Oncology (General Cancer)/DCIS

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QUESTION: I was diagnosed with DCIS 4 months ago with positive hormone receptor sites.  I am unable to have surgery at the moment so I have been taking intravenous vitamin C while I wait.  I was immediately taken off of my estradiol 1mg and now I am suffering.
I want to start taking Maca root (red) to help with my hot flashes, night sweats and insomnia.  I have read that it is NOT a phytoestrogen like soy and black cohosh and it might help balance my hormones and give support to the hypothalamus.
I am not interested in taking an anti depressant. I am also getting acupuncture and using peppermint oil with little relief.
I just want to know your thoughts on MACA and DCIS. Will it increase my estrogen levels causing my DCIS to proliferate?  Or would it be advisable to try it because some don't think DCIS is cancer anyway?

ANSWER: Maca root is, as you point out, not a phytoestrogen, and I wouldn't worry about taking it.  It's questionable whether it will help.  As for "phytoestrogens", we have no evidence at all that taking them makes DCIS proliferate.  I have had the best results (when I can't use an estrogen supplement) with low doses of drugs like Paxil.  Even though this is technically an antidepressant, it works by suppressing the chemical signals that cause hot flashes.  
My experience with plant phytoestrogens has not been good, and that is probably because you need a lot of them to get anywhere near the estrogen effect you want.  Most people don't tolerate that much phytoestrogen; they get upset stomachs.  Some people claim to respond to "oil of evening primrose" but again, I've not seen it work in my patients.  
Hope this helps.  

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QUESTION: Thank you so much Dr. Higby, I really appreciate your reply.  It seems I am on my own to navigate through the maze of information about DCIS. I'm so happy to have found you and this site.

Here's another question about hormones.  I have decided to take the BRCA test.  My thought is if it's positive, the odds of my DCIS turning into invasive cancer is much greater thereforeI would have the double mastectomy and reconstruction as a prophylactic.  My question is, could I go back on my estrodiol afterwards?  It seems to me that if all the breast tissue is removed then there is very little danger of DCIS returning or getting invasive cancer.  Does that seem logical?

Finally, just ot of curiosity do you prefer Paxil over Effixor?  orare they about the same in terms of side effects and results?

Thank you

ANSWER: I tended to use paxil, because there was more evidence for it's effect.  But it is in the same class as several other drugs, so I wouldn't be surprised if effexor worked as well.  I'd get a small rx of paxil, and if it isn't satisfactory, ask your doc for a small rx of effexor.  
If you are brca positive and end up having double mastectomy most physicians would advise you not take estrogens.  However, they have trouble giving a good reason, except to say that in very rare cases there is "ectopic" breast tissue.  (Humans evolved from animals that had several mammary glands).  I personally would let you go back on estradiol and I suspect many other docs would as well.   Hope this helps.  

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QUESTION: Hello Dr. Higby, I have received the incredible news that my DCIS or any calcifications previously present on my mammogram is gone!  The treatment I took was very high does of IV vitamin C, once a week for 2 months.

I had a follow up mammogram because I tested negative for the BRCA gene and I wanted to postpone surgery. The results showed no signs of anything and suggested a follow up in a year.

My doctor is stumped.  My question to you is, now that this has happened, I want to go back on my hormones.  I have been absolutely miserable.  I don't want an anti depressant. I prefer the hormones because the benefit goes far beyond my menopausal symptoms.  What is your opinion about taking low dose estriol/estradiol cream 80/20 with 100mg of progesterone at night? I understand that estriol is the weakest estrogen and can attach to estrogen sites preventing the more harmful estradiol from binding.  In addition using it transdermaly by passes the stomach and liver and it generally is a healthier way to go.  What are your thoughts?

Answer
I'm stumped as well.  We have very little information on high dose vitamin C, although when I was in medical school Linus Pauling insisted that it could cure cancer and had several other beneficial effects; he used to take it every three hours.  I believe he lived to be 93 and had very little in the way of medical problems, just wore out.  
The regimen you describe would probably be safe, although I would suggest you start out with just the progesterone before adding the estrogen to it.  I've had good control of menopausal symptoms with progesterone alone.  Your doctor wouldn't approve, I think, but it's your body.  As for the issue of weaker binding or transdermal vs oral, the bottom line is that to the extent estrogen type chemicals work, it has to do with how much gets bound to estrogen receptors.  Progesterone itself, although not an estrogen, does have some receptor binding.
The other thing that might be worth trying is very low dose testosterone, which I've had some success with in dealing with menopausal symptoms.  Generally you apply tiny amounts of testosterone cream.  IN very low doses you shouldn't have "masculinizing" effects.  Hope this helps.

Oncology (General Cancer)

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Donald Higby, M.D.

Expertise

I can answer almost all questions related to the treatment and natural course of most kinds of cancer, especially cancers of prostate, colon, lung and breast.

Experience

I have been a practicing medical oncologist for 36 years, and have been chief of service at a major medical center for 25 years. I've also done research in cancer treatments.

Organizations
American Society of Clinical Oncology

Publications
New England Journal of Medicine American Journal of Medicine Journal of the American Society of Clinical Oncology Hematology Transfusion Medicine

Education/Credentials
MD, Stanford University Internal Medicine residency, St. Louis University School of Medicine, St. Louis, MO Medical Oncology Fellowship, Roswell Park Cancer Institute, Buffalo, NY

Awards and Honors
America's Best Physicians, last 14 years

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