Hi Bunkie, no, I was not tested. I was asked if I wanted to be tested, so I could participate in the Herceptin trial, but I opted out. Since there is more evidence that ER- women have a different molecular (mainly genetic) signature than ER+ women there are some clinicians who are testing for HER2; but as of right now it doesn't change treatment decisions, so there is little gained. I think you have 6 months post surgery to sign up for the Herceptin trial ... and if you want to know your HER2 status that would be one way to find out!
Beesie, I'm sure I've posted this before but after two biopsy's and a BMX, all I know is that I'm ER+. I assumed MSK would at the very least give me PR results. I was not asked but I should have insisted they do the HER2 test. I went into my BMX knowing I had DCIS (high grade) in right and ADH in left but my final pathology report also showed LCIS and ALH.
I was just diagnosed with "High Grade DCIS" from core VAC needle biopsy. The specimen(amount of tissue taken for biopsy) was only 0.25-2.5 cm. There is nothing palpable in the breast, it was found on mammograms as calcifications. Surgeone said it was the size of a grain of sand. So if it is that small, why is it considered High Grade? It is ER/P positive, but there is no other detail in the pathology report other than there was also necrosis and microcalcifications.
Shouldn't I have a lumpectomy to further determine the biology of the cancer? They are all ready to go forward with lumpectomy/radiation or mastectomy as options. If I choose the latter I want immediate reconstruction. I hate to plan all this and wake up from anesthesia only to find out I couldn't get reconstruction right away because cancer is invasive and radiation is a must. Please help with this.
Tozie, Ultimately the decision is yours to make. Here you will find personal experiences and lots of great information. I had high grade DCIS with necrosis on my right and went for a second opinion. I was then told that my left side also needed a biopsy and it was determined that I had pre DCIS on my left. My choices were lumpectomy/radiation and tamoxifen, or mastectomy and the decision was easy for me to make. My final pathology report (post BMX) showed LCIS in both breasts plus more pre DCIS and pre LCIS. I've struggled with the reconstruction due to doctor error, but I still have no regrets and I have learned A LOT about the process.
I think that if the area is small, you MIGHT want to do a lumpectomy first, to see if, in fact there is more going on, such as invasive ductal carcinoma (as you stated, the "biology" of the affected area). Then you can make an educated decision as to whether to have a mastectomy or not. One can always move from lumpectomy to mastectomy, but obviously, not the other way around. You are not at all obligated, after doing the initial lumpectomy, to then proceed to radiation. You can, instead, move on to mastectomy, knowing (as well as possible) what you are likely to be dealling with. If the thought of doing more than one surgery is unappealling, and you just want to put almost all risk behind you, then maybe the mastectomy is the way to go. Beesie has written an excellent unbiased piece on the decision-making process (pros and cons). Look it up under her name. There's probably nothing better out there in the literature.
Let me refer you to a different discussion thread in which I posted the information that ballet12 mentioned (thank you!) about the pros and cons of a lumpectomy vs. mastectomy vs. bilateral mastectomy. Topic: Bilateral Mastectomy Decision It's my second December 7th post in this thread.
To your comment about why your DCIS is considered high grade when it appears to be so small, the grade of DCIS actually has nothing to do with the size of the area of DCIS. Generally large areas of DCIS are more likely to be high grade but a small area of DCIS can be high grade too. The grade is based on how closely the DCIS cells resemble normal cells. In high grade DCIS, the "DCIS cells tend to grow more quickly and look much different from normal, healthy breast cells." You can get more information about the grade of DCIS on the BC.org site: Type and grade of DCIS
Normally a lumpectomy or mastectomy is the next step after a core needle biopsy, if cancer was discovered during the biopsy. However a common interim step is an MRI, for patients who have not already had one. MRIs often tend to show more than either a mammogram or ultrasound. This means that they may present a 'false positive', leading to unnecessary concern, and that's why they aren't used as part of an initial screening. But once breast cancer has been diagnosed, an MRI can be helpful to the surgeon as it may be more precise in showing the size of the area of cancer. My mammogram showed only a small portion of my area of DCIS but my MRI showed that my breast was full of DCIS. MRIs may also provide an indication if there may be any invasive cancer present. MRIs are certainly not precise in highlighting invasive cancer, or distinguishing between invasive cancer and DCIS, but they are another tool that might provide the surgeon with some additional information prior to surgery. The information from an MRI can help you with your decision on surgery. Here is some information about MRIs from this website: MRI Better at Finding DCIS Than Mammograms
As for the issue of reconstruction after a mastectomy and the possibility of needing rads, it's possible that rads could be recommended to you even if your final diagnosis is pure DCIS, if some DCIS is found too close to the chest wall. On the other hand, if invasive cancer is found, it doesn't necessarily mean that rads will be recommended. Normally rads will be given after a MX only if the cancer is near the margins or if there are several positive lymph nodes. The simple fact is that there is no way to know if rads will be necessary after a mastectomy until the mastectomy is done. The good news is that with a biopsy finding of only DCIS and with what appears to be a small area of cancer, it's unlikely you will require rads after a MX. If you are interested in learning more about rads and reconstruction, I'd suggest that you do a search on the Reconstruction Forum on this board - there have been many discussion threads on this topic - or post a question there.
Tozie, because this thread is a general information thread it doesn't get a lot of attention these days. Once someone has read through it, they often don't feel the need to come back. So I'd suggest that you may want to start a new discussion thread with your questions so that more of the DCIS women who come to this forum see your post and provide their input and suggestions, and so that your concerns are the focus of the discussion. Just click on "Start a new Topic" at the top of the main page of the DCIS forum.
Hi. I am now recovering from surgery. I am almost 3 weeks out. Very sore in my breast and under my arm. I am doing my exercises with my lymph node removal arm. Jan. 8th I will meet with my radiation oncologist. Based on my husband's many hours of research and many hours of talking I believe I will not do radiation or the tamoxifen. I am nervous about all of this but I feel the risks are so high with both for my specific diagnosis. 3.5mm, 2% growth rate, 100% estrogen receptor, 25% progesterone receptor. Any thoughts?
I have grade 3 DCIS. I had lumpectomy and couldn't get clear margins. Now scheduled for a mastectomy reconstruction. My surgeon agreed to nipple and skin saving mastectomy. But what about feeling? You mentioned that there are newer ways to do surgery to allow more feeling. What does anyone know about that?
Also, does anyone know anything about the testing of "molecular markers" and understanding whether DCIS would become invasive?
Linda, you might want to post your reconstruction question in the Reconstruction Forum. You'll get more answers there. Certainly with a mastectomy, even a nipple sparing mastectomy, you will lose most if not all natural feeling. Often some skin sensation is regained (I have a lot of surface sensation), but with nothing but an implant or fat under the skin, there's no way to have any feelings inside the breast. Here are a couple of threads in the Reconstruction Forum that you may find helpful:
Topic: Nipple Sparing Mastectomy with immediate reconstruction
Topic: Has anyone had micro fat grafting?
As for molecular markers and knowing whether DCIS will become invasive, there has been a lot of work already done on this and a lot more is going on, but there are no clear answers yet. There have been a number of promising studies that have suggested that they've found the trigger that will tell us if and when DCIS will become invasive, but at this point the learning is early and preliminary. If you look at page 2 of this thread, there is some discussion about a couple of the more recent studies. When I have more time, I will see if I can lead you to other threads where this has also been discussed. But for now, I'm off the board for New Year's.
Wishing everyone a happy and HEALTHY! 2013.
Can DCIS be cured with a combination of Hyperthermia and low dosage of radiation as offered by for example http://www.bichercancerinstitute.com/ or UCSF ? The top surgeons I have talked to (from UCSF, Stanford and Good Sam hospital) and asked them about hyperthermia did not either know much about hyperthemeria or said that Hyperthermia is good for advanced cancers. My questioin is if Hyperthermia is a viable treatment for advanced breast cancers, then why can it NOT be good for DCIS which is far less aggressive?
Thank you in advance,
DCIS and advanced cancers are different. Chemo, for example, is known to be less effective on DCIS. I don't know if hyperthermia would be effective or not, but if it hasn't been tested, I don't think it can be assumed to be effective.
DCIS is the one form of breast cancer that can be considered "cured" with surgery alone. This is because DCIS by definition (and based on current understanding) cannot travel to the nodes or enter the bloodstream. So if all the DCIS cells are removed from the breast and no rogue cells remain (and that, of course, is the challenge and the unknown), then the patient can with DCIS is 'cured'.
Beesie, if DCIS cannot travel to the nodes why did they do a sentinel node biopsy on both sides - right with DCIS and left with ADH. My final pathology report showed more but I was told going into my BMX that they would be taking nodes from both sides. As always, thank you
Not Beesie, but I'll take a stab at it.
My understanding is that once a mastectomy has been done, there is no way to do a sentinel node biopsy, so they are often done prophylactically in case something unexpected (invasive) turns up on the pathology. If they don't do the SNB with the mastectomy, then the only option should unexpected areas of invasive cancer turn up is to do a full axillary node dissection as without the breast, there is no way of determining which nodes are sentinel nodes.
This is what we were told anyway when my mother was diagnosed a month before I was, as she needed a MX. Hope this helps.
Annette, thanks for jumping in. Yes, that is the reason why SNBs are done on those who have DCIS. GreenMonkey, here's what's written in my original post at the top of this thread:
- Checking the lymph nodes, i.e. a sentinel node biopsy, is not required for those who have pure DCIS. However women who have high grade DCIS have a reasonable risk that some invasive cancer might be found in the final pathology; because of this, often an SNB will be recommended (note that it is current practice to check the nodes if any amount of invasive cancer is found). This is particularly true for women having a mastectomy because an SNB cannot effectively be done after a mastectomy. Sometimes doctors will recommend an SNB to women with high grade DCIS who are having a lumpectomy. Current treatment guidelines suggest that women with DCIS who have a low risk that invasive cancer may be found (i.e. those who appear to have a small amount of lower grade DCIS), do not require an SNB even if they are having a mastectomy.
The latest NCCN Treatment Guidelines have actually changed the wording a bit from what it was at the time that I wrote that. Now the treatment options they list for DCIS are the following:
- Lumpectomy without lymph node surgery + whole breast radiation therapy
- Total mastectomy with or without sentinel node biopsy
- Lumpectomy without lymph node surgery without radiation therapy
So the guidelines appear to be are clearer now that an SNB is not recommended with a lumpectomy for DCIS, regardless of the pathology. For those who have a masectomy, their notes go on to say "... a small proportion of patients with apparent pure DCIS will be found to have invasive cancer at the time of their definitive surgical procedure. Therefore, the performance of a sentinel lymph node procedure should be strongly considered if the patient with apparent DCIS is to be treated with mastectomy or with excision in an anatomic location compromising the performance of a future sentinel lymph node procedure." http://www.nccn.org/professionals/physician_gls/PDF/breast.pdf
So for those who have a MX, the SNB isn't being done because of the DCIS; it's being done because of the risk that some invasive cancer might be found and if that were to happen, an SNB wouldn't be possible later because the patient had the MX.
It is a different question as to whether an SNB is necessary when someone is choosing to have a prophylactic MX or BMX. Some women on this board have said that their surgeons have insisted that they do an SNB on the prophylactic side; others have said that their surgeons said that the SNB wasn't necessary. Personally, knowing the risks of lymphedema after even just an SNB, and knowing how unlikely it is to find invasive cancer (vs. a pre-cancerous condition or DCIS) when having a prophylactic MX, I would refuse an SNB if I was having a MX prophylactically or for a pre-cancerous condition. But in the end we all have to do what we think is best and what makes us the most comfortable.
I had BMX. Left breast was DCIS and a SNB was done. Right breast was prophylactic side and a SNB was not done.
thank you Beesie and Annette47 - yes, my DCIS was high grade.
Beesie...I just read your "encyclopedia" on DCIS and I am amazed at your knowledge! My head is spinning with all of the info! I was diagnosed with DCIS in September. Nuclear grade 2 of 3 with focal comedo-type necrosis. ER-. I had a lumpectomy in October which resulted in 5 out of 6 clear margins. Since then I have had 2 reexcisions of the inferior margin. The first one showed multiple foci of residual DCIS less than 0.1cm of new margin. The next reexcision showed a small foci of residual DCIS. Many women think I am nuts to want to try for one more reexcision. I guess since there was a single cell instead of multiple cells left the last time, I have in the back of my mind that one more reexcision would get it!! Your post confirmed what my physician said about the possibility of DCIS having a gap between the areas of cancer cells; which is one of the reasons for radiation. There are so many pros and cons for lumpectomy with RADS or MX. Now, if i go with the MX next, the plastic surgeon wants to wait to place the tissue expander 3 months after the MX, since I have had multiple surgeries! Apparently, multiple surgeries pose a higher infection risk. Thank you again for your informative post. There is one thing for sure, DCIS can be complicated and unpredictable.
This afternoon I was at UCSF to seek out hyperthermia as a potential treatment for my DCIS (grade 3 6cm wide). Firstly I actually came to know that my DCIS is 6cm deep from just the tip of the nipple down toward the chest as oppose to my previous assumption that the DCIS cells were spread horizontally and hence 6cm width.
The Radiologist oncologist at UCSF told me the following;
1) Hyperthermia can not cure DCIS because the type of DCIS cells is different than those of cancerous cells. Cancerous cells have responded to extreme heat and can be eliminated while DCIS cells can not, hence Hyperthermia will not be effective. I did not ask in details on the nature of the difference between DCIS cells and cancerous cells, and I was wondering if you can shed some light on this to better understand the USCF's explanation.
2) I was also told that hyperthermia works best when the cancerous cells are closer to the surface of the skin, and hence because my DCIS was 6cm deep, hyperthermia most likely would not be effective anyway.
3) i was told, no clinical trials have been done treating DCIS with hyperthermia. when I asked why, i was told because of #1 above, no one has bothered trying out Hyperthermia with DCIS.
4) When i ask them then why places such as Bicher institude ( www.bichercancerinstitute.com/) claim otherwise, I was told if they can provide published scientific studies that proves Hyperthermia cures DCIS then that would be great, otherwise testimonials (otherwise "hearsay") is not enough. I will be asking Bicher institute if they can provide such published articles for after all Dr. Bicher is considered to be the Father of Hyperthermia. I was told Bicher institute is doing something that is at the edge of medicine and it would not be something UCSF would do. UCSF is one of the 3 places in the entire U.S that has the most advanced hyperthermia machine (the other 2 places are Bicher Cancer Institute, and Duke University).
There are many testimonials on the success of Hyperthermia over mastectomy etc. by patients that have been treated by Bicher institute - but i have not been able to find any published article with supporting scientific data.
Now, here I am sitting and thinking and thinking as what to do. Should I go with Bicher institute OR go with the conventional treatment (i.e. mastectomy)?
Also would anyone happen to know and explain the biology of DCIS cells (that are considered to be non-invasive pre-cacerous cells0 vs. those that are cancerous? The UCSF radiologists said the reason they do not even bother using Hyperthermia in clinical trials is that they had done studies that heat is not effective on DCIS cells as it is on cancerous cells. I would like to better understand this and see if there are any published documents on this particular topic.
Your thoughts are appreciated beyond words can express as I am trying to decide as what to do...
Thank you so kindly,
AJ - I don't know if this would address your concerns or not but you could type "hypothermia" in the SEARCH topic and see if there was information of interest to you. good luck.
Beesie, I can't thank you enough for all this information. I just wish I had seen it before my surgery. It has answered so many questions for me. I am one of the lucky ones who had pure DCIS so after my uMx I don't require any more treatment.
I have a very caring Surgeon who answered all my questions and gave me lots of information, but this is just wonderful. I am going to print it out for my family to read.
As a health professional, i would like to add my two cents to this conversation. "New" treatments, medical research, and trials need to meet very rigorous standards before they are considered standard of care. Some times the standards seem daunting, but they are there for a reason.
One of the important things is that whatever new is being done should be able to be done in a variety of settings, by a variety of providers. So if you're hearing something that only one place can do, and the results can't be reproduced by anyone else, be very very wary.
Anyone can claim, and can have very impressive results, but unless they are fully tested and reproduced, you have reason to question. This does not mean that the treatment isn't effective; it just hasn't been deemed valid. In that case, you should be enrolled in a trial to try this untested treatment. If they're not calling it a trial, I say walk away.
Nurse Lizzie, that's great advice! Do you mind if I steal it when this type of question about a new and/or non-traditional treatment comes up again?
AJ, the answer to your question "Also would anyone happen to know and explain the biology of DCIS cells (that are considered to be non-invasive pre-cancerous cells vs. those that are cancerous)?" is rather complicated. In fact there really isn't a known answer yet, although there's been a lot of research done on this and lots of preliminary information. But there's no consensus yet.
Although DCIS comes in lots of different forms, at this point, all DCIS is considered by some experts to be cancerous and by other experts to be pre-cancerous. The issue is how one defines cancer. DCIS cells are virtually fully formed cancer cells. But DCIS cells are confined to the milk duct and do not have the ability to break through the duct or survive/thrive outside of the duct, and therefore DCIS cannot move beyond the breast. For some experts, the definition of cancer includes the ability of the cancer cells to move to a secondary location in the body away from the main source of the cancer, i.e. the ability to metastasize. Because DCIS does not have that ability, there are some who call DCIS a pre-cancer. But with one small biological change, a DCIS cell can acquire the ability to break through the milk duct and metastasize. It's the same DCIS cell (with minor biological changes) that's moved from the duct into the open breast cancer and has now become an invasive cancer cell, and this is why there are those who do consider DCIS to be cancer, albeit a pre-invasive cancer and the earliest stage of breast cancer.
What is the difference between an IDC cell and a DCIS cell? What is the biological change that turns a DCIS cell into an invasive cancer cell? What causes this change to happen? That's where there is no consensus. Here's just some of the research on this:
New Light Shed On The Progression And Invasiveness Of Ductal Breast Cancer CDH1, a tumor suppressor that triggers cancer invasion and metastases upon reduced expression, was most commonly lost in DCIS and IDC. MYC, a strong oncogene that drives cell proliferation and regulates cell growth and differentiation, was most frequently gained from DCIS to IDC. MYC appears to play a major role in the transition from "in situ" to invasive breast disease."DCIS and IDCs are genetically related lesions as they both have similar imbalance patterns. However, according to their aberration patterns, the DCIS lesions are far further advanced than other precursor lesions with more stable genomes, such as colorectal polyps or cervical dysplasias," notes Dr. Ried. "The considerable degree of intercellular heterogeneity in the DCIS convincingly attests to the fact that chromosomal instability precedes the transition to invasive disease." (2012)
ASPN and GJB2 Are Implicated in the Mechanisms of Invasion of Ductal Breast Carcinomas Invasion is a multi-step process in which a multidirectional cross talk of tumor cells and stroma is modulated by paracrine signals coming from associated tumor-stroma and/or inflammatory processes. Our study confirmed that expression of ASPN and GJB2 occurs very early during carcinogenesis and may be related to the initiation of invasion and tumor dissemination. Further studies are required to confirm our data. These data would assist in the development of precise diagnostic markers of invasion and in the identification of new therapeutic targets. (2012)
Differentially Expressed Genes Regulating the Progression of Ductal Carcinoma in Situ to Invasive Breast Cancer Progression of xenografts to IBC was dramatically increased by suppressing four genes that were usually elevated in clinical samples of DCIS, including a protease inhibitor (CSTA) and genes involved in cell adhesion and signaling (FAT1, DST, and TMEM45A), strongly suggesting that they normally function to suppress progression. In summary, we have identified unique gene expression profiles of human DCIS and IBC, which include novel genes regulating tumor progression. Targeting some of these genes may improve the detection, diagnosis, and therapy of DCIS. (2012)
FGFR1 is amplified during the progression of in situ to invasive breast carcinoma Amplification of HER2, C-MYC and CCND1 seems to play a role in the early development of breast cancer, but not in its progression. However, the increased frequency of FGFR1 amplification in invasive carcinomas compared with pure DCIS and in the invasive components of individual tumors, and its association with decreased disease-free survival, suggests a role for FGFR1 amplification in the progression of breast cancer including in situ-to invasive transition, as well as initiation. (2012)
ER81 Expression in Breast Cancers and Hyperplasia Breast carcinogenesis is thought to undergo a transition from normal epithelium to invasive carcinoma (IDC) via hyperplasia of usual type (HUT), atypical ductal hyperplasia (ADH), and carcinoma in situ (DCIS). Over 14% of breast cancer diagnosed in the United States annually are DCIS, and approximately 50% of untreated DCIS will develop into an IDC within 24 years after the original biopsy. However, it is unclear how IDC develop from these lesions.... Conclusively, ER81 overexpression was present in the early stage of breast development. Together with previous study results, it is suggested that ER81 may play an important role in breast carcinogenesis. (2011)
Breakthrough Method Predicts Risk of Invasive Breast Cancer The study also found that different combinations of biomarkers measured on the initial DCIS tissue were associated with varying levels of risk of invasive cancer or DCIS. These biomarkers include estrogen receptor, progesterone receptor, Ki67 antigen, p53, p16, epidermal growth factor receptor-2, and cyclooxygenase-2. Women who express high levels of p16, cyclooxygenase-2 and Ki67 were more likely to develop invasive cancer after their initial DCIS diagnosis. (2010)
Loss of Protective Barrier May Link DCIS to Invasive Breast Cancer Ductal carcinoma in situ progresses to invasive breast cancer because of the loss of a protective cellular barrier, leading to fibroblast-induced disintegration of milk duct walls, investigators here reported.... The findings suggest the possibility that examining myoepithelial tissue for genetic abnormalities could identify patients with the greatest risk of progression from DCIS to invasive breast cancer. (2008)
Evidence that molecular changes in cells occur before morphological alterations during the progression of breast ductal carcinoma. we identified 147 genes that were differentially expressed between pure DCIS and in situ component of lesions with co-existing invasive ductal carcinoma, which can discriminate samples representative of in situ component of lesions with co-existing invasive ductal carcinoma from 60% of pure DCIS samples. A gene subset was evaluated using quantitative RT-PCR, which confirmed differential expression for 62.5% and 60.0% of them using initial and partial independent sample groups, respectively. Among these genes, LOX and SULF-1 exhibited features that identify them as potential participants in the malignant process of DCIS. (2008)
Every time a new study comes out, there are posts on this discussion board from those who happily announce that we finally know the answer as to what makes DCIS different from IDC and what causes the progression of DCIS to become IDC. But as you can see, we have 'finally known the answer' many times, and the answer seems to be different every time. It's great that this is a much studied topic, and hopefully one day we will have a better understanding and concensus on this.
Hyperthermia is not a new treatment. I did a literature search going as far back as 40 years ago and found articles on using hyperthermia for cancer treatment. Nobody is suppressing it. Although it generated excitement for a while, results have not shown it to be generally worth adding to the standard of care. When it is used, it is generally an adjuvant therapy intended to enhance other therapy, not as a substitute for surgery.
The treatment goals for patients with metastatic disease are to alleviate symptoms or to extend life. For DCIS the treatment goals are to reduce the risk of recurrence, especially recurrence of invasive cancer, to a level that is reasonable compared to the risks of treatment. Treatments are very different for stage 0 vs. stage IV.
I treatment fro dci and now have had a swollen liver and spleen for two years my abdomen is really swollen i feel there is athickening between my breats and all the trouble is coming from there but noone seems to be listening have had numerous test have pain in the same breast but again no one seems to be interested
Marjory, for the most part this discussion thread just provides general information about DCIS. I doubt that anyone who's had similar problems to you is likely to be be reading here. I'm not sure where it would be more appropriate for you to post, so that you get some responses. I will contact the Moderators to see if they have a suggestion.
My right breast is healthy and OK. i am signed up to do bilatiral mastectomy because of DcIS in my left breast and also being BRCA 2 positive..
However, I am wondering now if I should leave my right breast which is healthy with no issue alone and just go with the mastectomy of the left breast with DCIS and reconstructive surgery... This new study http://video.today.msnbc.msn.com/today/49991794 says chances of re-occurence in the other breast is 5-6%. But i am also BRCA2 positive. What should I do?
AJ, being BRCA2 position puts you in a very different situation than most of the rest of us here who have simply the random development (i.e. non-genetic) of DCIS.
There is a forum on this board specifically for those who are BRCA positive; you'll find many others there who've been in a similar situation to what you face now. They are in a better position to offer you advice on this or share with you what they considered in their own decisions. You may want to repost your question there. BRCA1 or BRCA2 Positive
The oncologist I saw drew lots of picutures for me when I had gone to see him on a consult. He drew a continuum of changing cells something like this for DCIS:
Normal Cells----->Typical Hyperplasia(the cells resemble normal cells but are increasing in number)---> Atypical Ductal Hyperplasia (these are precancerous cells and are further from resembling normal cells)-----> DCIS (noninvasive cancerous cells)----> Invasive Cancerous Cells
Here are some links to good info regarding the basics of DCIS:
----> this makes sense! thank you for posting cinnamon