Oncology Consult

66 yo had Mod. Rad.Mastectomy 5 months ago with no lymph node involvement. ER and PR positive (90%) and a high S phase. No Oncology referral was mentioned post-op nor was any further treatment. Would I have been better served by seeing an Oncologist soon after surgery? Tamoxifen has been discussed by my primary care physician but I am not yet convinced due to the risk factors and questionable benefits. To me it has always seemed "the norm" more than a truly beneficial treatment. My surgeon remains steadfast in his belief that when he finished my surgery he considered me "cured"!

[CCF-RN,MSN-JS]

Dear japdip, Recommendation for adjuvant hormonal therapy is based on the presence of hormone receptors.  The goal of hormone therapy is to prevent breast cancer cells from receiving stimulation from estrogen.  Estrogen deprivation can be acheived by blocking the receptor - which is the way tamoxifen works.  Standard care is to recommend adjuvant hormonal therapy to women whose breast tumors contain hormone receptor protein (ER/PR positive) regardless of age, menopausal status, involvement of axillary lymph nodes or tumor size.  This treatment has led to substantial reductions in likelihood of tumor recurrence, second primary breast cancer, and death persisting for at least 15 years of follow-up.  Possible exceptions to this recommendation include premenopausal women with tumors less than 10mm in size who wish to avoid symptoms of estrogen deprivaion or elderly women with similarly sized cancers who have a history of venous blood clots.

Seeing an oncologist for an opinion regarding follow-up is not a bad idea, they would discuss with you the risks benefits of adjuvant hormonal therapy specific to your situation, answer questions and discuss your concerns, then you can make a well-informed decision.