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We read with great interest the article by Hughes et al.,1 in which they suggest that ovarian ablation by radiotherapy is an effective treatment for the majority of patients with breast carcinoma. However, although their published results are very impressive, the concept appears to focus only on the hormonal activity of the gonad with regard to the development of carcinoma.

Bergfeldt et al.2 suggested a link between breast and ovarian carcinomas. It is widely accepted that women with BRCA1 or BRCA2 gene mutations are at an increased risk for developing breast and ovarian carcinomas compared with the general population, with a cumulative lifetime risk of developing breast and ovarian carcinomas of 60–85% and 15–65%, respectively. Unfortunately, because genetic tests revealing BRCA gene mutations are expensive and may have negative social, legal, or insurance implications, large-scale screening is not feasible. Because of the simplicity of the procedure and the lack of effective alternatives, prophylactic oophorectomy is considered to be the best available tool for reducing an individual's risk of ovarian carcinoma.3 Moreover, it is well documented that women with a history of breast, endometrial, or ovarian carcinoma are at a statistically significantly increased risk for subsequent colorectal carcinoma.4, 5

Between January 1996 and December 2002, we performed laparotomies in 109 patients diagnosed with ovarian carcinoma. Of these patients, 18 (16.5%) had been diagnosed with colorectal carcinoma, whereas 9 patients (8.3%) had a history of breast carcinoma. In two patients, both malignancies were present prior to the development of ovarian carcinoma. The histopathologic diagnosis in these cases was primary ovarian carcinoma, whereas in 11 additional patients (10.1%) we detected metastatic ovarian carcinomas, all of which were gastrointestinal in origin (with 2 of them being Krukenberg tumors).

To date, we have performed 28 prophylactic oophorectomies via laparoscopy in a select group of patients previously diagnosed with breast carcinoma. All these patients had undergone mastectomy followed by gonadotropin-releasing hormone (GnRH) analogue treatment. In 2 of these 28 patients (7.1%), the histopathologic finding in the ovary was adenocarcinoma, whereas the other specimens were found to be negative for malignancy. We fully support the view that the prophylactic removal of the ovaries is necessary in this group of high-risk patients.

Our data suggest that, in addition to playing a key functional role as a hormone-producing organ in the development of certain neoplasms, and in addition to lodging metastases of different tumors, the ovary has its own potential to develop a second primary neoplasm in a select group of patients who previously were diagnosed with certain types of tumors.

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József Bódis M.D., Ph.D., D.Sc.*, Miklós Koppán M.D., Ph.D.*, Katalin Németh M.Sc.*, * Department of Obstetrics and Gynecology, Baranya County Hospital and Institute of Clinical and Nurse Sciences, Faculty of Health Sciences, University of Pécs, Pécs, Hungary.