Preventative Hormone Therapy

Faith1984

I received my excision biopsy results today and was told that I do have not cancer!!! WoooHooo to that!!!! I was told however that my surgeon would be referring me to an oncologist to possibly discuss hormone therapy. He stated that although I did not have cancer that I had "atypia". I am still unsure what exactly this is and why I am going to oncology if there is no cancer. I was just wondering if this sort of situation has happened to anyone else? Can I have your thoughts and opinions on hormones to prevent the spread of these cells.

Thank you!

vlnrph

Hopefully the oncology folks will explain things better than your surgeon: congratulations on your benign biopsy results!

If you are at high risk due to genetic factors or family history, a prescription for hormonal agents might be in your future. Tamoxifen is a selective estrogen receptor blocker, used to reduce the chances of tumor development. It can stop certain abnormal or atypical cells from reproducing and should really be called endocrine treatment or something different.

When some women go through menopause, they get HRT=hormone replacement therapy to relieve symptoms of hot flashes, etc. Those medications have been shown to promote cancer and are not nearly as popular as they were years ago because of this.

So, the terminology is confusing. Keep reading, ask questions - you need to understand what the options are.

momoschki

hi Faith,

Atypia describes cells that have become abnormal, but do not meet the criteria for cancer. The histology is on a continuum, so sometimes the distinction is not even that clear. Both atypical ductal hyperplasia and atypical lobular hyperplasia put you at higher risk for developing BC. You are being referred to an oncologist because of these high risk circumstances and the oncologist can explain your own individual risk, as well as the pros and cons of hormonal tx.

Four years ago, at 53, I received a dx of atypical ductal hyperplasia (ADH.). At the time, I was not yet fully menopausal, so the only chemo preventive option for me was tamoxifen, which I declined. Since then, I have recently begun taking evista, which is an option if you are post-menopausal. Aromatase inhibitors, another class of drugs, can also be used if you are post-menopausal. All these drugs do have potential side effects. Read the section here on hormone tx-- it will give you a good background. Fwiw, in the 2 months I have taken the evista, I have had no side effects whatsoever, with the exception of being slightly nauseous for the first 3 days I took it.

Feel free to PM me if you have any questions..,

Faith1984

I truly truly truly appreciate your responses. You both have helped clarify what i am dealing with. I am not sure yet whether it is ductal or lobular . I have a few more questions if you wouldn't mind assisting me. What are some questions I should ask the oncologist when I see him/her? I just turned 30 in November do you think it is too early to start HT? Your thoughts on questions I should ask would be great since I seem to never be able to think of them until after the appointment.

It should be worth mentioning as well that everything was done solely on my left breast so I am now going to back to have a mammo done on my right and can only cross my fingers that nothing shows up there because i don't want to go through all of this again. lol

Thank you again!!

momoschki

I would ask the oncologist to assess your risks given your age and medical history. Is there a history of BC in your family? Was the atypia focal or widespread throughout the breast? What is the risk/benefit ratio of taking a preventive med? I don't think 30 is too young to start one of these medications-- on the contrary, because you are so young, I would think one of these medications would be especially important, since you have many years to live, hopefully cancer free. Ask also about the suggested surveillance regimen.

Faith1984

Thank you again for your response!!! The family history is gray as I don't my father and my mother has an adoptive father so we are missing a good chunk. Nothing immediate that I know of. History of cancer yes but BC no i don't think so. In regards to the atypic being widespread I don't know ,(is that a question i should ask them)? What I originally had was a diagnosis of a complex mass 12cm that shrunk to 9mm after aspiration and then I had the excision biopsy, and it was removed. As far as I know this was the only area of concern on the left side. In turns of surveillance, I was advised that I would be having mammos every six months until otherwise told. This was the order from the BS. I will definitly ask the benefits of the treatment. I have read somethings on here that when you have a lumpectomy that the pathology can tell how quickly the cells are multiplying and point of origination, is that true do you know? Would they know the same information from an excision biopsy even if its not cancer. Have you ever had a MRI after Dx? That was not something that was mentioned to me or offered.

I wanted to truly thank you for your responses, I feel like I am walking blind here and your advice truly helps.

Thank you!

momoschki

faith,

As far as the rate of cell multiplication from the pathology - I don't know about this, but I suspect that may be something tested when cancer is actually found. Never heard if this done for atypia. And yes, I rotate different tests every 6 months: in the fall, a mammo, in the spring, ultra sound. Then the following year, mammo again in the fall and MRI on the spring. Repeat, etc. I have fine this for 4 years now. This is the protocol my BS has designated for me, but I know that lots of high risk women here have an annual MRI. This can be helpful, particularly if you have dense breasts (another thing to ask: what category of density do they fall under? There are 4 levels ranging from fatty to homogeneously dense.). Oh, and request a copy of your pathology report and all subsequent reports-- it's good for you to keep track of all this stuff. It piles up quite quickly and you'll want to stay as organized as possible. Do you have someone who can accompany you to the oncologist appt? It can be hard not to become overwhelmed and it helps to have another set of ears if you walk out afterwards and can't recall a word the dr said (this certainly happened to me!)

Best of luck and let us all know how things turn out.

treetoo

what does your path report say? also have you considered being tested for the gene?

did you get a second opinion in regard to your path report?

grammakathy

definitely get a written copy of your pathology report! And take as many notes as you can when you go to appointments. My pathology report from a stereotactic biopsy in December 1999 states I had atypia or atypical hyperplasia with no malignant cells. No follow up was advised. In Sept 2013, I was diagnosed with cancer in that same spot. I would gladly have taken anything to prevent that progression!

Faith1984

I still have yet to get a copy of the pathology report. My BS is being super aggressive, I finally had the mammogram on my right today because of the DX atypia in left. The right shows clustered micro calcifications. I see oncology on the 3rd and the BS again on the 6th. I guess I will find out more than and request my reports at that time. My hospital automatically gets two opinions...one from the hospitals pathology department and then the samples are sent to Beth Israel in Boston to be reviewed as well and than my BS reviews for his opinion, so I have not considered going to another doctor for another opinion. The only pathology report I have is from the core biopsy, I don't have the one from the excisional biopsy. I have to say that I am super stressed every time I think I will be cleared and something else comes up. The mammogram today was over two hours long.

Thank you ladies for being supportive!!!

Are calcifications normal at 30?? Any insight..... could have anything to do with the atypia in left??

leaf

The diagnosis process is awful.

Here's an excellent website about calcifications. http://www.radiologyassistant.nl/en/p4793bfde0ed53...

I don't know about how common calcifications are in younger women. This is just one paper, but opined that breast arterial calcifications correlated with increased age. http://www.ncbi.nlm.nih.gov/pubmed/16890393 But I don't think there's a lot of widely accepted evidence on the issue.

Best wishes for a boringly benign outcome.

Faith1984

LOL Boringly benign. Love that!! I will take boring all day when it comes to my health. Thank you for the links. I will take a peek now.

vlnrph

Be sure to inquire as to the density of your tissue. The radiologist should have an assessment on their report. Being so young, you might be dense (as opposed to fatty which appears clear on x-ray) unless you've already had 3 or 4 kids! Many of us have dense breasts which can make mammograms more difficult to read: abnormalities may be obscured.

I always had to wait while they looked at the films and then called me back for additional views from different angles and/or ultrasound. It seemed like they didn't know what they were seeing until digital machines became available. Even then, my IDC was not found until I had my first MRI which was done after lLC was diagnosed by biopsy. I now alternate scans every six months.

The policy of having your pathology slides going for outside review is excellent. There still might be a need for a second clinical opinion as to what course of action to take however. Surgeons are good at performing operations but medical management is usually handled by the oncology department, even though it's not actually a real cancer.

They can also advise or refer you to a genetic counselor if appropriate, given your uncertain family history. Not just for "the gene" as treetoo implies above, testing for many mutations other than BRCA 1/2 is now possible and less expensive than it used to be.

Lotusconnie

Faith1984, I am reading your post. When you have time, please read mine too. I have widespread ADH.

I think you may be too young (born 1984?) to take Tamoxifen right now. It is said for;

●Age over 60 years
●Age over 35 years with a history of lobular carcinoma in situ (LCIS), ductal carcinoma in situ (DCIS), or atypical proliferative lesion of the breast (atypical ductal or lobular hyperplasia) (see "Atypia and lobular carcinoma in situ: High risk lesions of the breast")
●Women between 35 and 59 years with a Gail model risk of breast cancer ≥1.66 percent over five years
●Women with known BRCA1 or BRCA2 mutations who do not undergo prophylactic mastectomy