Hormone therapy vs. mastectomy?
Hi All--
This is my first post, so I hope someone will redirect me if I'm asking this question (the first of many I'm sure), in the wrong forum.
I was told yesterday that I have IDC. I don't have much info yet, but will meet with a panel of doctors this Friday to discuss treatment. I had a hysterectomy last October due to large fibroids. I chose to keep my ovaries because I'm only 44 and wanted to keep my girlie hormones. I don't know yet if the tumor is hormone receptor positive, but I know the chances are that it is. I'm really afraid of menopause. My question is this--if it turns out that the cancer has not spread beyond the breast, and I were to have a double mastectomy, would I still have to have the hormone therapy? Does it sound crazy that I'd rather keep my hormones than my breasts?
Thank you.
Comments
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They don't have anything to do with each other. A mastectomy or a lumpectomy plus rads get rids of the cancer IN the breast NOW. After a breast cancer is removed, if a breast cancer is found to be hormone-receptor-positive, it means that it has these hormone receptors, which act like ears or antennae. When estrogen in the body attaches to the receptors, the breast cancer cells respond to signals from the estrogen that tell the cells to grow and multiply. Lowering the amount of estrogen or blocking its effects reduces the risk of an early-stage, estrogen-receptor-positive breast cancer coming back AFTER surgery. So you take the pills to reduce your risk of the cancer coming back in the FUTURE. For me, taking Arimidex for 5 years reduced my recurrence chance by 40%....what I did surgically had nothing to do with that statistic.
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First and foremost menopause is no big deal. Not a fun time to be sure but for me it's mainly hot flashes and even those are manageable. Of course every woman is different. Don't know about hormone therapy. That will b your doctor's decision. You still don't have enough info to know. My sister has ILC and she had a MX. She dodged treatment but takes Arimidex.
Gotta admit if it came down to breasts vs hormones, hormones would b a distant second. But that's me.
Good luck - keep us posted.
Diane
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Forgive my naivite, but do I understand correctly that even if the breasts are completely removed and even if there is no sign of cancer in the lymph nodes, there can still be breast cancer cells elsewhere in the body--either now or later down the line? (Am I making sense?)
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Iwannacookie: There is still so much information that you do not have. Once you gather all the info about your particular breast cancer, your choices, recommendations, etc will help you to decide what is best for you. And no, your preferences and priorities are extremely important and have absolutely nothing to do with what others think or believe. There is nothing crazy about it!
You will learn what the actual benefit of using an anti-hormonal is for you. If it reduces a chance of a recurrence by a huge margin, then you may want to look at this option a bit closer. But often the actual benefit may be quite low, depending on your situation. It is impossible for you to make that decision without more info. Try not to stress about this until you need to face it as given whatever your dx is, it may not even become an option. Why worry for nothing. You will have more than enough to worry about. Lol
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Thank you all for responding.
You are right--I shouldn't borrow trouble.
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Iwanna -- Cutting off your breasts won't help you avoid chemo or hormonal therapy. It is a very specific treatment for women who have a generic predisposition to breast cancer, or whose breast cancer is large, or is in multiple places.
Right now, mastectomies are sort of like C-sections - everybody's doing them. But you really should consult with your breast surgeon as to what is right FOR YOU.
For most women, a lumpectomy plus radiation is much easier on the body, and has fewer long-term consequences.
Good luck - you are in the time frame that sucks. Once you and your docs have agreed on a treatment plan, it gets much easier -
iwannacookie - if you are not currently menopausal, and have estrogen receptor positive IDC, you would most likely be advised to take Tamoxifen in addition to whatever surgical/radiation treatment you are offered. Tamoxifen blocks estrogen from the receptors on breast cells, but does not interfere with circulating estrogen in the body. It is given to pre-menopausal women because estrogen does beneficial things for them, including protecting the heart and bones.
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I agree with TB90. Wait until you have the facts on your own personal diagnosis.....research your options from there. There are too many variables to make a blanket statement and say that everyone should do X, Y, or Z.
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I agree with everyone. You simply don't have enough info yet.
I'm a broken record on a couple things. You don't have to rush into anything. It's fine to say you need time to think and digest information.
Also, it's your body. You are in charge. That big group of doctors are there to make sure you understand your options, but they can't tell you what to do. They can suggest and explain.
Much love,
Rebecca
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No one here are medical staff seeing you in person so can not tell you what you will be doing. We are each unique as are our Drs. We can tell you our personal experiences but can not say what you will.
There are MANY horror stories about going through menopause - those are not true for all of us. I have never had a 'hot flash' and I went through naturaly menopause at 44 (DXd IBC at 63). I have been on Femara/letrozole for 4 1/2 yrs for ER+/PR- and have never had a 'hot flash' on it either. As I understand it very basically - Estrogen blockers are to prevent cells from picking up estrogen to feed/fuel them. Post menopause (natural or surgical), our bodies do produce estrogen and we get it in many foods. Different meds are used for different ones of us. You do not have to be Stage IV (metatstaic/ spread to other areas), to be on Hormone Therapy - it is related to your original DX.
With some types - neoadjuvant chemo (pre-surgery) is now being recommended to shrink the 'monster' but with others of us,t is a necessity. There are no absolutes no matter what the TX plan will be. Talk to your Drs before you start 'borrowing' problems that don't exist (or assuming they will).
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Hi Iwannacookie, this is not one OR the other but rather one AND the other. It is too early to speculate what you will be advised in terms of hormonal therapy. Many women get hormonal therapy after BC diagnosis and even though you see a lot of complaints about side effects the majority of women taking hormonals are fine and have only minimal side effects. For most of us the benefits far outweigh the side effects and libido is fine.
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You all are wonderful! It's amazing how quickly one can amass so much new knowledge. I have learned so much from you and from reading other threads here. Today I received the news that I'm ER and PR+, HER2 -. I was originally/ignorantly fearful of being hormone receptor positive, but now I realize that it's actually a good thing. Heck--I'm going to have to go through menopause at some point anyway. The other concern I had was about taking Tamaxifen because I wouldn't be able to continue taking the particular antidepressants that work so well for me, but today I learned that there are alternatives to Tamaxifen that wouldn't be affected by them. At this moment I am feeling much more optimistic. Thank you.
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I do not take any anti-depressants , but I do know there are some here do take them AND are on estrogen blockers/AIs. I'm sure some will post.
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Yay! I'm so glad you're feeling more in control! And, yes, being ER positive gives you so many treatment options!
I had already gone through menopause but I hope more women will post here that are in a similar situation regarding that.
Much love to you! Keep us posted!
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mastectomy can be brutal on your emotions, given the choice i would take anti hormonals.
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Tamoxifen won't shut down your ovaries or hormone production. It will just "block" the estrogen receptors in the breast cancer cells so they don't have the "food" that they thrive on. Some women do have unpleasant side effects, but many don't or have more tolerable side effects.
As others have said, it is not a one or the other decision. Tamoxifen is taken to reduce risk of recurrence (either local or distant, such as in organs or bones). It can also be take on as a preventative for new primaries, and so is sometimes taken by high risk women who have never had a breast cancer diagnosis. Surgery itself just removes the tumour; it does not affect risk of distant recurrence. Lumpectomy + rads and mastectomy have similar recurrence rates though mastectomy may reduce risk of local recurrence or new primary (but it is not foolproof, as local recurrences/new primaries can still arise).
Your oncologist should review with you your recurrence risk and how treatment options affect it. You DO have a choice, but it needs to be an informed one.
I am sorry you need to be here, but there is a lot of information and support so you have come to a good place!
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DiveCat, et al--I get it now. I understand that having a mastectomy and undergoing hormone therapy are not mutually exclusive. And I am better informed now about what the drugs are and how they work--my fears have been somewhat allayed...for the time being.
Thank you all!
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I was shocked to learn after my double mastectomy that I would need hormone therapy. Surgeon told me I was cured and would not need anything else. Yes, menopause for me sucked. It sucked when I went through it the first time and again with the hormone therapy. I still cant come to grips with taking arimidex and then taking more drugs to counteract the side effects...for this I do go to therapy.
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