Treatment for DCIS
Dear OncoLink "Ask The Experts,"
I was recently diagnosed with DCIS and LCIS. I have had a lumpectomy and will soon start radiation. My concern is that it has been suggested that I take Tamoxifen. I am 43 and I have not yet gone through menopause. My ER was positive. I am very afraid of this drug after all my reading on it. I have also read that using a natural progesterone has had similar results. How true is this, in your opinion? Do I have any other choices? Your reply will be greatly appreciated.
Julia Draznin Maltzman, MD, Attending Physician at the University of Pennsylvania School of Medicine, responds:
There is some controversy as to the "right" way to treat DCIS (ductal carcinoma in situ). Most oncologists, however, chose to use a tri-modality approach: surgery, radiation, and hormonal therapy. The data supporting the use of Tamoxifen shows a significant reduction in the occurrence of breast cancer in the affected breast (where the DCIS is found) as well as in the other unaffected breast. The finding of LCIS (lobular carcinoma in situ) does not effect this recommendation, as the data does not support any changes in the treatment approach.
Tamoxifen is an anti-estrogen. It does not work exactly as progesterone does. Furthermore, I am unaware of any randomized clinical trials that have been done with unopposed progesterone for DCIS. The best advice is to adhere to the data acquired through rigorous, scientific, peer-reviewed mechanisms. If you are uncomfortable with your doctor's recommendation, you should always feel free to seek a second opinion.