ER/PR positive, and surgical menopause

Hi Mommyathome.  My cancers were ER/PR positive.  I had to have a mastectomy and was put on tamoxifen.  My oncologist and gynocologist were in agreement that I needed an oopherectomy due to changes in my uterus that indicated I was possibly precancerous.  They took me off of the tamoxifen and put me on an aromatase inhibitor after my oopherectomy.  I was 47 at the time and had not entered menopause.  I was not given any estrogen to help deal with any of the menopausal symptoms.  I doubt that it would be a good idea to take estrogen.  I definitely would not take it without talking to your medical oncologist first.

Since she had DCIS, rather than invasive cancer it does change some of the recommendations and reasoning.    When Tamoxifen is prescribed after a BMX, it is for two reasons - to protect against a recurrence in the tiny amount of breast tissue left, and more importantly in the case of invasive cancer to protect against any possible distant recurrence that could be sparked by escaped cancer cells.   With pure DCIS by definition, the cancer cannot have escaped the breast, so the most important reason for taking Tamoxifen is no longer relevant.   With the chance of a recurrence in the remaining breast tissue so low, it is often thought that the risks of the Tamoxifen are greater than the risk of a recurrence, so in many cases, it is not prescribed in that situation.    

This is also relevant towards the decision to chance estrogen replacement treatment or not - in the case of invasive cancer, even after a BMX there would be a risk of feeding stray cancer cells that may have escaped.   Not so with DCIS - the risk is solely with the remaining breast tissue.   I would suggest discussing it with both your MO and your GYN to decide on how big that risk is, and how bad the side effects of surgical menopause are likely to be to decide whether it is worth taking the chance of encouraging a local recurrence, especially given that 50% of the time when DCIS recurs, it recurs as invasive cancer.   Only you can make that decision, but your first step should be gathering all the information as to relative risks so that you can make an informed decision.

Best of luck with whatever you decide.

I'm looking at the same decison re HRT after BSO (BMX already done in March with only a DCIS dx, ER/PR postive just like original poster).

In terms of tamoxifen my understanding is that for women with DCIS who have BMX taking tamoxifen does not reduce the risk of recurrence (basically b/c the risk of recurrence is so low). I spoke with two MOs about this and they both agreed no tamoxifen. So I'm thinking if I take out my ovaries (which I'm doing for BRCA mutation) and then take estrogen I will still have significantly less estrogen than I did when I had my own ovaries, and no one was recommending I block the action of estrogen before my ovaries were removed. It's kind of driving me crazy! I don't understand what the objection is! Yes, I know I have a small amount of breast tissue left but the risk of a new primary in that tissue is very low. Risks of surgical menopause (heart disease, osteoporosis, dementia, parkinsons, lung cancer) are not negligible!

Thanks for any info anyone has to add to this discussion!