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NCCN Guidelines for Patients


Breast Cancer - Carcinoma in Situ

(stage 0)

, Version 1.2016



Risk-reduction treatment

is not the same as hormone replacement therapy.

Not all women at risk for breast cancer should take

endocrine therapy. Your doctor can let you know if

endocrine therapy is right for you.

Which medicine is used sometimes differs between

women who have menstrual periods and those who

don’t. Tamoxifen is advised for women who have

menstrual periods (pre-menopausal). Tamoxifen

blocks hormones so the growth of cancer cells isn’t

triggered. Tamoxifen and similar medicines may also

be given to women without menstrual periods (post-

menopausal). In addition, post-menopausal women

may be given medicines called aromatase inhibitors.

These medicines lower the amount of female

hormones in your body.

Although endocrine therapy lowers breast cancer risk,

it can cause side effects. Side effects are unplanned

physical or emotional responses to treatment. Side

effects vary between medicines. Some side effects

of endocrine therapy are hot flashes, cataracts, leg

cramps, joint pain, blood clots, and other cancers.

Ask your treatment team for a complete list of side

effects. Your doctor may also know about research

of endocrine therapy or other medicines that you can


If you start endocrine therapy, you will have follow-up

visits with your doctor. Tell your doctor about any side

effects from endocrine therapy. There may be ways

to get relief. Depending on which medicine you’re

taking, you may need to get GYN (



exams, vision tests, and bone density tests.


A third risk-reduction treatment is surgery. Surgery

is mostly done among women at high risk for breast

cancer. If you choose surgery, a bilateral total

mastectomy is advised. This surgery completely

removes both breasts but no lymph nodes and chest


Following the mastectomy, or in some cases at the

same time as the mastectomy, you may want to have

breast reconstruction. Breast reconstruction is a

surgery that inserts breast implants or uses your body

tissue to make a more normal-looking breast mound.

Breast reconstruction is described in more detail in

Part 3.

Your doctor may suggest that you have a bilateral

salpingo-oophorectomy. This surgery removes both

ovaries and both fallopian tubes. It is only advised if

you have or very likely have mutations in the