DCIS Grade 3 - Post Mastectomy hormone therapy?

Frances2014

Hello everyone!  I was diagnosed in March with DCIS Grade 3 and had a lumpectomy (left breast) initially.  After that surgery, I elected to proceed with a BMX in June.  In the mastectomy pathology, they found an additional small area of DCIS and LCIS in the left breast; patchy areas of LCIS in the right breast.  The sentinel node biopsy came back negative.  I am starting the reconstruction process and am about a month into it.  I am scheduled to meet with an Oncologist shortly (recommendation by my breast surgeon) to hear what they might recommend.  Can anyone tell me if hormone therapy is being recommended after a mastectomy when nodes are negative and the margins were clear?

Frances

april485

If you are ER/PR+ then yes, it is often recommended. It was for me and even though I chose lumpectomy, the AI/Tamox is really not so much about recurrence as it is about a new cancer developing in people who like to make estrogen or who make estrogen positive breast cancer. I would at least here your MO out as to what he/she recommends.

Best to you!

Beesie

If you had a BMX, if the margins were acceptable and if all the conditions found were non-invasive (DCIS and LCIS), then NO, hormone therapy should not be recommended.  

Your risk of local recurrence or a localized new cancer is at most 2% (and could be lower) and you have no risk of distant recurrence. Therefore the most benefit you would get from hormone therapy would be a 1% reduction in your localized risk, taking your breast cancer risk from 2% to 1%.  However the risk of serious side effects from these drugs is more than 1%, so in fact you would be doing yourself more harm than good, from a general health standpoint, by going on hormone therapy.  Treatment standards suggest that no additional treatment is necessary after a BMX for DCIS/LCIS.

This would be different if you had a lumpectomy and therefore had a greater risk of local recurrence or a new primary in either breast.  And it would be quite a bit different if you had invasive cancer (i.e. if you were Stage I or above, and not Stage 0) because hormone therapy also reduces the risk of distant recurrence, i.e. mets.  That would certainly change the benefit vs. risk equation.

Edited to add reference to "a new primary in either breast" in the last paragraph.  Thanks for mentioning that, April.  Protection of the contralateral breast is one of the key benefits of hormone therapy for anyone who's had a lumpectomy or UMX.  In many cases, the risk of a new diagnosis is actually greater than the risk of recurrence.

april485

Ah Beesie, of course you are right..did not make the connection to the BMX vs UMX in my brain, but she did say that she had Bilateral. I know that if you make estrogen like I do, it is supposed to prevent a new primary in the other breast as well as reduce recurrence risk in my lumpectomy breast. Thanks for chiming in with your infinite knowledge on the subject of DCIS as you are most definitely the resident expert on DCIS!