Has anyone chose only a surgery option for DCIS?

Meh527

Yesterday, I got back my genetics testing. No genes that have either a propensity to cancer or are mutated or damaged and unable to protect me against cancer. I did have a mammogram post lumdectomy and the doctor reading the results saw some areas that might be calcifications, as well as some abnormalities. I had already made my decision to have radiation based on my fear of microscopic cancer left behind and I just want to be over this and hope that radiation will prevent future occurrence. I do not want tamoxifen for the next 5 years. And my oncologist wasn't pushing it and was okay with my decision.

Went today (Friday) and had my pre-radiologic pictures taken before I start Monday. Met with the nurse who gave me the spiel about cremes and breast care. Radiologist not around to talk about the "sliver of heart" that was going to be exposed, so will have to talk to her Monday before procedure as to what exactly that means.

Later I was on Amazon checking out reviews and deciding on buying Miaderm, Eucerin, and My Girls Skin Care, and searching my house for our old bottle of pure aloe vera, which we used for tan burns, but now in anticipation of my burned, peeling boob.

I'm scared about the visual changes as a daily reminder, the actual changes and possible pain and not having whatever I need for whatever comes.

I feel very aware and protective of my left boob. She's taken on a life of her own. I feel sorry for the poor thing that has been poked, prodded, squeezed, xrayed, cut into and stitched, and basically mutilated. And now the poor thing will be fried. I feel I must cradle her and protect her and ice her and maybe put her on a nice, soft pillow at night to rest, only to be assaulted again in the morning. I'm having a shortened course (4 weeks versus the usual 6 weeks here in the lower 48), but I'm concerned about nausea (it happens) and fatigue for the next 4 weeks. I'll be getting a CBC and be evaluated every week.

StillSurprised

Glad to find this discussion. I've had lumpectomy and started radiation for DCIS (High grade 1.8 cm with comedo necrosis.) Neither of those was a difficult decision. Have agreed to tamoxifen but having 2nd thoughts, esp with all news of over treatment. Another NYT article today. Biggest concern is changing antidepressants. I get the Tam would lower chance of recurrence. (Love the way they market it as "chemo prevention" - spin is everywhere). But not at all sure that outweighs other risks in big picture.

BarredOwl

Dear StillSurprised:

It is a very personal risk/benefit analysis, and it is not an easy one.

One thing I would say is that I do not believe that "chemoprevention" is a marketing spin. For example, tamoxifen is indicated in certain patients at high risk of breast cancer (e.g., certain BRCA-positive women without breast cancer) for the purpose of "chemoprevention". The guidelines for Breast Cancer Risk Reduction issued by the National Comprehensive Cancer Center (NCCN) cite several scientific articles regarding this application that use the term "chemoprevention".

To the extent that tamoxifen has been reported to reduce the incidence of contralateral breast cancers (which are ordinarily thought to be new cancers) in patients with DCIS, the use of this drug could be considered as "chemoprevention".

These are some articles regarding tamoxifen in DCIS in patients who had breast conserving therapy plus radiation:

http://jco.ascopubs.org/content/30/12/1249.full

http://jco.ascopubs.org/content/30/12/1268.long

If you include these in your decision-making, be sure to discuss them with your medical oncologist and ask if there are more recent studies available.

Hopefully, when you met/meet with the medical oncologist to discuss endocrine therapy, they can provide you with an explanation about the different types of risks that endocrine therapy can address in the DCIS context. They should be able to provide you with an estimate of the magnitude of those risks in your particular case, in light of your presentation, personal and family history, and to explain by how much the recommended treatment may be able to reduce those risks, so that you understand what the total level of estimated risk would be without treatment versus with treatment. Then, the possible benefit must be weighed against the possible risk of serious side effects.

The risk reduction factor usually provided is 45%. However, the real question is what are the base-line risk levels that may be reduced by 45%.

Good luck!

BarredOwl