Nov 10, 2020 10:42AM Beesie wrote:
I just answered your same post in the other thread. I will copy and paste it here:
If you had a BMX for DCIS, then unless you had close surgical margins or are very high risk for a new primary due to a genetic mutation (BRCA, for example), there is absolutely no reason to take Tamoxifen or an AI (for those who are post-menopausal).
Tamoxifen can reduce 3 risks. But as you well know, Tamoxifen comes with side effects. So whether or not to take Tamoxifen is always a question of balancing the breast cancer risk reduction benefit from Tamoxifen against the risk of serious side effects from the drug itself.
For someone who had a BMX for DCIS,
- the risk of local (in the breast area) recurrence is 1%-2%.
- the risk of distant recurrence with DCIS is effectively zero. (Note: This changes of course if the patient has an invasive local recurrence)
- the risk of a new primary after a BMX is 1%-2%.
Tamoxifen can reduce these risks by approx. 50%. So at most, the benefit is a 1% reduction in local recurrence risk and a 1% reduction in the risk to develop new primary. The risk of serious side effects from Tamoxifen, even for someone who has no pre-existing conditions or conditions that increase the risk of clotting, is 1%-2%. This means that at best, the benefit vs. risk equation is a trade-off; given that at least 50% of Tamoxifen users experience quality of life side effects, few if any doctors would ever prescribe Tamoxifen or an AI to a patient who has had a BMX for DCIS (assuming clear surgical margins).
I agree with Peregrinelady. In your situation, with the additional risk factor of clotting, it is criminal for your MO to push Tamoxifen on you. Change MOs. And ask this MO to explain the recommendation in terms of the risk reduction benefit you will receive from Tamoxifen. The numbers simply don't add up.
"Bilateral mastectomy – For women who have undergone bilateral mastectomy, there is no role for adjuvant endocrine therapy."