Topic: Delaying surgery to "shrink" DCIS with letrazole?

Forum: DCIS (Ductal Carcinoma In Situ) — Just diagnosed, in treatment, or finished treatment for DCIS.

Posted on: Sep 13, 2022 10:03PM

Posted on: Sep 13, 2022 10:03PM

orangeflower wrote:

Has anyone else ever heard of such a thing? My sister was diagnosed with DCIS several months ago and still has not gotten surgery. She has 4cm of grade 2 DCIS. She really, really, *really* does not want surgery and has had a mental breakdown over her diagnosis. She found a doctor willing to prescribe her letrazole for the next six months so that the DCIS may get smaller and she can get less of a lumpectomy. The doctor said it's "unlikely" that there is IDC hiding within the DCIS. My sister is 44.

Dx 1/29/2020, IDC, Left, 1cm, Stage IA, Grade 2, 0/4 nodes, ER+/PR+, HER2- Dx 1/29/2020, IDC, Left, <1cm, Stage IA, Grade 2, 0/4 nodes, ER+/PR+, HER2- Dx 1/29/2020, DCIS, Left, 4cm, Stage 0, Grade 2, ER+/PR+, HER2- Surgery 2/26/2020 Mastectomy; Mastectomy (Left); Mastectomy (Right) Surgery 6/15/2020 Reconstruction (Left): Silicone implant; Reconstruction (Right): Silicone implant
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Sep 13, 2022 10:17PM quietgirl wrote:

I actually had the option of being part of a research study for something similar (I can’t tell you what the drug was thought). There is a school of thought (can’t say if it’s right or wrong) the DCIS tends to be over treated (meaning that because of imaging is so much better more cases of DCIS are found and some of them if left alone would in fact never cause any trouble, so some woman don’t actually need surgery). Here is an example of one such study https://www.pcori.org/research-results/2016/comparing-treatment-options-women-low-risk-ductal-carcinoma-situ-dcis-comet-study (that’s not the one I would have been in and honestly my surgeon assumed that would NOT want to watch and wait which is as a very accurate assessment on her part).

I can’t say I have heard of anyone doing it outside of a clinical study but that doesn’t mean no one’s has. I think in the end the important thing is that she follows thru with the treatment plan at the end of her six months.

Surgery 2/7/2022 Lumpectomy (Right) Radiation Therapy 3/9/2022 Whole breast, Radiation boost: Right breast Hormonal Therapy 4/18/2022 Arimidex (anastrozole) Dx DCIS, Right, 3cm, Stage 0, Grade 2, ER+/PR+
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Sep 15, 2022 05:34AM jelson wrote:

Orangeflower - has your 44 year old sister gone through menopause naturally or has she had her ovaries removed or suppressed chemically? I am not aware of AIs being prescribed for women who still have a lot of circulating hormones for the purpose of preventing/shrinking breast cancer. I would think tamoxifen might be used for this purpose but not an AI such as letrazole. I am so sorry your sister has reacted so badly to her diagnosis, how terrible for her and for you. I am concerned that the treatment recommended by this doctor will not be at all effective, while in fact, tamoxifen might actually be effective.

Dx 4/17/2009, DCIS, <1cm, Stage 0, Grade 3, 0/0 nodes, ER+/PR+
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Sep 15, 2022 09:59AM orangeflower wrote:

Hi jelson. She actually did go through surgical menopause a few years ago. She had to have her ovaries taken out because of endometriosis, and she was on a low dose of estrogen since then. She recently tapered off the estrogen pill so she could go on letrazole.

Dx 1/29/2020, IDC, Left, 1cm, Stage IA, Grade 2, 0/4 nodes, ER+/PR+, HER2- Dx 1/29/2020, IDC, Left, <1cm, Stage IA, Grade 2, 0/4 nodes, ER+/PR+, HER2- Dx 1/29/2020, DCIS, Left, 4cm, Stage 0, Grade 2, ER+/PR+, HER2- Surgery 2/26/2020 Mastectomy; Mastectomy (Left); Mastectomy (Right) Surgery 6/15/2020 Reconstruction (Left): Silicone implant; Reconstruction (Right): Silicone implant
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Sep 16, 2022 05:50AM jelson wrote:

Thanks for the additional information Orangeflower, it makes her current doctor's proposed treatment regimen sound more reasonable. It also provides context for your sister's aversion to ADDITIONAL surgery. My heart goes out to you both. Here is an article from BCO on the topic of neoadjuvant hormonal treatment. https://www.breastcancer.org/research-news/neoadju... I am not sure whether there are studies on hormonal neoadjuvant treatment long term without follow up surgery but the BCO article is from 2016 so maybe there are more recent publications.

good wishes to you both

Dx 4/17/2009, DCIS, <1cm, Stage 0, Grade 3, 0/0 nodes, ER+/PR+

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