Anastrozole before surgery

Posted by kammcn @kammcn, Dec 30, 2021

This fall I was diagnosed with stage IIIb breast cancer. I have an approximate 3 cm tumor in my lower right breast with skin invasion and two palpable lymph nodes. It was EP+/HERT2-. My plan involves endocrine therapy for six months, surgery, and radiation. I was put on anastrozole on October 11, and my surgeon indicated that if my tumor shrank, conservative breast surgery could be performed instead of a mastectomy. I went to my oncologist after one month of taking anastrozole, and my tumor had diminished considerably and she said I was ready for surgery. I had an appointment six weeks later with my surgeon and told her this, explaining that the oncologist had even ordered pre-surgery diagnostic tests. I was really shocked when my surgeon stated that was not a possibility. She said even though my tumor had shrunk considerably, that I needed to complete the six months of taking anastrozole before surgery would be performed. I have read extensively on neoadjuvant endocrine therapy. Research shows that 4-6 months for first line endocrine therapy before surgery has proven to be beneficial to breast conserving surgery. I am having a hard time with my oncologist telling me that I was ready for surgery and my surgeon saying that regardless of the tumor shrinkage that I must complete 6 months. I want to do whatever is necessary to successfully beat this, but I am struggling with the inconsistency. Has anyone else gone through this regiment? How long were you on an AI before you had surgery? I have not been able to find anyone that has experienced this, and would love to hear from others that have gone through this experience. Thanks

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Colleen Young, Connect Director | @colleenyoung | Dec 30, 2021

Hi @kammcn, welcome. It is always disconcerting when opinions of the members of your medical team don't align. As you say, research shows that 4-6 months for neo-adjuvant endocrine therapy (before surgery) has proven to be beneficial to breast conserving surgery.

I'm tagging @roch on this discussion since she also had anastrozole prior to surgery. She started this related discussion before her surgery. I think you may appreciate the tips she got from fellow members back then:

- Breast Surgery; any advice to prepare for surgery? https://connect.mayoclinic.org/discussion/breast-surgery-any-advice-to-prepare-for-surgery/

Kammcn, are your oncologist and oncology surgeon at the same hospital? Do they communicate with one another?

kammcn | @kammcn | Dec 30, 2021

I live near Peoria, IL, and my care providers are all in the same area, but they are in different facilities. They did talk about my plan and were on a tumor board to make decisions. At the end of the appointment, my surgeon called the oncologist because I wasn’t sure what to do about the approaching diagnostic testing that had been scheduled by my oncologist. They did cancel those appointments and made new appointments for April when the 6 months of anastrozole before surgery would be up.

I did read the link you attached. It focused on getting ready for surgery. I would like input on how long others were on endocrine therapy before surgery. It hasn’t even been three months and my tumor has shrunk more than 50%. I would really like to have my surgery sooner than six months, but I would love some input on others experience.

I have called and made a new appointment with my surgeon to discuss this. I think I was so shocked at my previous appointment, that I didn’t know how to respond. I expected to be discussing surgery instead I was told that it wouldn’t even be considered for 3 1/2 months, and I didn’t need to come back until then.

I just feel very confused. The Mayo Clinic Connect has been a wonderful source of support for me since I was diagnosed in August. I just wondered it anyone had neoadjuvant endocrine therapy, how long the therapy lasted before surgery, and any advice/support about it.

Laurie, Volunteer Mentor | @roch | Dec 30, 2021

Hi kammcn @kammcn

I had similar situation. I was diagnosed with 2.5 cm mass tumor in breast and biopsy confirmed positive of one lymph node. Stage II.

My pre-surgery endocrine therapy was offered as part of a research project. I signed up for two reasons:
1. It would shrink tumor
2. I had 6 months to prepare for surgery. Though I would take time to be in best condition I could prior to surgery.

I could of declined the pre surgery option and had surgery right away.

Here is official site of study:
https://www.mayo.edu/research/clinical-trials/cls-20239997
The pre-surgery endocrine therapy was working, part way thru they did another biopsy and KI-67 2% decrease from 16% . They actually did not talk much about size of tumor.

I was on anastrozole and hated side effects, but stuck out the entire 6 months.

I had surgery at end of 6 months, and I was so ready. Waiting 6 months is stressful. I was better prepared but the last month was full of anxiety. I just wanted it out !

I stopped the anastrozole a week before surgery.

Results from surgery showed the tumor was slightly smaller. I had breast conserving surgery, tumor removed left breast, small pre-cancers spot removed from right breast and found two lymph nodes that tested positive on left side. Those were only two removed.

Do you have option of another surgeon for 2nd opinion who will work with you?

After, surgery, chemo and radiation I refused anastrozole due to side effects. I then tried different Ais with side effects. But everyone response different to Ais.

Good luck
Laurie

kammcn | @kammcn | Jan 1, 2022

Laurie, thanks for sharing your experience. It sounds like your study was focusing on anastrozole and its effect on KI-67 levels. I’m glad that your surgery, chemo, and radiation was successful.

My tumor was estrogen 99% and progesterone 98%. The AI was given to see if decreasing hormones would control the tumor growth. Obviously it has worked, and I will probably be on AI for 5-10 years. I am having joint/bone pain but it improves after I walk each day. I have insomnia, but the worse is that I feel constantly tired instead of having the boundless energy I used to have. Ironically my KI-67 score is 49%. I asked about this but my oncologist wasn’t concerned. My Mammaprint was low risk and indicated I would have less than 1% benefit from chemo. So AI and radiation are part of my plan.

I feel like everything has spiraled out of my control and it is frustrating. Thank you for sharing your experience. I pray that you continue to heal and grow strong.

Chris, Volunteer Mentor | @auntieoakley | Jan 1, 2022

In reply to @kammcn "Laurie, thanks for sharing your experience. It sounds like your study was focusing on anastrozole and..." + (show)

Although I do not share the treatment plan you have. I remember and to some extent still feel like everything spirals out of my control. I say it was like I was dropped onto a fast moving train to who knows where, and I cannot get off or change cars. I think this is a pretty common feeling when people start treatments for cancer. Do you have things in your daily life that you can control? Diet, exercise, or a part of your daily routine that you alone can control, are any of those things helpful for you?

jeaniebean | @jeaniebean | Jan 2, 2022

In reply to @roch "Hi kammcn @kammcn I had similar situation. I was diagnosed with 2.5 cm mass tumor in..." + (show)

Your story was very much the same as mine. Almost identical. I am 68 and quality of life was most important after the side effects literally crippled me. I am 2 years out now, stopped the AIs after 6 months, and feeling better than I ever have. I can move freely, with just my fingers still stiff and unusable, but the tradeoff to a drugfree life and excellent diet have made me happy again. I wish continued health to you!!!

kammcn | @kammcn | Jan 2, 2022

Thanks for the responses. Before I got my treatment plan (while all the testing and biopsies were ongoing), I felt things were out of control. As soon as I got my treatment plan, I felt somewhat in control again. In reflection, I think it is the waiting that is the problem. I felt so hopeful that surgery would be soon and I could move on. When the surgeon said I needed to wait four more months, it devastated me. I just want to feel like I am conquering cancer and instead I feel like I am just waiting and waiting.

I’m sure it doesn’t help that the anastrozole has my hormones all out of whack. I am tired, moody, and depressed. I see my surgeon again tomorrow for some discussion and questions. I don’t want to wait until May to have surgery. I fluctuate between knowing my surgeon is the most knowledgeable person for this decision and to just be patient to pushing for a surgery date sooner. Has anyone else had this experience. I would love some feedback. Thanks.