Postop mastectomy

Hi Lozz! You may want to go into settings and make your diagnosis and surgery info. public so it will show in the footer of each of your posts going forward. It will help others respond, esp. if the thread grows. It sounds like you already had mastectomy.... I'm glad you are pleased with what your BS was able to do. As far as the AI goes and whether or not to take such a med - what percent positive were you? I had, initially approximately 2.8x1.8x...? cm of DCIS Grade 3 comedo-necrosis that ultimately changed after surgery to 1.2 cm DCIS Grade 3 expansive comedo necrosis micropapillary and cribiform type with a host of other benign and precancerous stuff in a larger area. I had a BMX with SNB Aug.31. My ER was only 2% so basically negative so I was not open to an AI. I figured all the toxicity and likely no benefit, esp. with a BMX and no node involvement. Just sharing my experience. Talk with your BS and ultimately your MO. % Er is important to factor in.... BTW I'm going flat as well. There are many of us who are quite happy doing so... check out some of the other threads, breastfree.org, etc.

Microinvasions are more commonly found with grade 3 DCIS (as I had) but yes, I've seen other people come through here who've had a microinvasion with grade 1 DCIS.

As for the AI, there are three risk reduction benefits you will get:

First is an approx. 50% reduction in the risk of local recurrence. After a MX, your risk of local (in the breast area) recurrence is 1%-2%, so at most, taking an AI provides a 1% benefit.

Second is an approx. 35% reduction in the risk of a metastatic recurrence. With only a microinvasion, your risk of mets is about 1% - at least that's what my oncologist told me when I had a microinvasion. So that's less than a 0.5% benefit (basically what PREDICT told you).

Third is an approx. 50% reduction in the risk of developing a new primary breast cancer in your remaining natural breast. Having had breast cancer once, your risk to be diagnosed again is higher than the average woman. And you are soon to be entering the highest breast cancer risk years for all women - we are all highest risk to develop breast cancer between the ages of 60 to about 75. So the risk reduction benefit here, if you take an AI for 5 years (the benefit will extend for a number of years beyond that) is probably in the range of 3%-4%, or possibly higher, if your risk is higher based on personal risk factors.

What my MO explained to me is that for the DCIS-Mi itself, the benefit vs. risk equation for endocrine therapy (either Tamoxifen or an AI) doesn't work out in favor of endocrine therapy, simply because the risk after a MX and with only a microinvasion is already so low. But there can be significant benefit to endocrine therapy as protection of the remaining breast. But if you go ahead and have the other breast removed prophylactically, then you face a situation where the serious and qualiy-of-life risks from the AI may actually outweigh the small risk reduction benefit you would get from the AI. Now of course all this is based on my personal experiences and discussions with my MO, as well as what I've seen in posts from others here who've had a DCIS-Mi diagnosis. If you have not done so, you should have this benefit vs. risk discussion with your doctor.

And I agree with MinusTwo, with the microinvasion, and for a discussion about endocrine therapy, you should be seeing an MO.

Thanks for checking back in! Glad you are finally healing and mending better. Please let us know either just before or at some point after surgery so we know how you're doing. Sounds like you are quite comfortable with all your decisions related to surgeries. That is soooo important!