Widespread ADH and wanting a child right now - What can I do?

Lotusconnie

I have been reading posts about ADH, and I have WIDESPREAD ADH associated with microcalcifications (My pathologist kindly replied to me today. Please see below).

I have read or know some cases that ADH can turn into DCIS or IDC in a couple of years, including a friend's sister. I know maybe I should take Tamoxifen or do some prophylactic surgery. However, As I posted before, I am only 30 now and I really long for having a child as soon as possible. I wish I could...

Right now I am monitored at DFCI high risk clinic - annual mammogram and clinical exam per 6 months. I don't know if it is fairly safe already or not, especially during pregnancy if I could get pregnant. During pregnancy I will monitor with my OB regularly. Please help me with your suggestions. Thanks a lot!

Here is my pathology reports of two excisional surgical biopsies;

4/07/09 Multiple foci of atypical ductal hyperplasia, in a background of columnar cell change and flat epithelial atypia, associated with microcalcifications (grouped punctate and amorphous microcalcifications).

And also, my pathologist kindly replied to me today about my question of the severity and extent of my ADH as below,

"We did not feel that the atypia was suffciently severe to say that this was bordering on DCIS. But, the atypia was fairly widespread throughout the biopsy-Dr. Schnitt"

11/8/2009 ADH plus mucocele-like lesion adjacent to a fibroadenoma.

idaho

I wouldnt' wait to get pregnant.  I don't think mammograms can hurt fetuses.  Your Dr. will know.  My sister has had atypical cells and hundreds of micro calcifications for years, it has never turned into anything else.  Good luck. Tami

Anonymous

 You didn't say whether or not you have any family history of bc. Generally, the recommendations for ADH without family history is just to be vigilant with breast exams and mammos; some add tamoxifen to the recommendations if there is family history of bc. Unfortunately, they don't know how to predict if or when ADH may progress; it might not change from ADH for many years or may never progress. My decision was easier since I already had my children (I'm high risk due to LCIS, a step further along the bc spectrum with double the risk of ADH, and family history--just finished my 5 years of tamox); but I would say, if you want children, go for it and just remain vigilant with your breast exams and mammos, you can always take tamox when you're done having kids. Hope your doctor feels it is safe to do so.

Anne

Lotusconnie

Dear Tami, Thank you very much! 

I kept on thinking "fairly widespread throughout the biopsy" just now. It sounds like the atypia connects with each other and spread all over the place. It sounds worse than multiple foci of ADH.

I thank you very much for your warm post. I think I DO want to have a child as soon as possible, and try my best to be monitored.

leaf

From what I understand, if atypia and nothing worse is found on biopsy, it doesn't really matter how much you have. 

According to these authors, atypical lesions are best thought of as a general (bilateral)  increase in breast cancer risk http://www.ncbi.nlm.nih.gov/pubmed/17154175

Lillie Shockley gave this answer 11-17-02 Question #2244

ADH is a risk factor for possibly developing breast cancer in the future but not a big risk factor that warrants a great deal of attention or concern. you should talk with your doctor about additional pregnancies but based on literature to my knowledge there is nothing to contradict having more children as there is no evidence it increases your risk. Be followed by a breast specialist annually so that you can feel confident you are getting a good clinical breast exam and proper mammography annually. Since excisional biopsy has already been done there is no other treatment per se that is warranted for ADH, just merely to rule out by doing an excisional biopsy that there is nothing else there. good luck to you.

samiam40

I already had 2 children when I was diagnosed with ADH & LCIS in 2002.  I spoke with my breast surgeon who echoed what leaf said, that there was nothing in the literature to indicate that future pregnancies would increase my risk of developing cancer.  I went on to have 2 more children, one in 2003 and one in 2005.

Long story short, I was diagnosed with IDC this past January 2009.

Do I think the pregancies had an effect on my developing invasive cancer?  No one will ever know if it was causation or correlation. 

More importantly, I do not regret for one instant having those children.  I saw a cancer therapist after my 2002 diagnosis who advised me not to put off having more children if I really wanted them.  It was the right thing to do for me and I would do it again in a heartbeat. 

There's only one thing I would add to leaf's comment.  For me, mammography was useless.  My mammo showed nothing when in reality I had a 2.6 cm tumor growing.  Please incorporate MRIs into your early detection regimen.  That is the only way my tumor was detected, and might have been caught sooner and smaller if I'd had MRIs in years past.

Good luck to you.

Lotusconnie

Thank you all very much! Thank you all for your warm words and very nice suggestions.

I do not have family history up to now, but my Mom and aunts and cousins all have their kids in their early 20s. For my widespread ADH, no kids up to now, early menstruation (age 11 I'm not sure about the name of this word sorry), I do believe it IS beneficial to take tamoxifen. But as you said, I really don't want to wait to have kids. So I decide not to take tamoxifen right now. I hope I have the time to have kids first and then I will take tamoxifen - Just hope I do have the time...

As for MRI, thank you very much for your kindness. I will definitely include MRI into my early detection regimen. Currently my oncologist said to me that she will include MRI in my screening maybe next year after I have a kid this year (of course it is a tough task, but a sweet one). If I can not have a kid this year, I would like to have a MRI next year anyway.

Thank you all very much! Thanks for being so kind to me since the first day I came here.