Margins with BMX and question about tomoxifen...

Mckaylaleigh

Hi ladies.  A thought occurred to me tonight and I haven't really been able to find an answer. My DSIC (grade 3 comedonecrosis) is 7cm+ x 4 cm and 10 cm from my nipple. My point being that as far as I can tell, I believe it to be fairly close to my chest wall.  That being the case, how do they get big enough clean margins? Is there also a chance there is more they didn't see on the films? When I look at my films, there is an abrupt end to the one end of my DCIS where the film ends. I guess I don't understand how that works.

As for the Tomox question, my 2nd opinion surgeon suggested tomox (97% ER and 57% PR) even with my BMX. She said cancer can travel anywhere and she thought I should take it. My surgeon that I am going with (had to because the military) disagreed and said she doesn't think it is necessary.  Researching on the boards a little tonight, it seems most women that take it still have one or both breasts left so now I am thinking maybe my current surgeon was correct, or atleast had the more common approach.  Have there been many BMX around here that still took Tomox?

Thanks ladies

ksusan

BMX + Tamoxifen here.

Ringelle

I had a BMX for DCIS in Aug of last year. I am also being treated by a military BS but a civilian Oncologist. Apparently at my tumor board it was suggested that I at least discuss tamoxifen with the oncologist. My BS said he never recommends Tamoxifen after BMX. Oncologist said the same thing. She said the benefits were so small compared to the side effects

Unfortunately, my films showed very little DCIS, even my MRI but when we started surgeries it proved to be extensive. BS had to take quite a bit of skin to achieve a clear margin and I believe my deep margin was like 6 mm from the chest wall. They consider that "clear". Blows my mind because that is not much. Anyway, they also determined no Rads for me.

Interesting the one dr take. My BS kept reassuring me that if my diagnoses remained strictly DCIS there was very little concern with it "traveling". Thankfully that was my cas

Mckaylaleigh

I guess this, like everything else, is case by case basis. It also seems to depend on the doctor. I REALLY don't want to take tamox (or anything) if I can avoid it. I was premenopausal in my mid 20's and had to go on hormone replacement for a year. I have never been able to take birth control (tried again as early at 7 years ago), my hormones have always been unkind to me and I react to everything so I am sure tamox would send me in some sort of tailspin!

Annette47

Can’t answer about the margins, but there are two reasons to take Tamoxifen. First, to prevent distant spread (metastases) which if your diagnosis remains pure DCIS after your surgery is not a concern. The other reason is to prevent either a local recurrence or new primary. While both of those are possible after a BMX, the chances are so low that Tamoxifen is not usually recommended in cases of pure DCIS as the risks of side effects may be greater than the risks of cancer.

Mckaylaleigh

It makes a lot more sense now.  Keeping my fingers crossed for yet another reason for pure DCIS!!

Ringelle

Have you had surgery or are you scheduled for surgery?

Mckaylaleigh

I was scheduled for the 22nd but a virus went around our house and we were all sick so we had to reschedule for the 7th, next Monday.

calidancer

I had a uni MX and am on Tamoxifen to protect the remaining breast.

As for the margin question, in the MX your surgeon should take the fascia off the pectoral muscle. This gives you a clean separation even if the margin is very close. My chest wall margin was 1mm but since she removed the fascia she was not worried at all about it. No Radiation required either, and my case was reviewed by the tumor board at my request. Hope that info helps.

Mckaylaleigh

That does help. I am not even sure if they is the case with me but it helps knowing how they can still get clean margins when it is that close to the chest wall!

Kelly

TB90

The new accepted belief is that any margin is clear. No matter how small. Fascia comes away naturally and in fact is very difficult to leave intact.

So you should be just fine. My oncologist stated that he never recommends tamox any more for pure DCIS. But we all have a tolerance that differs about risk factors and SE's differ for everyone also. Your treatment plan should be customized to you.

SpecialK

mackaylaleigh - not sure if you are aware of how they determine margins, and their locations - so wanted you to know that they should ink the removed tissue with different colors to verify the position when it was on the inside. That way they know which edge of the tissue came from the anterior, posterior, how it was oriented, etc. Knowing this helps determine the needs for rads, or re-excision in the proper location, usually in the case of lumpectomy.

Mckaylaleigh

I did not know that, amongst most things BC!  Definitely helps to understand how they do it! Thanks!