Can somebody inform me of the chance of bc after lcis and pbmx?

iammommy

Hi all. Some of youight remember me. I was diagnosed with lcis after a biopsy and had a pbmx about 2 weeks later. Clean pathology report after pbmx, no malignancy. BS told me i lowered my risk of future bc to 1-3%. I just read on another forum here that it is possible to go from Stage0 (in that case dcis) to stage 4 shortly after. Is there a difference in pbmx progmosis between dcis and nompleomorphic lcis? Thanks in advance! Nan

Anonymous

Nan-----someone who was diagnosed with stage 0 bc (either LCIS or DCIS) initially, and then found to have stage 4 bc very shortly thereafter, most likely had some invasive bc already there, but it just wasn't initlally detected.  Since it is impossible to remove all the breast tissue completely during mastectomies, there is some risk remaining, but it is drastically reduced. Congrats on your pathology report---"no malignancy"---that's wonderful news! So now you can celebrate!

Anne 

leaf

I completely agree with Anne.  There aren't any decent statistics that I know of. 

LCIS is an unusual condition to begin with.  

In this paper, they had 40 women with LCIS, and 5 of them had BPMs.  None of the LCIS women in either group got invasive breast cancer  (the abstract does not state the time period).  http://www.ncbi.nlm.nih.gov/pubmed/16910353  These numbers are obviously way to small to make any conclusion.

On this 2000 website, it says that 2 out of 214 women who had BPMs ***FOR BRCA*** died. http://www.imaginis.com/breast-health-news/removing-healthy-breasts-reduces-breast-cancer-risk-dateline-april-17-2000  These are **NOT** LCIS patients.  Note that BRCA women with a known deleterious mutation have an estimated 60-90% lifetime chance of getting breast cancer, which is much higher than the numbers I've seen in long term studies of LCIS patients, such as this 2005 study by Chuba. http://www.ncbi.nlm.nih.gov/pubmed/16110014

In the Chuba study, 

Rates of IBC occurrence for patients with partial mastectomy were greater than with mastec- tomy, and the magnitude of this difference remained con- stant over time. At 10 years, the incidence rates were 8.8% for partial mastectomy compared with 5.7% for mastec- tomy (ratio, 1.5); at 15 and 20 years, the rates were 12.6% v 9.5% and 16.7% v 11.0%, respectively (ratio, 1.5; Table 5).

In the Chuba study, it looks like 1.8% of the women who were initially diagnosed with LCIS had a subsequent invasive cancer tumor size >5cm, as opposed to 5% of those who were initially diagnosed with invasive breast cancer (did not have initial LCIS.)    I can't find anywhere in the article where they mentioned anyone who had distant metastases or death. jco.ascopubs.org/content/23/24/5534.full.pdf

KellyMaryland

Hi Nan. I was also quoted the 1-3% chance of developing breast cancer in the future after PBMX.  As to the stage 0 to stage 4 question, I think Anne said it well and that in most cases there was some bit of invasive bc that was undetected at the time of diagnosis.  It's easy to drive yourself crazy thinking about this possibility.  If you are prone to constantly attempting to prepare for the worst (I speak  from experience) it's very hard to turn these thoughts off.  Maybe Leaf (helpful, kind Leaf....tired of me referencing her, I'd guess!) has some stats on this question but I highly doubt there is much that is helpful in the literature. 

Kelly

edited to add:  HA! took me too long to write that post and in the meantime Leaf has come!

Crescent5

I know this is an older thread, but I have a question for leaf if you're still around. Am I reading that info right? It looks like of the women w/LCIS who had PBM, 5.7% got invasive later? That stat goes up to 12.8% later?

leaf

In the Chuba paper, unfortunately, they don't specifically say that the women who got mastectomy had single or bilateral mastectomies. (It is certainly possible that the database - the SEER study information - itself was unclear so they couldn't tell. But I don't know.)  I don't know when docs realized that LCIS risk is bilateral; this database starts in 1973.  I suspect that some/many of the women got single, and not bilateral, mastectomies because in the abstract it  states 

"IBCs detected after partial mastectomy occurred in either breast (46% ipsilateral and 54% contralateral); however, after mastectomy, most IBCs were contralateral (94.7%)."

In table 5, it says that at 10 years, 5.7% of the 'mastectomy' group got invasive breast cancer, and at 25 years, 12.8%  of the 'mastectomy' group got invasive breast cancer.  I suspect, but do not know that at least some of these 'mastectomy' patients had single mastectomies.

Later in the paper, they state 

A substantial proportion of patients had mastectomy (n=1,281), and as expected, this intervention was associated with dramatic (although not complete) re- duction in the rate of ipsilateral occurrences of IBC, with less than 0.5% to 1.0% ipsilateral IBC 15 to 25 years after mastectomy.  (P<=.001)

So, I suspect some/many of these mastectomies were single, not double mastectomies.  (I don't know if any women in this study got double mastectomies.)

So I'm confused about their definition of 'mastectomy'; I'm not sure in each case if they mean single or double.  I suspect they mean that if a breast was removed, that the subsequent incidence of breast cancer was <0.5-1%, and if it was not removed, it was higher.   According to the numbers above, it sounds like  the 'partial mastectomy' group had rates that were about 3-5% higher. But I'm not sure.