Breast Cancer Questions To Ask The Doctor (cont.)
In this Article
Should I stop taking hormone replacement therapy
(HRT)?
Breast cells are programmed to respond to certain hormones as
signals for growth and multiplication. The most prominent examples
of
these hormones are estrogens and progesterone. Many breast-cancer cells retain hormone receptors (molecular configurations on
the
cell surface to which the hormones bind). The hormone receptors
therefore make the cancerous cells responsive to these particular
hormones.
In general, taking hormones is not recommended if a diagnosis of breast
cancer is under consideration. This does not necessarily mean that you can never
resume hormone replacement
therapy. This issue is generally reconsidered after the
completion of your evaluation and treatment. You should consult with your physician before you stop or start any new medications.
Even though my breast tumor does not have hormone receptors,
should I take tamoxifen to reduce the risk of a new tumor?
Following completion of your treatment for breast cancer, whether
or not tamoxifen is prescribed should at least be addressed. In many
cases, the primary
breast cancer for which the patient is being treated may not be
hormone-receptor positive. In these cases, tamoxifen (which binds to
the estrogen receptor in place of estrogen) is not generally part of
the treatment protocol.
However, the Breast Cancer Prevention Trial (a study of the use of
tamoxifen) demonstrated a significant reduction in the development of
new cancers in the opposite breast in patients who were treated with
tamoxifen. So, the possible use and benefits of tamoxifen should not
be ignored. A thoughtful evaluation of all the factors in a
particular case will lead to a recommendation which balances the
benefits of tamoxifen against the potential risks. Your treatment team should address this issue with you.
I have a ductal carcinoma in situ (DCIS), a type of localized
cancer. Why have I been advised to have a mastectomy when other women with invasive cancer have lumpectomies?
Ductal carcinoma in situ (DCIS) sometimes presents a difficult
dilemma. Most patients with DCIS can undergo successful breast-conservation therapy but not all. The diagnosis implies that this is
an "early" form of cancer in the sense that the cells have not
acquired the ability to penetrate normal tissue barriers or
spread through the vascular or lymphatic channels to other sites of
the
body. It is important to realize that breast cancer is a wide spectrum of diseases and no comparisons should be made just on the basis that someone you know has "breast cancer" and shares a different treatment approach with you.
However, the millions of cells forming the DCIS have accumulated a
series of errors in their DNA programs which allow them to grow out
of
control. There are varying degrees of disturbance, called "grades,"
of the normal
cellular patterns. Low grades are more favorable, and
high grades are less favorable.
The DCIS cells originate from the inside of the breast gland
ducts (microscopic tubes). As they multiply, the cells fill and
spread
through the normal ducts of the breast glandular tissue. With many
DNA errors already in place and millions of these cells exposed to
the
usual risks of
additional DNA damage, a few cells will ultimately become invasive.
This invasive change is the real risk of DCIS.
Treatment which does not physically remove all of the DCIS seems
to
leave a substantial risk of recurrence and, therefore, invasive
disease.
This risk of recurrence is particularly increased in the high-grade
form
of DCIS. In cases where the DCIS has spread extensively through the
breast ducts, even though the disease is in a sense "early" because
it
is not yet invasive, it may still require a large surgical resection,
at times even a mastectomy (removal of all or part of the breast).
Next: Should I start chemotherapy before surgery? »
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- Breast Cancer - Get the facts on breast cancer symptoms, signs, stages, types, research, risk factors, diagnosis, prevention information and treatment options: mastectomy, chemotherapy, radiation therapy.
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