ADH, family history unavailable (adopted)
Comments
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Hi, I am 65 and previously had a total hysterectomy due to severe endometriosis 8 years ago. Recently, after annual & diagnostic mammograms, I had a stereotactic biopsy with conflicting opinions. First path opinion diagnosis was "severe epithelial hyperplasia". Second opinion at a Comprehensive Breast Center was "Focal atyical ductal hyperplasia with cribriform pattern, Fibrocystic & columnar cell change, ductal microcalfications present." Just underwent wire placement with surgical excision biopsy of that area in left breast. Path report found no evidence of cancer or ADH. Had second opinion on path done at Vanderbilt by Dr. David Page and they concurred with the first. Breast surgeon says the stereotactic biopsy must have removed all the ADH. Now he is meeting with his entire "team" to discuss possible recommendation of partial breast radiation. I am a former runner and now a walker. Is this overkill? What about diet, or other non-traditional more healthy options? My husband is currently undergoing proton beam radiation for prostate cancer (former marathon runner). I am very aware of the dangers of regular radiation on left breast and not eager to consider it. Has anyone in my position had this recommended?
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Another adoptee diagnsoed with ADH. My surgeon isn't recommending any further treatment at this time, other than a mammo and U/S in Sept. or Oct. He doesn't want me on hormonals either as I'm premenopausal.
I think considering the lack of family history maybe your surgeon is being proactive? Maybe they want to be absolutely positive you are "clean" now.
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You might want to go for a second opinion. I don't think I've ever heard of someone having radiation for ADH. wioth or without family history.
Leah
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I agree that a second opinion would be a good idea if they recommend radiation therapy. I have not heard of radiation therapy being used for ADH. Usually the treatment is surgical removal (mostly to make sure it is nothing more than ADH) and maybe tamoxifen.
Although the difference between ADH and DCIS can be a fine line you have a second opinion confirming the pathology finding.
I am not a supporter of minimal treatment for DCIS and had radiation after lumpectomy for DCIS but I think radiation therapy would be overkill for ADH -- better to find a good surveillance plan.
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I agree that that sounds like overkill.
Since you asked this:
What about diet, or other non-traditional more healthy options?The biggest suggestion I would make is to start taking iodine (if you do a search on this forum or on a medical site like pubmed, or even Google, you will find that it has been shown to reverse ADH and fibrocystic disease). It will make a WORLD of difference (not just according to the research, but it has completely cleared up my very fibrocystic "good" breast in a matter of 5 months).
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I agree with others in feeling that radiation for this type of lesion would be overkill. ADH is generally considered a precursor to low grade DCIS and it's sometimes even difficult for pathologists to tell them apart. Neither ADH or low grade DCIS is a life-threatening problem (low grade invasive usually isn't either). If I were you and at your age, I would allow nothing further to be done about it and just continue to enjoy life while keeping a close eye on things through whatever type of screening schedule your docs recommend. I fully understand your concerns about radiation - I refused radiation for an invasive low grade left breast cancer after a lumpectomy over 6 years ago when I was 49 and have had no recurrence to date. Best wishes to you.
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When my doctor said to think of ADH as the stage before cancer, I decided on a unilateral mastectomy. When the final path report came back there was a small area of invasive cancer plus DCIS throughout my breast. None of this showed up on presurgery testing! There is no history of breast cancer in my family and I live a healthy lifestyle and eat all my vegetables yet I got cancer.
You might ask your doctor how much (percentagewise) benefit you would receive from the radiation treatments. Then ask about the benefits vs the side effects. Take care!
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I have a family history of breast (mom) and ovarian (aunt), but most of the time there is no family history with a breast cancer diagnosis. I have had 2 biopsies for ADH (once in each breast 18 months apart) and my surgeon only performed a lumpectomy to remove the areas and suggested Tamox. I was put on a watch and wait 6 month screenings with mammos after the first dx. After the 2nd biopsy I did start taking the tamox. Not one time was radiation treatment recommended. After my dx of DCIS I opted for bilat and did not need rads that time either. I would request a different pathologist read your slides and go to another doctor for a 2nd opinion.
edit: I just re-read your post and saw that you did get a 2nd opinion from a pathologist. I would still recommend seeing another doctor.
Sheila
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I had two lumpectomies for ADH and now I have IDC.Having ADH makes it much more likely that you will get cancer unless you take serious steps to prevent it. I wasn't given that opportunity. I was given the surgeries and that was the end of it, twice. Also have them put you on Taximofen. It will help to protect you
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tgood,
I am new to the site and don't understand all the abbreviations yet. Sorry, but what is IDC? When you had lumpectomies for ADH your surgeon didn't recommend Tamoxifen or did you decide not to take it? I just had a lumpectomy and it came back with diagnosis of ADH. I am trying to decide if I take Tamox or not. You would say yes?
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mvspaulding---generally, the recommendation for ADH is just yearly mammos with breast exams every 6 months; but some doctors recommend the addition of tamoxifen if there are other significant risk factors such as family history, The risk with ADH is about 20 to 25%. It is a good idea to discuss with your doctor all the pros and cons of taking a preventative such as tamoxifen. I took it for 5 years and now take evista and tolerate both meds well (but I have a much higher risk, so it was basically a given for my situation LCIS and family history of ILC) and am doing well nearly 7 years later. It is a very personal decision.
Anne
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Anne:
Thanks for the response. My BS has recommended taking Tamoxifen but I am just scared of the side effects because I also have endometriosis and they want to put me on Lupron with a Mirena IUD for that. It just seems like a lot of medication to be on and I am not used to taking anything. I really came on here to see if I could find anyone else in the same situation but haven't found it. It seems like a lot of women with ADH choose not to take the Tamox as preventative but I would almost feel like I was letting my family down if I didn't do everything to cut my risk. Almost wish I wouldn't have found the darn lump that started all this to begin with!
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Thanks for all the replies. My breast surgeon and I have agreed upon close surveillance at this time. Since the ADH was only found in the core biopsy and not the surgical biopsy, radiation has been removed as an option at this time. I will return for examination on Sept 7, 2010 (3mo after surgical biopsy). I am still on low dose estrogen (Vivelle dot) because of osteoporosis and prior total hysterectomy. I am seeking info on bio-identical hormones as an option.
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My surgeon sent me to an oncologist when I was diagnoised with ALH - he highly wanted me to take Tamoxifen for 5 years - I chose unilateral masectomies - tired of the biopsies, worry etc. I have not regretted the decision - good luck!!
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iobella----willl you be going off the HRT? I had to have a TAH/BSO 5 years ago (total hysterectomy/oopherectomy---everything removed-----ruptured ovarian cysts) and went thru immediate surgical menopause, but was unable to take any HRT at all due to the elevated risk of bc (I also have family history of ILC in addition to the LCIS). I have been doing close surveillance and meds for years (tamox for 5 years, now evista)--not a choice for everyone, but works for me.
Anne
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