Breast réduction to reduce cancer risk and other things

alicki

hello,

I had a breast reduction and was initially told that it doesn't modify the risk of getting cancer.

Yesterday I met with a plastic breast oncologist surgeon (he does both: oncology and breast plastics). 

He said that yes, in case of FB, even without atypia you do reduce your risks because you re taking off some of the tissue that could become cancerous.

I noticed a few years ago that someone on this site had mentioned the same thing. I wonder if any research has been done in the US on this. I went from cup E to C. 

And no (I hope Melissa is reading me), you don't need a BMX for your breasts if they are without atypia. Right there gal :-)

FB is no longer known as a disease but a condition and lymphatic massage greatly helps the circulation in the breasts to get better. 

Anyways, I have at last found two docs and a radiologist I can trust.

I wanted to get a mammo done but as I had to have an emergency procedure here in Switzerland they said 'no' and the radiologist wasn't too happy about the low quality resolution of the mammography. I have now learnt that in addition to all our other concerns, we need to make sure that the digital mammograms being used by our radiologists are of high resolution. Seriously? 

European docs are allergic to the idea of mammographies more than one a year which explains why we are being sent for ultrasounds and MRIs all the time. They fear that radiation will induce cancers 

Lastly, from another doc here, I found out that the 3D can be used with only one dose of radiation. In case of doubt, they will do an MRI. They are MRI mad here I think. 

Don't know if any of this info can be helpful but wanted to post anyway

Best,

Alicki

momoschki

This topic generates a lot if controversy in the medical world.  I had a bilateral reduction after reading some research, mostly done in Canada and Scandinavia, that showed reduced occurrence of BC after surgical reductions.  I will try to dig up the citations and post them here later.  The risk reducing effect was more pronounced in older women (I think I remember 45+ being considered "older"), also the greater the amount of tissue removed, the greater the risk reduction.

I suspect that many hospitals do not have oncoplastic teams, which is really too bad, since reductions could be offered as a viable option for many women as something midway between a lumpectomy and a mastectomy.  Both my PS and onc estimated I cut my risk somewhere in the neighborhood of 50%. Sure hope they're right...

alicki

hello,

Ah you re the one! Mine was done by a plastic surgeon but an onc was in the background and due to my insistence, EVERYRHING removed was sent to pathology and ANALYSED. All came back fibrocystic which explained what was going on. 

Let's take this from a logical point of view, if you cut stuff off, cancer can't grow there although it can grow elsewhere. Moreover, screening becomes easier.

I'm monitored both here and in the UK. UK onc is one of the top five in the country and I trust him.

There are also cultural differences between Europe and US.

Here mascetomy for DCIS is uncommon and my onc here keeps saying that studies shows that life expentency is no different between lumpectomy and mascetomy. I don't know personnally.

To my horror, I read that someone on the boards had a tumor come back after mascetomy on surgical scar. 

IN the US, and correct me if I'm mistaken, you can get a mammography done twice a year or have many views done Here it's considered as a health risk and no way they will do it, they prefer to do an MRI instead or ultrasound.

So BC care is also determined by culture practices. 

Anyways, our experience is interesting. I think in addition exercise and healthy food can make a difference. I don't have atypical cells ...yet at least. 

Monitoring provides reassurance and after that you just get on with life and hope for the best.

Best

Alicki

alicki

one more thing,

Massage does a lot of good. Moves the circulation around :-) 

DiveCat

Yes, it is true that having fibrocystic breasts is no longer considered a "disease", but a benign condition...which 60% of pre-menopausal women have. I am glad they now treat it as a condition, not a disease as it isn't and I think referring to it as a disease scared too many women. I wish someone would tell the life insurance company who called me a couple weeks ago for my phone interview that it is a CONDITION that a majority of women have as they seem under the delusion it is still a disease or a "high risk disease"...!

Yes, cancer can recur in a scar. This is because mastectomy does not remove all breast tissue. It just can't. So the primary cancer can recur in the scar or in the breast tissue that remains. This is usually a local recurrence, and is different than a NEW primary occurrence or mets. And yes, for cancers where lumpectomy is appropriate, it combined with radiation has very similar recurrence rates to mastectomy. There are cases where lx is not appropriate though.

I am not surprised MX is less common there for DCIS (I imagine it is still on a case by case basis, like widespread DCIS or where a woman has a higher risk due to other atypia or a genetic mutation though). There are definitely cultural differences at play. This happens in terms of getting prophylactic mastectomies where one is BRCA1/2+ or has high family risk...uptake rates for preventative surgery can vary DRAMATICALLY across the world. I also think being properly informed has lots to do with it...not only about DCIS, but about the limits and risks of mastectomy. This can vary from doctor to doctor as well.

I think it is great that you can get ultrasounds and MRIs there relatively "easy"...being MRI mad is not a bad thing in my view. Though MRIs do bring back more false positives they are much better at detecting cancers than mammogram..this is especially important in women with dense breast tissue as mammograms have real limitations there. It can be a real struggle for many women here (in both US and Canada) to get breast MRIs.  There are exceptions of course, but it is not routine standard of care. I can easily get mammograms, and I do, but I give a "clear" mammogram little weight since I have dense breasts and they may only be able to see a cancer in that case a minority of the time (estimates range between 25-50% of the time, last time I checked). Anyway, I am in Canada, not US, but I only get mammograms once a year and would not want more than that knowing the limitations and not wanting to add more radiation. As I am high risk, I do also qualify for MRI and ultrasound, but if I was not assessed as high risk I would have to "rely" on once a year mammograms which in my case could miss a cancer. I did have 2 mammograms last year, but one was as part of my workup for surgery. My mammograms (for last 8 years ) have all been digital mammograms, two views of each breast (one from top, one from side). I don't think this is unusual and the reason they flatten the breast is so the tissue spreads out and they can capture more tissue in the image. More views are only done if they spot something..then it becomes more diagnostic.  

It is great to hear that you have trust in your medical team

momoschki

Alicki,

Yes, I'm the one!  I had an excisional biopsy done first by a BS ( hospital #1) and then had the reduction done by a PS (hospital #2) who routinely works as part of an oncoplastic team which does preventive and reconstructive surgery.  BS at the first hospital was very dismissive of the path I chose, which was discouraging, to say the least, and made me doubt my decision. My onc (same hospital as the PS) is on board, though.

I only get one mammo a year-- 2 views on each side.  This alternates at 6 months intervals with an US or an MRI.  I am glad I am being closely watched, but the 6 months go very fast and all this checking, testing, and poking around makes me crazy.  I have an US coming up in 3 weeks and I already feel anxious.  I am not very good with the "whatever happens happens and then I will deal with it" strategy.  Alas.

alicki

Hello momo,

I can imagine it drives you crazy, and like you the 'what happens, happens' isn't for me either. I don't think we can do anything though, and maybe it's a good idea to say to ourselves, even if BC comes a lot, at least with all the monitoring, it will be caught early.

What else can we do?  Only difference with you is that I have regular ductal hyperplasia and fatty breasts so easy to see.

But the uncertainty is not nice.

One question I have, how did they know that you had ADH? What led them to the decision to do the biopsy?

Cheers,

alicki