Why not hormonal treatment to shrink tumor before surgery?

rokel · August 2017

i'm scheduled to have a mastectomy this week and I'm told I will be on tamoxifen for many years after. I'm just wondering why I wouldn't be put on tamoxifen before surgery to see if it could shrink the cancerous areas. I have a small area of IDC and a larger area of dcis which is why I could not have a lumpectomy but I really don't want this surgery. I haven't seen an oncologist yet, only a breast surgeon

Racy · August 2017

Welcome, Rokel. I can't answer your question with authority but at the very least you could seek a second opinion from another surgeon.

How large is the DCIS, how large is your breast and what age are you?

I urge you not to proceed with an option you are ubcomfortable with until you are convinced it is the only option.

Have you had a consultation regarding reconstruction options?

I hope you get the answers you need soon so that you can proceed on your treatment path with confidence.

Mucki1991 · August 2017

if you are really interested in options for shrinking the tumor you should meet with a medical oncologist before deciding on surgery path. I did not get with an oncologist first and it may have changed my surgery if I had. Also I have been told I should have gotten chemo first instead of surgery by my oncologist that I have now. Explore all options, for some surgery is not a very painful for others like myself it can be a tough road. It's a huge decision and you have time to explore all options. Don't feel rushed into a surgery

Best wishes for you

rokel · August 2017

thank you both. I am 37 with two little kids.I have gotten two opinions from breast surgeons and three opinions from plastic surgeons for reconstruction. Both breast surgeons said lumpectomy was not an option for me due to the multi-focal nature of my disease and I have very small breasts. The area of idc is at 12:00, dcis is at 3:00. I had not considered going to see an oncologist first until someone mentioned it the other day and now Im wondering if I should have. I've already delayed this surgery once though and am anxious to delay any longer, but really hate this surgery.

Michelle_in_cornland · August 2017

Probably time to have the surgery. Mastectomies are very normal for scattered site invasive breast cancer and DCIS.. The longer you wait, depending on grade, the larger an area it can become. With 5 opinions on the matter, there is a consensus. Chemo is generally used with triple negative or triple positive cancers, and later stage cancers. Chemo can shrink the tumor site. I understand your fear, but once it is done, no more mammograms. I am weighing all my options right now, one year post lumpectomy. You are young, do as much as you can.

rokel · August 2017

Thank you. Only two opinions were breast surgeons. The other three were plastic surgeons so just gave their opinions on reconstruction and have no opinion on whether to have a mastectomy or not. I will still have to have mammograms (actually MRI) because I'm just having a single mastectomy and will have to monitor the (very dense) non-cancerous breast. Still I think you are probably right, I just worry that I may have been given a different option if I'd thought to see an oncologist earlier

debiann · August 2017

I have never heard of hormone therapy to shrink the tumor before surgery. Perhaps it would not work quickly enough? Some do get neo-adjuvant chemo (before surgery) to shrink tumors. I believe there are two tests, Oncotype or mammaprint. which will determine if you need chemo. To set your mind at ease, you may want to try to see your oncologist prior to surgery.

If you have a lumpectomy you will also need radiation. For some who are node negative, depending on the location of the tumor, radiation can be skipped if you have a mastectomy. Many have no complications from rads, but some have life long side effects, so its something to research before you make your decision.

KBeee · August 2017

Do a web search for neoadjuvant hormonal treatment. I have read clinical trial info on it; I just don't remember the site off the top of my head.

I would recommend meeting with a medical oncologist to discuss all options

Kicks · August 2017

To me, it only makes sense to see your entire TX Team and get the suggestion from the Tumor Board at the Facility before jumping into TX. Surgeons are only part of the Team and their expertise is, basically, cutting. Medical Oncologists (Chemo Dr) expertise is in Chemo. Radiological Oncologist (Rad Dr) expertise is with radiology. The 3 are all part of the Team and should be working together for best ultimate outcome for each of us - not just doing 'whatever'. Each has there own speciality and while they do intertwine, no one of them is the expert in all.

In my case, I saw my Surgeon on Mon, my Rads Dr (RO) on Wed and Chemo Dr on Thurs.

Hopeful82014 · August 2017

Neoadjuvant treatment with hormonal therapy is commonly used in Europe and the UK. It is occasionally offered in the US but not very frequently.

Neoadjuvant chemotherapy is, as others have suggested, another option. I'd recommend seeking the advice of a good oncologist.

Michelle_in_cornland · August 2017

Rokel, was there any discussion of you having chemo to shrink the area? I don't see any indications for chemo, based on the information that you presented in your description. If I were your age, and it were me, I would have the double mastectomy and immediate rebuild. I would also get back to living my life as fast as possible. If I ever need to have a single mastectomy, I am doing both for a matched set. It does get old dealing with mammograms. I am not sure if oncologists doing yearly MRI's on mastectomies. For some reason, I did not think insurance companies paid for that.

rokel · August 2017

thank you so much for your replies. The first doctor I saw after my diagnosis was a breast surgeon at Sloan Kettering at the suggestion of a friend. I asked him if I should be seeing an oncologist and he said to wait until after surgery. He said I should not be on chemo at this time because my tumor is her2 negative, but that I may end up on chemo after surgery depending on lymph node involvement and oncotype score. I would definitely be put on tamoxifen (80% er, 50%pr).

Now that I'm researching neoadjuvent endocrine therapy (thank you for the correct term!) I'm wishing I had been put on tamoxifen first. It's been two months since my diagnosis and I could have been on it this whole time. The studies show it can have an effect after 4 weeks. I will ask my surgeon about this Monday and maybe delay surgery

rokel · August 2017

By the way, this seems to be an option for post-menopausal women, but neoadjuvent therapy doesn't seem to be an option for pre-menopausal women.

NotVeryBrave · August 2017

I would definitely see a MO before surgery. You may or may not need chemo - many times they do wait until after surgery - but you should still have a MO involved, even if you are only prescribed Tamoxifen afterwards. With both DCIS and IDC, I'd feel better having their opinion.

Hopeful82014 · August 2017

Rokel, for what it's worth, I met with surgeons (3), MO and RO prior to surgery and am glad I did. The range of perspectives was very helpful. As you go through this process, keep your mind focussed on the fact that none of them are infallible AND that none of this is about their preferences or convenience. It't about your health and happiness.

Falconer · August 2017

Rokel, it looks like we might have a similar diagnosis, IDC with DCIS, ER/PR +. I didn't meet with an MO until after surgery, but I did see a radiation oncologist, who basically said, we won't know until after pathology. I didn't start hormone therapy until 6 months after I found the lump in my breast. I sometimes wonder why. Everything seemed to be a hurry up and wait situation. My BS did bring my case to the tumor board at the hospital, and I believe an MO is on the board, and they were in consensus about the treatment plan. Of course, I'm only a year out, but I will say that in the three months from diagnosis to pathology following surgery the tumor had stayed the same size and I had only micromets in one lymph node. I did not have chemo as my oncotype score didn't show a benefit, which may mean that the cancer cells are of the slower growing kind. I too have a young child so I understand your desire to do everything to keep the bc at bay. Best to you as you travel this road.

rokel · August 2017

Thanks so much everyone. My friend set me up to talk to an oncologist last night and she confirmed that seeing oncologist would not have change my treatment plan. She said I have a "busy breast" that they see in a lot of young women with this disease. Even though tamoxifen would shrink the cancerous cells they would still have to do some kind of surgical procedure on the DCIS and there are too many areas to operate on. It was a really helpful conversation and I feel more confident going into this procedure having all the information.

Why not hormonal treatment to shrink tumor before surgery?

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