OVARIAN DISEASE IN WOMEN WITH BREAST-CANCER

Objective: To correlate ovarian pathology findings with the indication s for surgery, age, initial breast cancer stage, prior therapy for bre ast cancer, and current status of disease. Methods: We reviewed the ch arts of women with breast cancer who underwent oophorectomy at a singl e institution during the period 1987-1993. Two hundred thirty women we re identified. The indications for oophorectomy were divided into thre e groups: 1) incidental, with no ovarian symptoms; 2) therapeutic ooph orectomy for treatment of metastatic breast cancer; and 3) patients wi th adnexal or pelvic mass. Ovarian pathology was classified as benign, metastasis from breast primary, or primary ovarian or tubal malignanc y. Results: Eighty-nine women underwent oophorectomy incidental to pel vic surgery; one patient had metastatic breast cancer present in the o varies and three patients had a clinically unsuspected ovarian or tuba l primary cancer. Twenty patients had bilateral oophorectomy as therap y for metastatic breast cancer, and five of 20 (25%) had metastatic br east cancer to the ovaries. One hundred twenty-one women with a preope rative diagnosis of adnexal or pelvic mass underwent oophorectomy (uni lateral or bilateral). Sixty-one (50%) had a benign process. Sixty pat ients were found to have a malignant neoplasm, including 44 new ovaria n or tubal primary cancers and 16 with metastatic mammary cancer. Conc lusions: Patients who present with new findings of an adnexal or pelvi c 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 co mplete evaluation; one should not assume that the adnexal or pelvic ma ss represents metastatic disease from the breast primary cancer.