Armed with a list of questions, I enthusiastically flew to San Francisco to hear what Dr. Esserman had to say about my DCIS situation and her recommendations for risk reduction and monitoring. After waiting 2 hours in the lobby and 1.5 hours in the exam room, Dr. Esserman finally greeted me. (I learned this extremely long wait is pretty standard for her patients.)
Dr. Esserman immediately sat down and told me her thoughts:
#1. She would NOT have done a wide excision (surgical biopsy) after an initial core needle biopsy revealed a diagnosis of Atypical Ductal Hyperplasia (ADH) in October 2009.
#2. She would have tried talking me into taking “Preventa” — the term she thinks we should be calling tamoxifen.
Dr. Esserman began by asking me, “if I could give you an intervention that could drop your risk by 80% — so instead of having a 25-30% risk of invasive breast cancer — I could take it down to 5%, would you do it?”
She went on to say, “tamoxifen, in young women, has almost no side effects; it reduces breast density and it is actually something we can measure. We know that in the case of atypia, (which is very similar to low grade DCIS), we reduce the risk of invasive cancer by 85%.”
I said, “there is so much conflicting information.” (I have been told by several doctors that tamoxifen would not benefit me enough to subject myself to the side effects). Dr. Esserman’s response was, “it’s not conflicting, it’s just that people don’t know about it. It’s right there in the P01 study. There were 13,670 patients in that study. And the people who had atypia had the biggest benefit.”
She went on to say, “With you — you have little bits here and there and I’m sure it’s everywhere. I wouldn’t keep taking it out.” A better option she suggested was to do “a global risk reduction” using tamoxifen.
I told her I am taking bio-identical progesterone as part of my natural risk reduction plan. Her response: “The one thing you should NOT take is progesterone. It’s like putting gasoline on a fire. That’s the one thing you should not be doing! I am adamant about that.” She said, “Nobody should be telling you to put something in your body that is mytogenic and actually is cancer causing. And bio-identicals — progesterone is progesterone — it’s the one thing you want to minimize.”
I said, “I tested that I was low in progesterone.” And she responded, “Good, fantastic, great — keep it that way.”
Oy! Can there be any more contradictory information!! My naturopathioc Dr. highly recommends bio-identical progesterone for patients like me with DCIS and who test low in progesterone and are “estrogen dominant” as a means of breast cancer risk reduction. Dr. Lee’s book, What Your Doctor Might NOT Tell You about Breast Cancer: How Hormone Balance Can Help Save Your Life, and other books I have recently read and list on my “Resources” page say the exact opposite to what Dr. Esserman is saying!!! I know many other women diagnosed with DCIS who are being advised by naturopathic/preventative doctors to take bio-identical progesterone.
Continuing the conversation with Dr. Esserman regarding tamoxifen, I said, “But Dr. Lagios told me that the studies on tamoxifen showed very little benefit for prevention and risk reduction and he believes DCIS is not hormone related. Also, my San Diego oncologist told me I would have only a 1-2% risk reduction,” so I pretty much disregarded it as an option. Dr. Esserman responded, “It’s true, in the UK, the studies on tamoxifen were all on high grade cancer and it didn’t work. Why? Because in the UK, they don’t biopsy the kind of calcifications you had. Their cancer to biopsy rate is 50%. Ours is more like 20%. We biopsy every calcification that looks even remotely suspicious. Which is why we find all this stuff. Which is why I wrote all those things you have on your website.”
Next steps discussed: Dr. Esserman will order the Oncotype DX test which will determine whether I am at higher risk (15%) for invasive cancer or lower risk (5%). I told her the outcome of this test may effect my decision to consider taking tamoxifen, but I would definitely need to do more research on it.
More about Dr. Esserman: http://www.nobhillgazette.com/wp/2011/01/profile-2011/
More about tamoxifen: http://en.wikipedia.org/wiki/Tamoxifen
Are there natural Alternatives to tamoxifen? Thanks to Elyn Jacobs, we have some answers. Please see her article here.
I know this is quite a controversial subject and I’d love to get some feedback on this so please share your comments!
DCIS 411 