of their ovaries and they may be consigned to a markedly poorer quality of life in the future. Many of these women will be discouraged from taking hormone replacement because of their history although the limited evidence that exists suggests that replacement of estrogen does not abrogate the beneficial effect of oophorectomy on breast cancer prognosis. These are often young women with partners and small children who may be at the peak of their lives as home-makers or working professionals. They deserve every opportunity to understand both the shortand long-term benefits and risks of early oophorectomy. Fortunately, there is now an increasing trend that these women are referred to specialist menopause services before surgery, where they can be fully appraised of the consequences and given the best possible advice on hormone replacement. The recent data from the Mayo Clinic Cohort Study help clinicians working in this field to counsel any woman who is considering or has undergone premature surgical oophorectomy.

Goserelin plus anastrozole in the treatment of premenopausal hormone receptor positive, recurrent or metastatic breast cancer

1030 Background: Aromatase inhibitors (AIs) are highly active in postmenopausal women with hormone receptor positive breast cancer. However, the AIs do not suppress ovarian estrogen synthesis and are not effective in premenopausal women. This phase II study was initiated to estimate the activity of anastrozole when given with ovarian suppression by goserelin in premenopausal women with ER and/or PgR positive metastatic breast cancer. Methods: Premenopausal women with measurable recurrent or metastatic, ER and/or PgR positive breast cancer; no prior AI or LH-RH agonist/antagonist; no adjuvant chemotherapy within 6 months; ECOG performance status of 0–2; adequate organ function; and who provided signed, informed consent were eligible. A 2 stage phase II design was utilized. Treatment was with goserelin 3.6 mg SQ q4wk and anastrozole 1 mg/day begun on day 22 of protocol treatment. Treatment was continued to disease progression. Results: 35 patients (pts) were enrolled. Three were excluded from analysis for the following: 1 postmenopausal, 1 consent withdrawal, 1 early oophorectomy. Of the remaining 32 pts, median age was 43 yrs (range 26–51 yrs), 18 (56%) had prior chemotherapy, and 9 (28%) had prior SERM. Pts were Asian/Middle Eastern 22%, Caucasian 62%, Black 13%, Hispanic 3%. Disease sites were lymph node 50%, breast 44%, bone 81%, lung 41%, liver 22%, pleural effusion 6% and soft tissue 6%. Receptor status was ER+/PgR+ 75%, ER+/PgR- 22% and ER-/PgR+ 3%. Response: Treatment resulted in complete response (CR) in 1(3%), partial response (PR) in 11(34%), stable disease 6+ mos (SD) in 11(34%), and clinical benefit (CR+PR+SD) 23 (72%). Median TTP was 8 mos (range 2 - 63+ mos); median OS was 26 mos (range 11 - 63+ mos). Estradiol levels were detectable in 30/31 pts at baseline (median 56 pg/ml, range <10 - 273 pg/ml). Mean estradiol levels (pg/ml) were 75 at baseline, 21 at 1 mos, 19 at 3 mos, and 15 at 6 mos. TOXICITY: One grade 3 weight loss. All other toxicities were grade 1–2. Conclusions: Ovarian suppression with goserelin in combination with anastrozole is well tolerated and highly active in the treatment of premenopausal, hormone receptor-positive metastatic breast cancer. Support provided by AstraZeneca Pharmaceuticals No significant financial relationships to disclose.

Early Oophorectomy Linked to Dementia Risk

Early Oophorectomy Linked to Dementia Risk

Early Oophorectomy Is Linked With Doubled Risk of Later Parkinson's

Early Oophorectomy Is Linked With Doubled Risk of Later Parkinson's

Early Oophorectomy May Increase Parkinson's Risk

Early Oophorectomy May Increase Parkinson's Risk

An electron microscopic study of cells with steroid-secreting morphology in the paraaortic lymph node of the hamster.

Clustered cells with steroid-secreting morphology (SH), located within the paraaortic lymph node (PLN) capsules of normal and pregnant female golden hamsters, were examined by light and electron microscopy. Hydroxysteroid dehydrogenase (HD) activity of the SH cell cluster also was examined by histochemical techniques. The cluster was composed of mostly packed SH cells and surrounding mesenchymal cells. Individual SH cells possessed prominent smooth endoplasmic reticulum, well-developed Golgi complexes, some lipid droplets, and numerous mitochondria containing tubulovesicular cristae common to mammalian SH cells. Intermediate-type junctions were often observed between SH cells. The same SH cells were rarely detected in the subcapsular sinus and in the cortical parenchyma of the PLN. Early oophorectomy of the hamster resulted in cytoplasmic degeneration of the SH cell at day 5 after the operation. On the other hand, normal adult male hamsters possessed similar PLNs, but no SH cells were recognized in the nodes. The present histochemical preparation of normal female PLNs revealed moderate-to-strong HD activity, probably associated with SH cell clusters, in the limited regions of the capsules. Based on the present ultrastructural and histochemical findings, it is proposed that the SH cell cluster consists of steroid hormone producing cells.

Early ("prophylactic") oophorectomy and adrenalectomy in carcinoma of the breast: a ten-year follow-up.

Early "prophylactic" oophorectomy and adrenalectomy has been performed on 12 patients with carcinoma of the breast. The patients selected were considered to have a very bad prognosis on account of axillary node involvement associated with internal mammary chain deposits (9 patients), supraclavicular nodes (2 patients) and a parasternal mass (1 patient). Five patients had evidence of spread beyond the primary lymph drainage area (axillary and internal mammary nodes), and all had died within 4 years. In 7 patients the disease was confined to the primary lymph drainage area and 4 lived for more than 10 years, 3 being alive and well at 11 to 12 years. This is a higher proportion than in a control series but does not quite reach the level of statistical significance. In the 7 patients with disease confined to the axillary and internal mammary nodes prognosis was not apparently related to malignancy determined histologically, but did have an association with the extent of invasion of the axillary nodes. Urinary oestrogen estimations performed in 4 patients did not give any evidence that outcome was related to persistence of oestrogen production. Details of the patients' management and replacement therapy are given and from prolonged personal follow-up of these patients it is concluded that women who have undergone oophorectomy and adrenalectomy are able to lead full and active lives.

Early (prophylactic) oophorectomy and adrenalectomy in carcinoma of the breast; an interim report.

Early (Prophylactic) Oophorectomy and Adrenalectomy in Carcinoma of the Breast; An Interim Report