what to do now

I have lcis with invasive lobular carcinoma,stage 1 the nodes were neg. I had bilateral mastecomy with reconstruction. Am er/pr pos. do I really need further treatment. especially since the recommended are for stage four please help sort out this mess What about Evista for breast cancer know anything about this I know it's not fda approved but they us it in europe

[CCF-RN,MSN-JS]

Dear sevenofnine, Information that is often used to determine whether adjuvant treatment (treatment given after surgery to try to prevent or minimize the growth of microscopic deposits of tumor cells that might grow into a recurrent tumor)would be recommended are tumor size, node status, estrogen receptor status.  On the basis of available data, it is accepted practice to offer cytotoxic chemotherapy to most women with primary cancers larger than 1cm in diameter (both node-negative and node-positive).

Adjuvant hormonal therapy should be recommended to women whose breast tumors contain hormone receptor protein, regardless of age, menopausal status, involvment of lymph nodes, or tumor size.  Possible exceptions to this recommendation include premenopausal women with tumors less than 10mm in size who wish to avoid the symptoms of estrogen deprivation or elderly women with similarly sized cancers who have a history of blood clotting disorder.

Tamoxifen is the most commonly used form of hormonal therapy.  There are no data currently to support the use of raloxifene or aromatase inhibitors as adjuvant hormone therapy, although clinical trials of their use in the adjuvant setting are currently being done.
This information comes from the National Institute of Health Consensus statment of adjuvant therapy for breast cancer, December, 2000.

Evista is currently FDA approved for use in prevention and treatment of osteoporosis in post-menopausal women.  There are studies looking at it's role in a prevention setting for women at high-risk of developing breast cancer.