Treatment choices question...HELP!

2bme

I'm almost 60 years old. A few weeks ago after my annual mammogram, I was found to have small DCIS, high grade (comedo necrosis), hormone receptive, in my left breast. Surgeon recommends lumpectomy, radiation (21 sessions), and hormone therapy, stating recurrence rate of 5-7% afterwards. I'm really nervous about hormones, as I've battled hormone-related depression, including postpartum depression, on and off throughout my life, but finally have been feeling free of the ups and downs (had a hysterectomy years ago, still have ovaries). I would not feel secure not taking hormones after the lumpectomy, as it is said to greatly reduce the risk of recurrence. I'm seriously thinking of a double mastectomy, after which I would not have to take hormones.The removal of one breast would be the treatment, with the removal of the other for preventative measure and to be move symmetrical. Surgeon says mastectomy is always an option, but of course feels that breast conservation is best. I need to start a treatment plan soon, and want to decide this week....HELP!?

MTwoman

2bme, I am so sorry that you're here trying to make difficult decisions about your treatment. There is a great and comprehensive thread where women have discussed the lx vs mx question. I'm going to post that thread here so that you can read through it and then ask any lingering questions there: https://community.breastcancer.org/forum/68/topics/806074?page=1

You might also want to ask about women's reactions to an AI. The "hormone therapy" is very different from taking "hormones". As you are post menopausal, you'll be recommended to take an Aromatase Inhibitor. " Aromatase inhibitors work by inhibiting the action of the enzyme aromatase, which converts androgens into estrogens by a process called aromatization. As breast tissue is stimulated by estrogens, decreasing their production is a way of suppressing recurrence of the breast tumor tissue"

best of luck!

Annette47

Just to piggy-back on what MTWoman said, the therapy you would be offered after the lumpectomy is ”anti-hormonal”, so if anything would decrease the effect of any estrogen remaining in your body. Very different than hormone replacement therapy, which is what it sounds like you are thinking about.

For what it’s worth, I’ve been on Tamoxifen (an anti-hormonal) for almost 5 years and have had very little side effects from it. Most of what I have noticed would probably be happening anyway given that I am 50 years old and peri-menopausal (hot flashes, etc).

One thing to consider is that you could always have the lumpectomy, and later decide to go back for a mastectomy, but once your breasts are gone, there is no going back. You can also try the anti-hormonals and if you find the effects unbearable, you can quit them - it’s not a life-time commitment.

Canary2

Have you had genetic testing done? If not, it may really help you to make your decision. I had lumpectomy and radiation with my first DCIS (ER-/PR-) 4 years ago on recommendation from my surgeon although I considered mastectomy at the time mostly because radiation limits future options but it just seemed so extreme. I was shocked to get diagnosed with a new DCIS (ER+/PR+) this year and subsequently learned I have CHEK2 genetic mutation that increases my risk for breast cancer. I ended up with a mastectomy anyway and now am sorry I ever had radiation. My MO is recommending strongly for a prophylactic mastectomy on my right now given my risk. If I were to choose to keep my right breast she would want me on Tamoxifen even though it's not known how well it really fares when it goes face to face with a genetic predisposition for disease. It's a no brainer for me, right breast will be gone as soon as I can schedule it. No Tamoxifen and double mastectomy reduces risk to 1%. If your genetic testing is negative then your surgeon's recommendation is right on. If you may have a genetic mutation then you may be better off with double mastectomy not because you don't have to take Tamoxifen (or radiation) but because your risk for any future concern would be low.

NotVeryBrave

If you're cancer is ER+ then it will still be recommended to take some sort of endocrine therapy after any surgery. Even a BMX can't remove every single cell.

I had a pCR after chemo and a BMXand they still want me on Tamoxifen to reduce my remaining risk.