Dcis and tamoxifen?
hi - anyone else out there whose been prescribed tamoxifen after a pure DCIS diagnosis? I had over 7cm high grade. Thanks.
Comments
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Yes, I have been on Tamoxifen for several months now. I don't think it's an uncommon part of a treatment plan if your growth was ER+/PR+.
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I'm ER mildly positive and PR-. Also when I asked about margins my BS said it's not something they measure? I had a mastectomy.....? Sorry, got my final pathology today, pure DCIS so I should be happy, right? I am but surely I need to know what the margins were so I can calculate recurrence? Or maybe margins don't effect recurrence for DCiS? Because I've had the pure DCIS diagnosis, everyone is congratulating me and popping open the bubbly - I'm just as scared as I was when I first got diagnosed? ....rant over
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Hi Jonesy, did you do a bilateral or unilateral mastectomy? If there is still one natural breast, then the Tamox would be appropriate to try to prevent a new cancer in that breast. If you had bilateral mx for pure DCIS, it is rarely recommended that one take Tamoxifen, and the average recurrence rate for bilat DCIS is 1 to 2 percent, and if you had nice clean margins, that would be your recurrence risk. If you are brca positive (which I assume you aren't), then the recurrence risk is higher. If there are dirty margins with DCIS, they sometimes treat the margin with radiation. There was a recent case where there was a narrow margin (<1mm), and I think the surgeon recommended either Tamox or Radiation. Beesie, any comments?
As far as your anxiety goes, it's understandable to basically complete treatment, and then worry about recurrence, but if you really did do bilateral mx, your odds of moving on really are good. It takes awhile to live with the uncertainty that comes with the end of treatment.
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I had a single right breast masectomy - so yes I guess the tamoxifen will be to reduce occurance in remaining breast. I wasn't told what my margins were - my BS said this wasn't procedure for DCIS masectomy (I'm in the UK) - but I'm going to call the nurse now and ask more questions. I had some blood clotting from previous biopsies in my breast tissue and I'm hoping this hasn't obscured the final pathology report......blimey this "survivor" status is hard!
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I had a uni. mastectomy on right side for DCIS 12/15/10. I tried Tamoxifen and it made me feel really depressed. Where I already have a problem with depression and am on medication for it, my doctor felt it's o.k. for me not to take it. Quality of life is important too!
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Another uni here. I discussed Tamoxifen with my oncologist and while he would have prescribed Tamox for risk reduction for my remaining breast if I asked for it, he really didn't feel that the benefit was worth the risks and side effects. I did my own research and figured out the benefit I'd get from 5 years of Tamox (the benefit is specifically related to your risk level and how long you take Tamoxifen) and decided that the benefit wasn't worth it to me.
That said, if I'd had a lumpectomy and a significant recurrence risk, that would have increased the amount of benefit I'd get from Tamoxifen (in terms of overall risk reduction) and I would have given it a try. So I'm not against Tamoxifen but I think each case needs to be assessed individually to determine the benefit that someone will get and whether it's worth it to them.
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I had a small DCIS in right breats and had lumpectomy and rads. I took tamoxifen for a year but couldnt handle the joint pain. Now considering a PBMX as i fear my risks for recurrence and new cancer go up from being off tamoxifen. Wish they had a better way to predict my risk level...making such a decision is so hard and confusing.
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I am a right Uni too, my Surgeon left the decision about Tamox up to me, but said that it wasn't indicated in my case.
I did consider it, but chose not to go ahead, both because I have Rheumatoid Arthritis, and didn't want to risk any more joint pain, and my Mother, who had BC, took Tamox for 5 years and displayed many of the known SE's. I just didn't think, for me, that the benefits could outweigh the negatives.
I agree with Beesie that each case needs to be assessed individually.
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Hi, I'm 46 and just had a unilateral mastectomy in December for DCIS intermediate grade. I tested negative for the brca 1 & 2 gene. I opted for the mastectomy to avoid radiation treatments. I am two weeks in on taking tamoxifen. I have reservations about taking the medication but I personally feel it is important to reduce my chances of a new breast cancer. My oncologist discussed other drug therapies other than tamoxifen that is available depending on your age, disposition with menopause. I am a runner and hope it doesnt interfere, I will ride it out and see how I feel.
The day of my mastectomy I spoke with one of my nurses and she said she had DCIS when she was 38 and did not take tamoxifen. 14 years later the cancer came back, she had to have that breast removed as it had been radiated to much and a lumpectomy was not an option. I know it's only one case but food for thought. Also, if you had a nipple sparing mastectomy that would make a difference too, as your nipple is attached to your milk ducts and it only takes one cell for cancer to grow and DCIS being in the milk ducts it can travel. I also took chlomid when I was 33 and even though its doesnt seem to be a determining factor for BC I am finding out by word of mouth that many other women developed BC that took it as well. As with a mastectomy it is a personal decision what you do in regards to follow up treatment. Good luck
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How long did it take everyone to become accustomed to tamoxifen ?
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Ariom: I'm glad you posted your thoughts. I was diagnosed in October 2013 and had a uni on Jan 21 with reconstruction. My BS said it was my decision as to whether take Tam or not . I thought I would try it but with my research it scares me so I have decided not to take it.
Thank you and everyone else on here for the thoughts and ideas ...
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I've been taking it for 10 months with no problems other than the occasional mild hot flash. I had a lumpectomy though, and wanted it to a) reduce recurrence risk and b) reduce risk of a new primary since I still have lots of breast tissue for cancer to set up shop in.
My MO said it was up to me - presented the risks and benefits and said he would support either decision. Since I am not at particularly high risk for the more serious side effects (blood clots and uterine cancer), I decided to try it with the knowledge that if the quality of life side effects became too onerous, I could quit. They haven't been though ... and I've even received some extra benefits in the way of reduced cyclical breast pain and more regular periods.
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I've been feeling hyperactive and happy - I'm hoping these are positive side effects of tamoxifen -I'm one week in - early days I know!
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I also started Tamoxifin last Friday after finishing Rads on Thursday.. Only SE is mood swings.
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Thanks, everyone, for your posts and thoughts. I have read all your posts with great interest.
Another "uni" here (right) 3 months ago, with recon. I see my oncologist again this week for a discussion. Last November, she took all history and blood tests to determine hormone levels as I still had my period last summer- (I know, probably not a good thing!). I am hoping she will provide me with the data I need to be able to decide. I am super sensitive about weight gain, having dealt with anorexia as a younger girl, and depression (been there, too). I guess I'll figure out what my risks are and go from there. Can you think of anything I should specifically ask?
Thanks, Ann
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Omg! you and I had our surgeries one day apart except I went with Lump and Rads. Started Tamoxifen on Feb 1st..
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I went for a second opinion because I tried the Tamoxifen and had too many adverse effects. The MO had me stop the med immediately and gave me some good evidence suggesting that I may be over treated. There were a lot of reasons, some good, that my first MO and BS wanted me to try the med, but at the end of the day my margins were very good, no invasion and risk was estimated at 12-13% of a new primary with 1-2% risk of recurrence. The numbers didn't justify an impaired quality of life.
That is my individual case.
I am very comfortable with not taking the medication.
Edit to add: My MO also encouraged continued exercise and controlling my weight as equally effective steps to take to control my risk.
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I understand how you feel Skiergirl. I wonder how many of us with bc have struggles with eating disorders? Ask the doc how much benefit you'd get from the Tamoxifen in your particular case. Does your doctor know you have eating disorder/depression issues? That's an important thing to discuss with him and see if he thinks the benefits outweigh the risks, since anorexia and depression also carry very serious risks and consequences. Maybe he'll want you to try it for awhile and see how it goes. If recurrence is something that you'll tend to be anxious and worried about a lot, that's something you'll need to take into consideration also.
I just had a lumpectomy for grade 3 DCIS with necrosis and am only having 4 wk. of radiation without any drugs. I'm not worried about recurrence, but we all react differently to the situation.
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Lily-- long time ED sufferer here. I will most likely need to go on tamox since I am strong e+p+. If weight gain is a side effect, I know I will have issues. I have had anorexia since I was 13-- now 45. It is under control ATM, but you *know* how tenuous it can be.
I also have depression and anxiety issues and am on zoloft and xanax. *sighs*
thanks for such good questions and advice. But why does it seem the more I read, the more everything seems to get more wonky?
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Hi faerywings, Lifelong ED struggle also here . Sounds similar to you - stabilized for several years with the occasional minor slip - also on Zoloft in addition to Buproprion for depression. I hate that so much of bc treatment can possibly cause weight gain. As if there's not already enough body image issues to deal with.
Even with radiation I'm dieting because I'm concerned about how exercise level will be affected. Didn't help that the nurse said, don't kid yourself, you WILL get tired during rads (not the thing to say....some people whiz through treatment and don't get fatigue.). Getting off estrogen replacement adds to the mix. Picked up a few pounds and am not waiting until it becomes an issue to take them off because then that triggers the ED. You know how that cycle goes. Met with a nutritionist that said I could safely diet during rads if I don't go under 1300 calories a day, and eat healthy. As long as it's not more than 1/2-1lb. a week weight loss.
Maybe it would work for you to be proactive and plan a healthy diet ahead of time and have a contingency plan worked out with your doctor in case you start gaining weight? Set some healthy weight maintenance plans ahead of time so you don't get taken by surprise and fall into the ED trap. But you may luck out and find you don't gain weight on it at all. I know what you mean about reading stuff! Too much to think about.
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For what it's worth, I've struggled with my weight most of my life and haven't found anything changed in that area after 10 months on Tamoxifen. Losing takes the same huge amount of effort as it always did, but I haven't actually gained anything other than the normal winter few pound gain, which I'm already getting rid of.
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Annette-- great news! Good luck with that!!
Lily- I have a feeling you will understand this. Your post made me more anxious of dx and tx than the drs did! Not b/c of anything you said, but it made me really think about body image/weight-numbers and omg-- the loss of control. You are right, I should be proactive. I always eat better in the spring/summer months. Winter is tough b/c I crave carbs so much, but man,I hate when I get on my scale and see those winter pounds (Bad Faery, on the scale!)
I might end up bugging you as i go ahead with all of this if the ED gets the best of me. I hope you don't mind.
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faerywings, You won't be bugging me at all! I definitely don't mind. Dealing with an eating disorder makes treatment a lot more of a challenge. I may be bugging you! LOL Yes, winter brings on the cravings for sweets and fruit is slim pickings this time of year.
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Lily--
Reach out any time!
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Thanks faerywings! :-)
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I was diagnosed with DCIS in my left breast in November, a few weeks after my husband of 13 yrs informed me that he wanted a divorce. It's been very stressful. I opted for a mastectomy/reconstruction for peace of mind and to avoid radiation. I was told originally that I would be put on tamoxifen for 5 yrs but after final pathology showed ER negative my oncologist told me that it would not benefit me. I am confused. Is it good that I'm ER neg and can't take it or does the ER neg mean I don't NEED it???? After hearing about all the side effect I'm even more confused if I should be happy about this news.
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Giabellasmom, it's true that tamoxifen is not used for those who are HER negative, but there ARE treatments available. The article Treatments for Hormone-Receptive-Negative Breast Cancer at the main Breastcancer.org site will give you more information, until you hear from other members with their own experiences.
Best wishes,
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