LCIS and Evista

I was recently told that Evista was not proven to work with LCIS, but was with DCIS.  I was hoping to be able to take Evista, as I had horrible gastro SE's with Tamox and Arimidex.  My LCIS was discovered along with an IDC tumor.  I had a lumpectomy and rads, as well as a total hysterectomy many years ago.  I need to go back and find the studies that were quoted.

Any other info would be great on the effects of Evista on LCIS.

Thanks,

Bren

This is the info I was referring to:

LCIS
First the facts, briefly: for stage I-II breast cancer such as yours, local recurrence occurs in approximately 10%-20% of patients treated with BCS (breast-conserving surgery, aka lumpectomy), which is significantly reduced by postoperative radiotherapy, but the reduction is primarily a reduction of ipsilateral - not contralateral - breast tumor recurrence.

As to LCIS, its biological significance as a "risk indicator" versus a "breast cancer precursor" has been a matter of considerable debate. Note that the risk indicator nature of LCIS is not in dispute - in fact, it is widely accepted that LCIS confers a modest increased risk of development of invasive carcinoma of about 1 to 2% per year, with an 8-year risk of about 4.4 - 4.7%, 10-year risk of between 7% and 8%, a lifetime risk of 30 to 40%, and a relative risk of breast cancer of 8 to 10-fold.

Now, as to the balance of the latest evidence, it suggests:

1. That LCIS is both a risk indicator and a non-obligate precursor of invasive breast cancer; what this means is that LCIS should be considered a predisposing determinant of risk for subsequent invasive disease in either breast, but as a non-obligate / non-inevitable precursor the development of subsequent invasive carcinoma is not assured, although its risk is elevated, and the invasive carcinoma, should it develop, is not necessarily assured to be of lobular histology.
2. Nonetheless, as a preneoplastic state from which progression may not be inevitable, LCIS is in general a reversible condition of low biologic potential and typically slow progression to invasive cancer if any.
3. Local recurrence risk (LRR) varies somewhat with tumor size, with tumors > 3cm sustaining higher risk, and with young age (< 50) being an independent significant factor.
4. Risk reduction with unilateral mastectomy is only modest, and it is for this reason that PBM (prophylactic bilateral mastectomy) needs to be considered an option for selected patients, based on the cumulative weight of all risk factors.
5. The landmark NSABP P-1 Study established that progression to invasive disease seems to be significantly inhibited by the use of tamoxifen.

A Warning
Now. although the standard of care with LCIS is currently close follow-up together with chemoprevention via tamoxifen, the recommendation of your PCP to deploy the other SERM, raloxifene (Evista) instead of tamoxifen is in error and wholly against the evidence, and would lead to a false and dangerous illusion of preventive value: as decisively shown in the recent STAR trial, one of the largest breast cancer prevention clinical trials ever conducted, raloxifene (Evista) is of no significant benefit of risk reduction in LCIS; while tamoxifen was been shown to reduce by half the incidence of both LCIS and DCIS, raloxifene (Evista) did not have any appreciable effect on these diagnoses. And this result confirms data reported earlier in 2004 from the large CORE study of raloxifene (Evista). And, unlike tamoxifen which is chemopreventive in both premenopausal and postmenopausal women, raloxifene (Evista) is sanctioned, and of value, only in the postmenopausal setting.

Anne,

Thanks for your post.  I get it, kind've like an "aha" moment.  You're right, I can't prevent what I've already got!  Never looked at it that way before.  I did have LCIS, DCIS and IDC and sure don't want the latter two back. 

I was really dreading having to try Tamoxifen or Arimidex again.  My doc had suggested Evista.  How long have you been on it and how are you doing with it?  Any gastro SE's?

Thanks again for your point of view. Appreciate the "aha" moment.

Bren