Breast Cancer Expert Forum
Is tamoxifen needed?
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Questions posted in the Breast Cancer Forum are answered by medical professionals and experts. Topics include Breast Biopsy, Chemotherapy, Hormone Therapy, Lumps, Lumpectomy, Lymph node dissection, Lymphedema, Mammograms, Mastectomy, Radiation Therapy, Reconstruction, Self Breast Exam, and Surgery.

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Is tamoxifen needed?

I need to make a choice.  It was found that I had calcifications Calcifications in left breast.  Outcome: DCIS stage 0(non invasive,non aggressive cells).  Had lumpectomy with clear margins,and radiation for 6 weeks including boost.  44 years old,4 children(each breastfed for 1 year), non smoker,exercise,normal weight,good nutrition, no family history except for my mothers first cousin. Lived on Long Island my whole life. DCIS cells were not tested for ER. Can they be tested now? Everything I am reading says tamoxifen only works with ER+.  Will this drug help me? Have seen many doctors and everyone says it is my choice.  What is your experience with women having my profile?  How about other new drugs on market? The big question...if I were your wife what would you tell me to do?Also, I drink wine every week..about 4 glasses.  Should I stop?  Does wine increase my chances of getting this back?  I saw a nutritionist and she put me on mushroom pills, CoQ10,B50, and green tea.  Sound ok? Please Help me.  I am scared to go on the drug for 5 years, but I am also scared not to do anything to prevent this from coming back. Does DCIS usually stay away if caught and treated early.  Also what do you say about mammos?  How many times a year?  THANK YOU SO MUCH.
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Dear MPM, The whole issue regarding the best treatment for DCIS continues to be researched.  Answers regarding how it starts, or what the natural history of the disease is are not thoroughly understood, so knowing what the best treatment is, is not known.  

The use of tamoxifen in addition to lumpectomy and radiation in DCIS has been studied.  In 1999 the National Surgical Adjuvant Breast and Bowel Project (NSABP) published the results of their study of tamoxifen in the treatment of DCIS.  They randomized 1804 women with DCIS to lumpectomy, radiation therapy vs. lumpectomy, radiation therapy and tamoxifen for 5 years.  The follow-up time was 5 years.  The results showed that women in the tamoxifen group had fewer breast-cancer events at 5 years than those who received placebo (8.2 vs 13.4%), which was statistically significant.  The interpretation of their results was that the combination of lumpectomy, radiation therapy, and tamoxifen was effective in the prevention of invasive cancer.   Side effects included two cases of phlebitis in the placebo group and nine in the tamoxifen group with one nonfatal pulmonary embolus in the placebo group and two in the tamoxifen group.  There was about a 10-percent higher incidence of hot flashes, fluid retention, and vaginal discharge in the tamoxifen group than in the placebo group. There were about 3.5 times as many cases of uterine cancer in the tamoxifen group as in the placebo group, although there were no uterine cancer deaths.

This is a complex issue and your decision to proceed with tamoxifen or not, will ultimately be yours after weighing risks and benefits in your particular situation.  Continued close follow up will occur no matter which route you choose.  Follow-up includes exam by the physician, at least annual mammogram.  Sometimes the mammograms are done at six month intervals the first year then back to annual checks.
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