Prophylactic mastectomy for LCIS?

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Question from awb: Do you feel BPMs are indicated for LCIS or is close monitoring/tamoxifen a safe alternative?
Answers - Beth Baughman DuPree, M.D., F.A.C.S. Bilateral prophylactic mastectomies have many indications but this is certainly a decision that would need to be made in conjunction with several other factors such as genetic predisposition (such as carrying the BRCA1 or 2 gene), family history, and certainly the number of previous biopsies that have yielded results of either LCIS or atypical ductal hyperplasia. Tamoxifen and the drug Evista (chemical name: raloxifene) have been shown in the STAR trial to be effective at decreasing the incidence of developing a breast cancer by approximately 48%. With the prophylactic surgery, there is still approximately a 2% risk of developing a breast cancer even with removal of the breast. In my personal practice, if a patient is requesting prophylactic surgery with a history of LCIS, I would go through an extensive process of education, medical options, and certainly have them understand the overall risks and benefits as well as obtaining a psychological assessment to be certain that this was the appropriate treatment for that patient. If this is something that you are considering, it is very important to absolutely understand what the surgery and reconstruction entail, and what your other medical options are such as anti-estrogen therapy with tamoxifen, close clinical monitoring, and digital mammography alternating with bilateral breast MRI. And in addition, maintaining a healthy body fat, exercising, and a healthy diet.

The Ask-the-Expert Online Conference called Updates From the 2009 ASCO Annual Meeting featured Nick Robert, M.D. and Beth Baughman Dupree, M.D., F.A.C.S. answering your questions about the newest findings on risk, screening, treatment, and more.

Editor's Note: This conference took place in June 2009.

The materials presented in these conferences do not necessarily reflect the views of A qualified healthcare professional should be consulted before using any therapeutic product or regimen discussed. All readers should verify all information and data before employing any therapies described here.

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