Breast cancer is the most common type of cancer seen in women all over the world and in our country, and it is thought that one out of every 8 women will develop breast cancer in a lifetime. In the examination after breast cancer, they go through a process in which drugs such as surgery, chemotherapy, radiotherapy and then tamoxifen are used for many years.
Since the breast is a hormone-sensitive organ, there is a very close relationship between breast-related conditions and the female reproductive system, especially the uterus and ovaries.
Likewise , gynecologists and, if necessary, gynecological oncology surgeons are important in the follow-up of women with breast cancer, since conditions such as obesity, late menopause or BRCA familial breast-ovarian cancer syndrome, which cause breast cancer in the post-breast cancer examination , also cause some changes in the female reproductive system organs. understandably, it has a place.
Menopause and related complaints after breast cancer treatment:
Chemotherapy drugs used after surgical treatment in breast cancer can reduce or completely eliminate ovarian functions in these women. This is seen in approximately 50-80% of patients. If patients have not entered menopause before, these patients will experience complaints such as cessation of menstruation, hot flashes, mood disorders, and vaginal dryness due to early menopause.
After the breast cancer examination, some patients may return to their ovarian functions after the effect of chemotherapy and they may begin to menstruate again. Even in patients whose ovarian functions have returned, there will be a risk of re-menopause due to chemotherapy.
After breast cancer examination, women should be evaluated by a gynecologist and appropriate treatment should be started in order to eliminate menopausal complaints and reduce the risk of osteoporosis.
The standard and best treatment of hot flashes is hormone drugs, but the use of these drugs in patients with breast cancer will not be appropriate because breast cancer is a tumor sensitive to female hormones. Some psychological drugs have been shown to be beneficial in relieving hot flashes in these patients.
Ovarian suppression in breast cancer treatment:
Since breast cancer is sensitive to the female hormone estrogen in the examination after breast cancer, sometimes medical oncologists especially want to suppress ovarian functions and apply monthly or 6-monthly injections for this.
In some patients, ovarian functions may not be suppressed despite these injections, or patients may get bored with monthly injections and may want to plan a more permanent solution. In this case, medical oncologists and gynecological surgeons can jointly decide to remove the ovaries and tubes.
After this surgery, the patient’s estrogen hormone production will be completely eliminated. Patients should be informed about the surgical menopause that will develop after removal of the ovaries.
Follow-up during the use of Tamoxifen Derivatives and Aromatase Inhibitors:
It has been shown that some drugs with hormonal effects are beneficial to prevent recurrence of breast cancer in women who have completed surgical treatment and subsequent chemotherapy and radiotherapy. There are two types of drugs used for this:
Aromatase inhibitors: Drug groups called aromatase inhibitors, which are three different drugs called anastrazole, eczemastan and letrozole. It is a group of drugs used after the first treatment of hormone-sensitive breast cancer.
These drugs prevent the production of femininity in the surrounding tissue and reduce the rate of estrogen (female hormone) in the body. Aromatase inhibitors are used in postmenopausal women because they use the ovaries to have the opposite effect in premenopausal women.
The points to be considered in the gynecological follow-up of patients receiving aromatase therapy are related to the possibility of hot flashes and osteoporosis caused by these drugs. Unlike drugs in the tamoxifen group, aramotase inhibitors do not have the risk of causing thickening of the uterine wall.
Drugs in the tamoxifen group: They consist of a group of drugs called tamoxifen, raloxifene and toromiphene. The mechanism of action of these drugs is to bind to the receptors to which the female hormone binds in the tissues, sometimes reducing and sometimes increasing the effect on these receptors.
Drugs in the tamoxifen group reduce the effect of female hormones on the breast, while increasing the effect of female hormones on the uterine wall. While this effect may lead to a protective effect on breast cancer, it can cause uterine wall thickening and sometimes an increased risk of uterine cancer.
However, the thickening of the uterine wall can be followed and there is no need for an intervention (taking a sample from the uterine wall, etc.) if the patients do not complain of abnormal bleeding. However, if patients have complaints such as increased bleeding, spotting, and unending discharge, a piece of the uterine wall (biopsy) will be required.
Evaluation for Familial Breast-Ovarian Cancer Syndrome (BRCA) Risk:
The information that cancers are caused by genetic causes is increasing day by day. Some of these genetic changes are due to various reasons throughout human life (smoking, radiation, sunlight, various chemicals), and some come from genes in the family before they even start life. One of the most common of these familial genetically inherited cancer syndromes is Familial Breast-Over Cancer Syndrome.
In this syndrome, which is caused by mutations in the genes called BRCA1 and BRCA2, the risk of pancreatic and prostate cancer and melanoma increases, especially breast and ovarian cancer. Although this unfortunate situation increases the risk of cancer in patients, if this situation can be detected by professionals dealing with cancer, it makes it possible to perform treatment opportunities and preventive actions for both the patient and his/her close relatives.
It would be appropriate to evaluate the familial cancer risk in the presence of the following conditions:
In the presence of breast, colon and ovarian cancer that occurs at a very early age or under 50 years of age.
If cancer is observed in more than one organ (such as breast and ovary) in the same patient
In case of cancer in both breasts or at two different points of the large intestine in the same patient
In case of having the same type of cancer in close relatives, especially on one side of the family (mother or father’s side).
In the case of rare types of cancer, such as breast cancer in men.
Together with a medical geneticist, your gynecologist will interpret your results and help determine the most appropriate strategy for you.