Does anyone know if "minimal ALH" is the same as microfocus?

shabby6485

Hi!

I am trying to understand my risk of BC after being diagnosed with a microfocus of ALH after a stereotactic biopsy.  Had surgical biopsy which was b9.

Is a microfocus of ALH the same as "minimal ALH?

I have never heard the wording "minimal ALH" and was wondering if it is also called microfocus?

thanks! 

Anonymous

shabby--I would think that "microfocus" pertains to the amount of ALH (a small area); the risk with ALH is generally about 20 to 25%. Sound glad to hear that nothing more serious was found.

anne

vmudrow

My last biopsy came back with -  surgeons words "just a little bith of ALH", I had biopsy because of microcalcifications which were biopsied 2 years ago with a stereotactic biopsy, this year they were clustering so had an excisional biopsy.  With a family history of breast cancer, previous biopsies, cancer risk of 40% the surgeon sent me to an oncologist who wanted to put me on tamoxifen for 5 years.  I decided on May 6th to have a double preventative masectomies.  No further ALH was found or cancer - but I am so happy with my decision!!

leaf

Well, I don't know; I'm not a pathologist. 

This does not answer your question, but I can find these sentences in ONE academic paper in 2005.

Minimalexamples (so-called minimal ALH) contain the characteristiccells without distention of the lobules⁴; we reserve the diagnosisof LCIS for characteristic changes that grossly distort lobularunits.⁵ <snip>

We conclude with some enduring facts and some open clinicalquestions. First, lobular neoplasia places both breasts at riskfor subsequent invasive carcinoma that may be dominantly hormonereceptor positive. Second, there is a minimal lobular neoplasiathat carries little or no implication for increased risk. Third,ALH and LCIS are precursor lesions,¹ but the multiplicity andmulticentricity makes the location of later disease probablydependent on density and distribution of these lesions. <snip> 

We need to have better understanding of the associations betweenthe incidence of lobular neoplasia, magnitude of cancer risk,age, mammographic density, and distributions of lesions withinthe breast. We conclude that there are many special aspectsof lobular neoplastic disease in situ and invasive in the femalebreast; what remains to be clarified is the practical implementationof this knowledge, particularly in the implementation of preventivestrategies.

(http://jco.ascopubs.org/cgi/content/full/23/24/5432) (emphasis mine)

Another paper opines about LCIS:

RE risk: Despite the limited follow up (12 years) the NSABP study also yields insight into the relative aggressiveness of LCIS.  Only 2 patients in the cohort (1.1%) have died from breast cancer and one of those was attributed to a contralateral “recurrence”.  <snip>

 Those authors also found that disease recurrence/progression was more likely in patient having more extensive disease (i.e. those with involvement of >10 lobules).  This tendency has also been observed with ALH  (see Degnim et al) and I am surprised that extent of disease has not achieved utility as a parameter in clinical decision making for patients with LN.www.pathology.med.umich.edu/./07/./Case%208_Visscher.doc
Do realize that our knowledge of breast cancer risk is very, very limited.  The Gail model is probably the most widely used model used for women that have not yet had breast cancer or LCIS.  In one paper they compared the Gail model to a model that included other breast risk factors such as breast density, which they called the Italian model.  In this editorial, for the prediction of breast cancer for an individual, Thus, for any given woman, the two models were better at prediction than a coin toss—but not by much. http://jnci.oxfordjournals.org/cgi/reprint/98/23/1673.pdf (emphasis mine)

If  their knowledge of prediction is that poor for women in the general population, you can imagine the state of breast cancer risk prediction is for persons with an uncommon breast condition.