I had a lumpectomy in 2022 for DCIS with a reduction, and size to match on my left. It was 1.6 cm and in the right lower outer quadrant. High ER+ and high PR+, HER2 untested. There was a 1 mm margin, just a focal point. Because the low margin was on the side closest to my skin I decided to not have them go back in a scrape another mm off to make it a 2 mm margin everywhere. I had already decided to have radiation and knew that area of skin would be weaker, and thinner, if they went back in. I wanted to preserve as much of the full thickness of skin and supporting cells to help reduce possible damage from radiation. I had decided on radiation after talking with the oncology radiologist and looking at the risk of return.
I was 68 at time of surgery. I’d did 5 days of partial breast radiation. 5 days of 600 gy, total 3000. It was the type where they lay down layers of radiation with the highest volume at the surgery bed. It was also the deep breath regulated - which means the radiation stopped and started as I took a deep breath (lifting my breast up and farther away from my ribs and lung).
I am on hormone therapy. I went through menopause at 50 so it had been 19 years. An AI is usually recommended at my age, but I have osteoporosis and am not a high risk for thrombosis and uterine cancer. My medical oncologist was okay with tamoxifen, 20mg. I have very few side affects. Some cramping, warm flashes, and vaginal discharge in the first 4 weeks that all went away. Benefits were it reversed my vaginal atrophy and improved my skin and hair. In some postmenopausal women, tamoxifen and act like an estrodial enhancer in body parts other than the breast. In the breast it is blocking the growth of cancer cells. Unfortunately at about 3 1/2 month in I started having headaches 24/7. We started investigating why, even had a brain MRI. All indications were that it was the tamoxifen. I am on 5 mg now. Some early research shows that may be enough. Time with tell. Personally I would rather take tamoxifen than an AI - although if my risk were high and I needed it to prevent invasive cancer, I’d take it. These meds affect everyone differently. Some people do fine on an AI, but I prefer to keep some estrogen in my body if I can. Only time will tell.
I am glad I did not give up all hormone treatment because at my one year follow-up the MRI showed a small lesion on my left breast and an enlarged level one lymph node on my right. They believe both are benign. The left side being surgical scar and the right node simply inflammation. I don’t so easily set these things aside, and I worry- but have gotten better with my perspective. I have another MRI and mammogram in 6 months. At that point those spots will be larger and need biopsy, or they won’t. Welcome to the “intercellular space ship” called cancer! I’m traveling to a world unknown! Science is protecting me the best it can. It’s the most we can ask of life, because anything can happen tomorrow!