DCIS Treatment And Tamoxifen ?

I just met with my oncologist yesterday. I think before your mother panics, you should go find an oncologist and talk to them.  Surgeons are better advised on surgery.

The purpose of the tamoxifen is to reduce the chance of a reoccurance of DCIS as well as a new bout of some other type of breast cancer in both breasts.  One of the things that is taken into consideration is the grade of DCIS.  This means how aggresive is it.  With low grade DCIS, my oncologist told me that taking tamoxifen doesn't really improve odds of not getting another type of breast cancer.  But in my case, where I have high grade, more aggressive DCIS, it might help.  Also I have some other "funky" things going on and the tamox would help with that as well.

There are risks ---and they can be scary--but some of them may or may not apply.  For example, there is a risk of uterine cancer.  For me this is a non-issue as I haven't got a uterus.

Finally on the mastectomy front, I was told by more than one surgeon and plastic surgeon that a mastectomy with reconstruction can be better than a lumpectomy if they are taking too much away.  All of my doctors have said that it is very hard to do some types of reconstruction with a radiated breast because of the changes to the tissue.

Maybe your mother wants to do more consultations.  The good part of DCIS is that you can take your  time about making decisions.

Good luck!

Alohagirl-  I read this thread sometimes and just wanted to say it is really good to hear that not everyone has all the SE from Tam. I have invasive tubular carcinoma as well as DCIS.  I am having a dmx in 4 weeks and the plan right now is just the Tam. for 5 yrs.  The SEs can be very scary. I think tamoxifen is what I worry about most.  I hope I fare as well as you on it.  I see my BS Mon.  Any suggestions on what I should ask him as far as the Tamoxifen?

Tamgam, good luck at your meeting with the surgeon!  I don't know anything about tamoxifen and invasive tubular carcinoma, but I know with DCIS one of the medical oncologists I met with wanted to test my estrogen receptor status before putting me on it (though the other didn't mention that).  It might be worth asking about that.  My sense is that if the cancer is ER- it is less likely that the tamoxifen will help prevent a recurrance/second cancer.  Also, I would try to talk to the surgeon (or medical oncologist if you meet with one later) about his/her sense of your risk of recurrance or second cancer with and without tamoxifen and your risk of side effects.  I found it very helpful to sit down with the medical oncologist and talk about risk and side effects and how they might apply in my individual circumstances.  I would think if you are having a bilateral mastectomy (not sure if that was what you meant or if you are having a unilateral), your risks of a second cancer or recurrance from DCIS would be very small.  I don't know about the tubular carcinoma though.  Maybe that is why tamoxifen is being recommended?  Sorry I can't be more help.  Good luck!

Tamoxifen is to prevent the hormone receptors from allowing the estrogen to feed a cancer cell.  Even after menopause, we have estrogen in our bodies that is produced by our adrenal glands and fat tissue.  An estrogen negative woman would get no benefit from tamoxifen.  A mastectomy does not prevent the need for tamoxifen or an aromatase inhibitor.  There is still breast tissue that remains, there can still be a recurrance due to hormones feeding the cancer cells.

I will complete my five years on tamoxifen in July.  I have been fortunate to have had few side effects other than hot flashes and some joint pain.  When I first started taking it, I had several "hit and run" side effects, but for the first month only, once my body acclimated to it, the odd side effects disappeared.  I have an elderly aunt who was diagnosed with bc about 30 years ago and was put on tamoxifen.  She is in her 90's now and is doing extremely well, no recurrance.  For myself, I considered it my insurance policy.  If God forbid I were to have a recurrance, I wanted to know in my heart that I had done everything available to prevent such a thing from happening.  Hopefully your mom will be like so many of us and have few side effects at all. Tamoxifen has been the drug of choice for DCIS for many years and has been proven successful in preventing cancer from returning in the affected breast and keeping the healthy breast cancer free.

OK, so I am going onto the other track with Tamoxifen. I had Grade "0" DCIS, which was successfully removed with clear margins a week and a half ago. My chances for recurrance were approximately 5%, and the Tamoxifen would only alleviate it by 1/2, bringing my overall risk for more cancer to 2.5%. With the other types of cancers that Tamoxifen seems to increase (uterine and liver), I decided the path of less risk is to not take Tamoxifen.