If I have BMX will I still need Tamoxifen?

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Saighin
Saighin Member Posts: 4
edited October 2017 in DCIS (Ductal Carcinoma In Situ)

I'm 38. Diagnosed last week with highly HR+, Grade II DCIS with necrosis. That mass doesn't appear to have infiltrated, but we're also not sure yet if it's the only one; mammogram shows what may or may not be other smaller clusters of microcalcifications deeper in the breast that because of how dense my breast tissue is are hard to distinguish clearly right now I'm meeting with the breast surgeon on Wed to see what we do next, but after lengthy discussion with my family & GYN, have already made the decision that due to family history (mother passed from HR+ HER2+ IDC & ILC) and other factors, I've already decided that I'll be pursuing requesting bmx.

I know that with HR+, it is pretty common to also treat with Tamoxifen. If I have the bilat, tho, how likely is it that I will need hormone blocking treatment as well? The side effects would potentially keep me from returning to my current career path.

I will do whatever I need to, I'm certainly not going to refuse treatment. I just wanna kinda be prepared for what I might be looking at here.

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  • Peacetoallcuzweneedit
    Peacetoallcuzweneedit Member Posts: 233
    edited October 2017

    Hi Saighin -

    I am sorry you find yourself here and for the loss of your mom...

    Typically when you have a lumpectomy --> the path is radiation and Tamox or AIs, but also with BMX and resulting pathology treatments can change and there are women who take Tamox after bilateral mastectomy. I am not sure if you are ER+ and PR+ for your DCIS? The final pathology will be the decider about further treatment. In my case, so far no hormone treatments/blocker were recommended. I am still gathering more opinions though. I would say discuss your concerns with your cancer team hopefully including a breast surgeon and a breast oncologist.

    There is a great info page about DCIS and treatment - let me see if I can find the link...


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  • Peacetoallcuzweneedit
    Peacetoallcuzweneedit Member Posts: 233
    edited October 2017

    http://www.breastcancer.org/treatment --- see if this helps and you may know most of it because of your mom...sorry if it is repetitive to you...

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  • Saighin
    Saighin Member Posts: 4
    edited October 2017

    Both. ">90% ER+" & "81% PR+".

    Thank you for responding, btw :-)

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  • ksusan
    ksusan Member Posts: 4,505
    edited October 2017

    Lots of women who had ER+ tumors take Tamoxifen or (if older, usually) an aromatase inhibitor (AI) after BMX.

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  • Legomaster225
    Legomaster225 Member Posts: 672
    edited October 2017

    I have bilateral BC and had a BMX in June. I am finishing rads tomorrow and starting tamoxifen in 2 weeks. My larger tumor was 23%ER the other side was 100%. Hope the tamoxifen works until I switch to an AI. Maybe your plan will be different but tamoxifen was always the plan for me

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  • Annette47
    Annette47 Member Posts: 957
    edited October 2017

    If you have any invasive cancer (as did several previous responders), then Tamoxifen is recommended after a BMX to address any cancerous cells that may have escaped the breast. By definition, that is not a possibility with pure DCIS, so if your diagnosis following pathology from the BMX remains pure DCIS, there is little reason that you would be given Tamoxifen as any remaining breast tissue (which would be the only concern) would be minuscule and the benefits would be outweighed by the risks.

    That said, your treatment decision are up to you - even if for some reason they recommended it, you could always decline. If your diagnosis remains pure DCIS and they still recommend it after a BMX I would question them as to exactly why they think you need it though, as I explained above it isn’t usually necessary. I had a lumpectomy/radiation for DCIS with a tiny micro-invasion and my oncologist was still somewhat wishy-washy on whether Tamoxifen was a good idea - he left it up to me.

    What side effects are you concerned about that would interfere with your job? The only one I’ve noticed after 4.5 years on it that can definitely be chalked up to the Tamoxifen is a light clear vaginal discharge. Everything else, hot flashes, bouts of insomnia, etc., are all thing my friends who are the same age but not on Tamoxifen are experiencing, so I tend to think they are more due to our being perimenopausal (I was 45 at diagnosis, 50 now).

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  • aussielovergirl
    aussielovergirl Member Posts: 46
    edited October 2017

    I was under the understanding also that if you have DCIS and get a bmx you don't need the tamoxifen, or anything else either.

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  • ksusan
    ksusan Member Posts: 4,505
    edited October 2017

    I was told I might need radiation on the DCIS side, though the tumor board decided I wouldn't need it there.

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  • Annette47
    Annette47 Member Posts: 957
    edited October 2017

    Radiation is occasionally needed even after a BMX for DCIS if the margins aren’t considered large enough. The goal is still to prevent a local recurrence. I suppose in that case Tamoxifen might be offered, but very rarely.

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