Breast Atypical Cells

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tdbyaya
tdbyaya Member Posts: 5
edited June 2014 in High Risk for Breast Cancer

I have routine digital mammogram. They discovered some changes from my last mammogram. On 2/10/09 I had a Stereotactic Core Needle Breast Breast and was told that I had Atypical cells and that need to discuss my case with medical conference to see want treatment plan will be best for me. I am scared about the about not doing nothing.

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  • tdbyaya
    tdbyaya Member Posts: 5
    edited March 2009

    tdbyaya

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  • leaf
    leaf Member Posts: 8,188
    edited March 2009

    Often, but not always, they do an excision after a core biopsy shows atypical cells, to make sure there isn't something worse going on in the area.   The rate that this happens varies from study to study, but roughly 10-40% of the time they can find something worse.

    Do get a copy of your pathology report.  There are (at least) 2 different types of breast atypia: atypical ductal hyperplasia (ADH), and atypical lobular hyperplasia (ALH).   You can also have LCIS, which is a more advanced case of ALH.

     Some people who get diagnosed with ADH choose to have their slides reread to make sure of the diagnosis.  Sometimes it can be hard to tell the difference between ADH and DCIS, and they are usually treated differently.

    Your family history MAY be factored into this equation.  Sometimes women are offered tamoxifen or another anti-hormonal, if you have ALH and/or ADH.

    I have LCIS and ALH, and ductal hyperplasia (not atypcal ductal hyperplasia).  Its the 'atypical' adjective that does put one at higher risk.

    In any event, if you do have an excision, and your diagnosis stays ALH or ADH, then you do have time to decide how you want to be followed.

    I know this is scary.   Even though you may be described as 'high risk', they don't know a lot about breast cancer predictions.  Some people opine that LCIS (which is probably more advanced than what you have) gives approximately a 30-40% lifetime incidence of breast cancer.  ALH and ADH may be about half of that (in other words, about 15-20%).  Note that the risk of breast cancer over a lifetime for an AVERAGE woman in the US is about 12% (1 in 8).  

    But these prediction numbers are very, very soft.  They are quite good in predicting how many people in a US population may get breast cancer, but they are VERY POOR at predicting which particular individuals in that group will get breast cancer.  So our  current models are not good at predicting whether or not YOU will get breast cancer.

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  • tdbyaya
    tdbyaya Member Posts: 5
    edited March 2009

    My case results was Negative for atypical ductal hyperplasia. Negative for carcinoma.  The radiologist and pathologist have discussed the findings and due to the fact that there is flat epithelial like tissue and atypia and 2 foci and scattered areas of calcifications in the right breast, it is recommended that we discuss her case at our Clinical Management Conference and determine the appropriate management.  They have concluded that I will not need the additional biopsy or excision.  I will need to continue with routine mammogram yearly. I am not sure I am satisfied with the results.

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  • KarenSil15693
    KarenSil15693 Member Posts: 5
    edited March 2009

    I am reading through a few of the different forums and posts today because I had an excision biopsy 2 days ago. Leaf you seem pretty knowledgable, I have seen your posts on a couple of the forums I looked at and hope I can ask you a few questions.

    A little about my history: I am 49, my 40 year old sister was diagnosed with stage one last year - she is the only breast cancer history we know of in our family. I felt a lump in late November, had a mamo and then an ultrasound. The lump I felt was determined to be a benign cyst but they found another area of suspicion at that time. I had and MRI and a needle biopsy which came back Atyical Ductal Hyperplasia. So I was sent to the surgeon who did the excision 2 days ago. Tomorrow I should get results.

    A couple questions about the abreviations that you use: What does LCIS and DCIS stand for? I read in another post by you about the GAIL numbers? What does that stand for?

    I thought I was fairly educated about breast cancer because of my sister last year, but finding this forum today has made me realize I don't know as much as I should about my diagnosis.

    I realize I should ask for copies of the pathology report from your suggestion. Do you have any suggestions for questions to ask my surgeon during followup tomorrow?

    Thanks for any help you can give me

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  • leaf
    leaf Member Posts: 8,188
    edited March 2009

    LCIS stands for lobular carcinoma in situ; DCIS stands for ductal carcinoma in situ.  LCIS is usually considered a misnomer, and a marker of higher risk/in a small number of cases it may be a nonobligate precursor for cancer.  On the other hand, DCIS is usually considered a cancer or pre-cancer; it does need to be treated.

    Gail is the name of a researcher who developed the Gail model that estimates the breast cancer risk of women in the US.  Here is a modified Gail model. http://www.cancer.gov/bcrisktool/

    There is another term that rates imaging that is called BIRADS.  BIRADS score is a score they can give to mammograms, and I believe other imaging.  It estimates the risk of the image. Here is a website (the American Cancer Society) that explains more.

    Breast Imaging Reporting and Data System

    Assessment is incomplete

    Category 0: Additional imaging evaluation and/or comparison to prior mammograms is needed.

    This means a possible abnormality may not be completely seen or defined and more tests are needed, such as the use of spot compression, magnified views, special mammogram views, or ultrasound.

    Assessment is complete

    Category 1: Negative

    In this case, there is no significant abnormality to report. The breasts look the same (they are symmetrical) with no masses, distorted structures, or suspicious calcifications. In this case, negative means nothing bad was found.

    Category 2: Benign (non-cancerous) finding

    This is also a negative mammogram result, but the reporting doctor chooses to describe a finding known to be benign, such as benign calcifications, intra-mammary lymph nodes, or calcified fibroadenomas. This ensures that others who look at the mammogram will not misinterpret this benign finding as suspicious. This finding is recorded in the mammogram report to help compare with future mammograms.

    Category 3: Probably benign finding -- Follow-up in a short time frame is suggested

    The findings in this category have a very good chance (greater than 98%) of being benign. The findings are not expected to change over a period of follow-up. But since it is not proven benign, it is helpful to see if an area of concern changes over time. Follow-up with repeat imaging is usually done in 6 months and regularly thereafter until the finding is known to be stable (usually at least 2 years). This approach helps avoid unnecessary biopsies but allows for early diagnosis of a cancer should the suspicious area change over time.

    Category 4: Suspicious abnormality -- Biopsy should be considered

    Findings do not definitely look like cancer but could be cancer. The radiologist is concerned enough to recommend a biopsy. The findings in this category can have a wide range of suspicion levels. For this reason, some doctors may divide this category further:

    • 4A: finding with a low suspicion of being cancerous
    • 4B: finding with an intermediate suspicion of being cancerous
    • 4C: finding of moderate concern of being cancerous, but not as high as Category 5

    But not all doctors use these subcategories.

    Category 5: Highly suggestive of malignancy -- Appropriate action should be taken

    The findings look like cancer and have a high chance (at least 95%) of being cancer. Biopsy is very strongly recommended.

    Category 6: Known biopsy-proven malignancy – Appropriate action should be taken

    This category is only used for findings on a mammogram that have already been shown to be cancer by a previous biopsy.

    http://www.cancer.org/docroot/CRI/content/CRI_2_6X_Mammography_and_other_Breast_Imaging_Procedures_5.asp

    When I first had my 'suspicious calcifications' on routine mammogram, I thought breast cancer only occurred in women who ignored their breast lumps.  And I'm a pharmacist.  See what I knew.

    This site is wonderful.

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  • KarenSil15693
    KarenSil15693 Member Posts: 5
    edited March 2009

    Thanks for answering - I already went to the 2 links you provided. Very informative. I have a feeling I will be on this website until my appointment tomorrow.

    Some of my friends and family were just so happy to hear I ONLY have "pre-cancer" but I can't get the worry out of my head and they don't understand my worries.

    Thanks again.

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  • seltzer
    seltzer Member Posts: 68
    edited March 2009

    Are Lobular Neoplasia and LCIS the same thing?

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  • Anonymous
    Anonymous Member Posts: 1,376
    edited March 2009

    Some in the medical community are referring to LCIS as lobular neoplasia now, but it has not been universally accepted as the new terminology. (from what I"ve read, that's due to the fact that "lobular neoplasia" clumps ALH and LCIS all together, when in fact they should remain separate entities, as LCIS imposes a much greater risk of invasive cancer than ALH (double).

    Anne

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  • tdbyaya
    tdbyaya Member Posts: 5
    edited March 2009

    KarenSil15693

    First, I need to tell you that I am employed with cancer hospital. I have read thousands of transcribed documents with my job. However, it is scary to say that this possible dx is yours. They staff was superb as I know we are.  I received my results yesterday it was negative for atypical ductal hyperplasia or carcinoma.  There was 3 doctors Clinical Management Conference team that through looked at my case. We will schedule her back in 1 year for breast cancer screening with mammography. But I know that I need to keep up with my mammogram on yearly basis. I am kicking myself about my realization that I was not do that.  I need to forgive myself for that.

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  • tdbyaya
    tdbyaya Member Posts: 5
    edited March 2009

    Leaf,

    My pathology report shows the following.

    (A)  RIGHT BREAST 10 O'CLOCK, STEREOTACTIC CORE NEEDLE BIOPSY:

    Flat epithelial atypia, at least two foci, arising in a background of expanded lobular units with columnar cell change with usual type hyperplasia and papillary apocrine change, and involved by calcium oxalate crystals. (see comment)

                    Negative for atypical ductal hyperplasia.

                    Negative for carcinoma.

    GROSS DESCRIPTION

    (A)  RIGHT BREAST 10 O'CLOCK - Received are six cores of white-tan-yellow soft tissue ranging from (2.5 x 0.3 cm to 3.0 x 0.3 cm).  Entirely submitted.

                    SECTION CODE:  A1, two cores inked black; A2, two cores inked black; A3, two cores inked black. PX/tlc

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  • leaf
    leaf Member Posts: 8,188
    edited March 2009

    Maybe links like this will help.

    http://surgpathcriteria.stanford.edu/breast/flat_epithelial_atypia/

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  • Karen27
    Karen27 Member Posts: 1
    edited March 2009

    KarenSil15693,

    I sent you a private message.

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  • Anonymous
    Anonymous Member Posts: 1,376
    edited March 2009

    My sister has recently opted to have a surgical biopsy done after getting another biopsy that showed the atypical cells.  This, after she saw me go through all my treatments, which included six weeks of radiation for DCIS on top of everything I went through for my first breast cancer.  She has opted to take the approach of "get it now,'' simply because she can't stand the thought of not doing anything and wondering.  Having surgery on any part of you is a serious decision, and one that in the end, only you can make.  Good luck.

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  • shakira
    shakira Member Posts: 5
    edited April 2009

    I hope you getting fine, dont be scared!

    get well soon

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