Would you offer adjuvant endocrine therapy to a patient with a history of ER-positive DCIS, s/p bilateral mastectomy, now with chest wall recurrence of DCIS four years later?
Patient in her 30s, initially with intermediate nuclear grade DCIS, ER 100%, 8.4 cm in extent, underwent bilateral mastectomy with widely negative margins and received no adjuvant therapy.
Four years later, she developed recurrence in the subcutaneous fat at superior flap of her reconstruction, intermediate nuclear grade DCIS, 2.8 cm, ER 95%, now status post wide local excision with widely negative margins >2 mm.
Germline testing was negative.
No invasive disease was identified in either the initial pathology nor her present resection specimen.
Typically, one would not pursue endocrine therapy for DCIS in a patient who is post-bilateral mastectomy; however, considering young age and disease which has already demonstrated an unusual propensity for recurrence, would these factors sway your decision to offer tamoxifen?
1 Answer
Mednet MemberInvited Expert
Medical Oncology · Duke University
Answered on
This is an unusual case, and I wonder how she presented initially and with the recurrence, and if she has a history of exposure to radiation. In addition, a pathology second opinion to confirm the lack of an invasive component is in order.
Theoretically, close to all of the breast tissue should have been removed at the time of mastectomy, and the risk of local recurrence would thus be exceedingly small.
Available evidence supports neither preventive endocrine therapy nor radiation, but these would be options discussed if she were seen at our tertiary care center. Ultimately, though, with lack of evidence and based on prior similar cases, I believe we would suggest ongoing monitoring.