Low Grade DCIS - "Calcifications"? (BL, Beesie, etc all)

NSJ2

Hi there BL, Beesie, et All

So I am looking at going into radiation soon and I'm wondering about the finding on my earlier biopsy path where it reads that I also had the following in my left breast (aside from the DCIS):

"No suspicious microcalcifications are identified. Benign appearing calcifications are seen in the left breast".

Here are my questions:

- How likely is it that these "calcifications" will become micro/suspicious/cancer given it's in the same breast as where DCIS was found?  Percentage risk?

- Does radiation have any impact on "calcifications"? Can rads prevent them from becoming cancer, or can it even cause them to become cancer?

Note: In the final surgery path my margins were clear and quite wide as intentionally requested (4.5c sup-inf, 2c ant-post, 5.4c med-lat). This path also reads "Microcalcifications = not identified".

Thanks,

NSJ2

BLinthedesert

Hi NSJ2!

Benign looking microcalifications don't "turn" into suspicious ones.  Radiation won't effect microcalcifications.  The literature is all over the place (meaning no good evidence either way really) - but many clinicians feel that radiation will inhibit (e.g., kill) all atypical/proliferating cells -- meaning ADH/ALH/FEA/cancer.  So, if the microcalcifications are associated with any proliferating cells, then the radiation is, theoretically, supposed to zap them.  If they are associated with normal breast tissue, then, again theoretically, the radiation should not affect them.

Sounds like really good pathology!!

Beesie

Ditto to everything BL said!

There are lots of different things that can cause calcifications to develop.  If you have calcs that developed because of some harmless reason, those calcs won't ever 'turn' into breast cancer.  And those calcs also won't be affected by radiation, but then they don't need to be because they are harmless.

Calcs that represent breast cancer formed because of the cancer.  They are completely different than benign calcifications. 

I agree with BL, what a great pathology report. Those might be the widest margins I've ever heard about!

NSJ2

Thanks BL and Beesie. Very helpful as always. Don't know what any of us would do without you two on this forum. We're blessed.

Yeah, the margins were big. I didn't want to revisit surgery if I could help it. So I told her to go wide, and please just leave me something to look okay in a bra if possible. My DCIS was in my inner lower quad.

Also just another question on naming. For some reason I always thought there was a distinction of "micro-calcs", which I thought by virtue of the "micro" were cancerous, and "calcifications" were not. True?

Beesie

Nope, not true.  Larger calcifications, what are called "macrocalcifications" are always benign.  Smaller calcifications, or "microcalcifications" might be a sign of breast cancer, but the vast majority are benign.  Only suspicious looking microcalcs, i.e. ones that form into a cluster or line - are biopsied, and 80% of the biopsies end up being benign. Since a good portion of microcalcs aren't even biopsied (if they are randomly scattered, for example) and 80% of the ones that are biopsied are benign, it means that well over 80%of microcalcs are not cancer.

I had suspicious looking microcalcs in both breasts 7 years ago.  Biopsies were done on both breasts.  The calcs in my right breast were a sign of breast cancer.  The calcs in my left breast formed for some other reason (who knows why!) and were benign. They're still there but they are nothing for me to worry about. 

TeresaF

Hello,

I have just received my pathology report today following a lumpectomy on Nov.2.  The DCIS is only 8mm but 'abuts onto anerior superior margin.'  The surgeon wants to do do a reincision and take out more tissue to get the clear margin.  I have been struggling with my decision to do lumpectomy or Mx.  The only reason I am again considering mastectomy is wording in the report that sounds like more is happening away from the carcinoma.  Will radiation take care of it? or is a wait and see? or should I be concerned at all? "Atypical lobular hyperplasia, ductal epithelial hyperplasia, cystic change and apocrine metaplasia away form th in-situ carcinoma" I also have "microcalcifications present with carcinoma and also elsewhere"  Why is nothing in this 'adventure' cut and dry?

Thanks for any info you can offer.

(DCIS, Grade 3, Stage 0, no clear margin (yet)

Beesie

Teresa, have you had an MRI?  MRIs are more effective than mammos at showing high grade DCIS.  I had an excisonal biopsy that left me with no clear margins.  I would have preferred to have a lumpectomy, but my MRI showed that my breast was full of "stuff".  There was no way to know for sure that the "stuff" was DCIS but the odds were that it was.  So that convinced me to have the MX.  It turned out that all the "stuff" was more DCIS so it was the right decision.  Lots of us here have been helped in our decision-making by the results of an MRI.  If it's clear, that could lean you towards the re-excision.  But if more shows up, that could make the decision to have a MX easier.

TeresaF

Thanks so much for your prompt response!  I think I had MRI on Sept. 19 after initial Mammo.  But oddly enough I don't remember ever talking about or seeing pictures/images.  It was just used to confirm that the area of DCIS. Initially they 'saw' something in right breast as well but later said "could not be confirmed" .  This gives me something more specific to ask my doc.  I find that my questions are too general and not helping me make a decision that is specific to me.  I guess I am looking for the 'obvious' sign to direct my next step.  Often the advice is to 'trust your gut instincts' or 'listen to your gut'.  I laugh at that because my 'gut' and I don't have that kind of relationship.  We don't 'speak'.  I like information and facts.  And even better if facts lead to clear decisions.  

NSJ2

As always, thanks Beesie.

So where my path reads (bold below):

"No suspicious microcalcifications are identified. Benign appearing calcifications are seen in the left breast".

Are they describing "macro-calcifications"???

proudtospin

nope, just plain old calcifications it seems to me

Beesie

NSJ2, it doesn't matter if they are describing micro calcs or macro calcs.  The important words are "Benign appearing".  Whatever the calcs are, they are not at all concerning.  What I said earlier was "Only suspicious looking microcalcs, i.e. ones that form into a cluster or line - are biopsied".  In other words, not all microcalcs appear suspicious.  

50% of women develop calcifications. They might be macrocalcs or they might be microcalcs. Most calcs do not appear suspicious.  You have some of these run-of-the-mill calcs. Or as proudtospin put it so well, some 'plain old calcifications'.  

Don't try to parse all the words and read too much into every word. You have harmless calcs that you don't need to worry about.  So do lots of us. Don't worry about them.

Teresa, you say you think you had an MRI. Were you put into that lovely (!) tube, lying face down with your breasts through these holes, and told to lie perfectly still for 30 to 45 minutes while the machine generated all these really weird and loud noises?  That's a breast MRI.  It's kind of hard to miss. And usually breast MRIs have to be scheduled in advance. If you were sent for another test right after your mammo, it's might have been an ultrasound. That happens a lot.  With an ultrasound, you lie on your back on the table, they put some goo on your breast and they run a wand over to breast to see the images.  So if in fact you didn't have an MRI, it could be helpful to your re-excision vs. mastectomy decision. It's definitely worth talking to your doctor about. 

TeresaF

I took time to look back at my appointments and realized that I have NOT had an MRI.  I am thinking about your response to others about not trying to read too much into every word of the pathology report.  My decision changes depending on what information I decide to focus on.  My family doc is out of the country until the end of the month.  My surgeon who is on holidays has a spot to do re-excision surgery this coming Wed. and then he is away again.  Should I be putting much weight on the fact that  it is identified grade 3 DCIS?  That I am 45 and have many years to keep looking over my shoulder hoping to 'catch' it as early as it was caught this time? That my mother had breast cancer? Common sense decisions require facts, and emotional decisions require calm rational thought.  I feel short on both accounts. The re-excision would give me another pathogoist report (more info) and 'buy' me more time but right now sitting here in pain, even though lumpectomy was 2 weeks ago, I am not looking forward to doing it again if my final decision will be a mastectomy.  

ballet12

Teresa, if you are not sure what to do, don't rush into anything.    If you haven't had an MRI, it makes sense to do that before you do the next surgery, to get an idea of the extent of the DCIS.  Also, with a family history, were you tested for BRCA genes?  That's something else to do, although it does take a few weeks to get results.  Those who are positive for BRCA 1 or BRCA 2 have a much higher probability of developing IDC, and many do go on to have mx.

It does sound like you don't have all of the information yet.

Good luck.

TeresaF

I have submitted all the info for the genetic testing but it can take up to 8 weeks to get results.  I think i will ask if an MRI would be possible before next step.  Thanks.  Can I ask what treatment you decided on since you also have Grade 3 DCIS?

ballet12

Teresa,  about the BRCA testing, it shouldn't take that long to get preliminary results from BRCA testing.  It is done by Myriad Laboratories.  Let your physician (or geneticist--whomever is initiating the test) that you have a cancer diagnosis and are waiting for this result to make a treatment decision.   Myriad states that preiminary results should be available by three weeks at the latest (you can actually also call Myriad directly, not to get the results, but to find out if the testing has been completed or if it's still in progress).

About what I did (as you asked).  I did two re-excision surgeries (three total surgeries), and the surgeon obtained clean margins on that third attempt.  Now I will be proceeding to radiation.  If you want more details, feel free to send a private message.

As is often stated on this message board, the decisions one makes are so individual.  It depends, not only on medical data, but very much on what each individual is comfortable with, in terms of risk tolerance.  That is so individual.  You have to go with your gut, and you have to look into the future to sense how you might feel in a few years.  There are many questions to ask.  Beesie  did an excellent review of the mastectomy vs. lumpectomy/rads decision process.  I recommend that you look that up.

TeresaF

Great advice to check out Beesie's review.  You are an excellent resource Beesie, thanks so much for all your posts.  I have looked at several on these boards and other readings and it seems to keep coming down to the 'it's a personal choice' .  There is other calcification in the breast that my DCIS is in and there was some question about the right breast on an earlier mammo but the second mammo could 'not confirm' anything and I was told to have it checked in January.  (They even put in the requisition for appointment - which would be only three months from original check-up).  Those of you who go back to check regularly, does it play on your mind much or do you get used to it?  How long did it take others to make their decision.  I realize some of you had no choice or the information clearly pointed out the obvious but anybody else with hgh grade DCIS trying to make up their mind out there?

Beesie

Teresa, I had a single MX.  No choice (or not really much choice) about the mastectomy on the cancer side because I had such a large area of DCIS.  After a benign biospy (for calcs) and clear MRI on the other side, I decided to go for a single only. That was the right decision for me but as you said, it really is a personal choice.  A very personal choice.  We all assess differently the pros and cons of a lumpectomy vs. a MX, we all deal with risk differently and have a different risk tolerance, we all have different fears. And of course, we all start off with a different diagnosis and a different health history so our risks both from the disease and from the treatments are different. 

Since I had the UMX, I can't say how I would feel about getting regular checks and screenings on the cancer side. I can say that going back for screening on the non-cancer side (on which I've had 4 biopsies and lots of cysts) hasn't been a problem for me.  Well, that's not completely true. I probably started to think (and worry) about my first post-diagnosis screening a good 2 months before the appointment. I was very anxious for a couple of weeks before. My breast tissue is extremely dense so I get alternating mammos and MRIs every 6 months.  By the next 6 month screening, my anxiousness was down a bit - maybe it was only a month that I worried. Within a couple of years, I didn't start to think about the appointment until a day or two before hand.  And finally at around 3 1/2 or 4 years, as I was sitting there in the gown waiting for my mammo, I realized that I hadn't thought about it or worried about it at all. I've had a few 6 month call-backs over my 7 years but even those don't worry me now. Having gone through the BC experience and knowing so much more about what to expect, I honestly think I worry less than I used to, before I was diagnosed. 

I've seen a lot of women who've had lumpectomies or single mastectomies come back for a BMX after 6 months or a year.  They come back because they can't live with the fear.  When I see that, I wonder if they've given themselves enough time.  It's normal to worry about BC if you've just been diagnosed with BC within the past year or two. Lots of women who've had BMXs still worry about recurrences or mets (mets, even after a DCIS diagnosis) after a year.  But after a while, I think most of find that the fear does fade. 

That's not to say that a lumpectomy is a better option for you. Maybe it is, or maybe a MX is a better way for you go, or maybe a BMX is the option that you can best live with.  But it answers your question - from my perspective only - about how it feels to go back for checks after having had a diagnosis of BC.  

BLinthedesert

Teresa, I am on two different schedules - for both breasts.  One, that I had DCIS in, I see either my RO or my BS every 6 months for a manual exam, and yearly diagnositic mammograms.  For my "good" breast, I am also getting 6 month MRI's for an area of BIRADS 3 (probably benign but short term follow-up) - I have had two of these MRIs since my original diagnosis.  Not too stressful, and as a matter of fact, I expected the MRI stuff to be "over with" and was sort of surprised to hear that they wanted me to come back in 6 months, I was looking forward to "no more MRIs". 

My first mammogram post-treatment was a "baseline" mammogram - I did not expect anything with this one, as I had just finished treatment and pretty much knew the original cancer was gone.  My first mammogram post-treatment is in February, and though I might change my mind as the time gets closer, I am actually not feeling stressed about that one either.  

I feel that with such close follow-up, on the off chance they ever find anything again it will be early - so I am in pretty good shape.  Not to mention, I have been lucky this far, why not continue to be lucky?  

TeresaF

Hello again.  I loved the positive attitude.  I do feel lucky it was something caught early.  I am headed for re-excision surgery on Dec. 12th to get a better margin.  I still fret about some of the wording in my Path report but after doing some reading I guess that is why the radiation is recommended and the Tamoxifin.  I had just settled my mind that this was just how it was going to be.  One more surgery, radition and back to the every day.  But just yesterday I recieved my appointment letter in the mail for the screening of my right breast.  I can honestly say it really annoyed/upset me.  I haven't even finished dealing with the Left side (the bad side) and already I am looking over my shoulder wondering/worrying about what the results might be for the right mammo coming up.  I took a deep breath and remembered how many of you have posted and said that eventually the anxiety around the check-ups goes away.  Thanks for your encouraging words and being willing to share.  

Beesie

Teresa, good luck with the re-excision surgery on the 12th.  Let's hope you get nice wide margins this time!  And good luck too with the screening on your right breast.  What you need to ease your mind are a few screenings with no call-backs!