Ovarian disease in women with breast cancer

To correlate ovarian pathology findings with the indications for surgery, age, initial breast cancer stage, prior therapy for breast cancer, and current status of disease.

We reviewed the charts of women with breast cancer who underwent oophorectomy at a single institution during the period 1987-1993. Two hundred thirty women were identified. The indications for oophorectomy were divided into three groups: 1) incidental, with no ovarian symptoms; 2) therapeutic oophorectomy for treatment of metastatic breast cancer; and 3) patients with adnexal or pelvic mass. Ovarian pathology was classified as benign, metastasis from breast primary, or primary ovarian or tubal malignancy.

Eighty-nine women underwent oophorectomy incidental to pelvic surgery; one patient had metastatic breast cancer present in the ovaries and three patients had a clinically unsuspected ovarian or tubal primary cancer. Twenty patients had bilateral oophorectomy as therapy for metastatic breast cancer, and five of 20 (25%) had metastatic breast cancer to the ovaries. One hundred twenty-one women with a preoperative diagnosis of adnexal or pelvic mass underwent oophorectomy (unilateral or bilateral). Sixty-one (50%) had a benign process. Sixty patients were found to have a malignant neoplasm, including 44 new ovarian or tubal primary cancers and 16 with metastatic mammary cancer.

Patients who present with new findings of an adnexal or pelvic mass are more likely to have a new ovarian or tubal malignancy than metastatic breast cancer, by a ratio of 3:1. These patients require complete evaluation; one should not assume that the adnexal or pelvic mass represents metastatic disease from the breast primary cancer.