Has anyone changed Dr's?

Hi InStitches:

Regarding your post-menopausal friend with DCIS, it is frustrating that she received a referral when you cannot get one. However, it is not surprising to me that tamoxifen was prescribed to her. It is conceivable that the same thing would be recommended to you by an MO. As noted above, tamoxifen is routinely prescribed to post-menopausal women with DCIS in the risk reduction setting. In post-menopausal women, consideration of a variety of factors, including risk/benefit profiles, will be factored in when choosing from among tamoxifen, raloxifene, or an aromatase inhibitor (either exemestane (Aromasin) or anastrozole (Arimidex)) for risk reduction purposes. Very generally, the guidelines favor tamoxifen over raloxifene in this setting (although in any particular case, this may not be so). Moreover, tamoxifen is FDA-approved for risk reduction purposes (the labeling of the drug reflects use in the DCIS setting). As for the two aromatase inhibitors, while considered an available option under the guidelines based on the MAP.3 and IBIS-II studies, they do not appear to be FDA-approved for breast cancer risk reduction (based on the quote I provided above). However, I think in view of your diagnosis of both LCIS and DCIS, you are looking for a more in-depth discussion of whether an aromatase inhibitor might be a suitable or even preferred choice in your particular case.

Do you know if the MO is requiring a referral because of some practice within their office, or because your insurance requires a referral? In the latter case, you could contact your insurer to explain that the breast surgeon has made a recommendation for endocrine therapy, but that you would like a second opinion from an MO, and what steps do you need to take to get one.

BarredOwl

". . . Then I called both my BS and RO office to ask about getting the referral. Finally, the nurse with my RO office called me back and said that was in the BS's court and that apparently he was not going to refer me to an MO."

Like InStitches, I initially read this as a refusal emanating from the BS's office following a direct request to the BS's office for a referral. But I think 614 has a point. It is an assumption on the part of the nurse from the RO's office that a referral is not forthcoming. It is worth another call to the BS's office to inquire, since the ball is still in his court. Inaction (so far) on a request for a referral is not the same thing as a refusal to refer.

Good Luck!

BarredOwl

Why can't your GYN refer you

Dear Wendy:

I am so sorry that your first oncologist treated you that way.  Some doctors have truly awful bedside manners.  I am glad that you found a new doctor.  Good luck.