Anyone with LCIS, tamox, and then cancer?
Well, I met with the oncologist last week and I am going to start tamoxifen as soon as I get results from a uterine biopsy. I've been swaying back and forth between the medication route and the mastectomy route. I'm at least going to give the tamox a shot until I meet with PS in mid-Dec. My oncologist said I have a 25% lifetime risk of developing invasive breast cancer, but IF I can tolerate taxoxifen for 5 years, my chances are cut in half. Sounds good in theory, but I still can't get the thought out of my head that I have these crazy cells in my breasts!!!! I'm just curious if any of you had a diagnosis of only LCIS at one point, did the tamoxifen and then DID develop invasive BC?!?!? I'm soon just going to flip a coin to make my decision what to do!!! If I knew I wouldn't have tons of complications from the NSMX, I'd do it in a heartbeat. There just aren't any guarantees with any of this, are there???? Thanks so much!
Dawn
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I was diagnoses with LCIS, ALH and ADH after 3 years of every 6 month diagnostic mammos and sonograms. After my lumpectomy in May my BS suggested starting Tamoxifen and I decided not to because I was already having issues with large fibroids and bleeding every month and I didn't want to deal with those issues and tamoxifen. I ultimately had a hysterectomy and ovaries removed 2 months later so I am dealing with surgical menopause which is no picnic. I have recently found a lump in the same breast that had the lumpectomy and it doesn't show up on either the mammo or sonogram so tomorrow I am going back to the BS to see what she thinks. Not sure where this will take me, if it's another lumpectomy I am not sure that I can keep doing this watch and wait deal. I don't think that there are any guarantees with this disease, it does what it wants, when it wants. We can certainly try to weigh the options but ultimately the decision of what do is ours.
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Your onc's data came (at least mostly) from the NSABP-1 and STAR studies.
The NSABP-1 study looked at tamoxifen vs placebo, but included fewer LCIS women.
Risk was reduced by 56% in the subset of 826 women with a history of LCIS, and the average annual hazard rate for invasive cancer fell from 12.99 per 1,000 women to 5.69 per 1,000 women. In women older than 50 years, this benefit was accompanied by an annual incidence of 1 to 2 per 1,000 women of endometrial cancer and thrombotic events. (Refer to the PDQ summary on Breast Cancer Prevention for more information.) http://www.cancer.gov/cancertopics/pdq/treatment/breast/healthprofessional/page5
So, tamoxifen does not totally eliminate the risk of invasive breast cancer for LCIS women. It cuts it in about half (50%).
In the STAR study, they looked at almost 900 LCIS women who got tamoxifen and almost 900 LCIS women who got raloxifene. They were enrolled sometime between 1999 and 2004. This paper is an update as of 2009. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2935331/?tool=pubmed. After a median of 81 months, there were 50 (out of 892) LCIS women on tamoxifen who got invasive breast cancer and 57 (out of 889) LCIS women on raloxifene who got invasive breast cancer.
They don't present information about the LCIS group only as to invasive uterine cancer or thromboembolic events. But, for all women with various risk factors, for the women with a uterus, there was an annual incidence of 2.25 cases of invasive uterine cancer per 1000 women in the tamoxifen group, and 1.23 cases of invasive uterine cancer per 1000 women in the raloxifene group. There were annual rates of 3.3 cases of pulmonary embolism (1.36) or deep vein thrombosis (1.93) per 1000 women in the tamoxifen group and annual rates of 14.58 cases of cataracts per 1000 women in the tamoxifen group.
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marie-----I was diagnosed with LCIS 8 years ago and my risk is further elevated by family history of bc (mom had ILC). After wieghing all the pros and cons, I decided to go on tamoxifen and take the very low risk of serious SEs (less than 1% for blood clots or endometrial cancer) to help decrease my high risk of invasive bc (doctor guessed mine to be 36.6%, but stated it could be higher, he really wasn't sure). I took it for the full 5 years and tolerated it well. I now take evista and tolerate that well too. I continue with high risk surveillance of alternating mammos and MRIs every 6 months with breast exams on the opposite 6 months. (so essentially I'm "seen" by some method every 3 months, which gives me more peace of mind that I'm watched so closely). I haven't needed any further biopsies in the past 8 years, so for me the meds are working well. I'm not ready to go the route of PBMs. There are definitely pros and cons to both choices and the decisions are so difficult and personal. But no one can say what is right for you and your particular situation. If you do decide on taking tamox, be sure to talk with your doctor about having a yearly transvaginal US to monitor both the uterine lining and the ovaries. (and about taking a daily baby aspirin (81 mg) to prevent blood clots).
Anne
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I found these postings very interesting. I had surgery for DCIS 3 1/2 years ago.started on Tamoxifen after completing radiation therapy. I had a stereotactic biopsy 2 weeks ago with the diagnosis of LCIS. Am scheduled for an open biopsy in January. I wonder what good the tamoxifen has done?. Can I depend on it to prevent me from getting invasive cancer? So, depending upon the results....it can either be 6 month close follow-up or bil mastectomy. Am concerned now that I have been put into the high risk group.......
Donna
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donna------the LCIS might have been there all along, (and not detected), there's no way to tell. But by taking tamoxifen the past 3.5 years, it may have prevented you from developing an invasive bc.
I was diagnosed with LCIS 8 years ago---I took tamox for 5 years, now I take evista for further preventative measures, and I continue with high risk surveillance of alternating mammos and MRIs every 6 months. My risk is further elevated due to my mom's history of ILC.
You were actually already considered high risk due to your DCIS. The main thing with LCIS is that it is a bilateral disease, so both breasts are at risk. Praying you have no more DCIS found or any invasive bc.
Anne
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Anne, thanks for your reply. You are so right. The biopsy was only done because of suspicious calcifictions, and found then. Will see what happens when I have my exploratory biopsy.
Donna
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Ok Back in 2002 i was dx with LCIC and was put on the regiment of Tamoxifen for the 5 yrs...did what I was suppose to do stopped in 2007 ....In Oct 2009 Was Dx with Tubular Carcinoma and Lobular Carcinoma had a Bilaterally Mastectomy in Jan 2010 and startd reconstruction at that time ...I was the first Person in My Family Dx with Bc ...Good Luck Christina
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