Large area of microcalcifications

Of course you're scared.  Everyone in their right mind is scared when they are where you are now.

Here's an excellent website about calcifications, courtesy of momzr. (It contains pictures.  When I had my biopsies, they had my mammos hanging on the wall.  I got to glance at them, so I had some idea what they were looking at.  The website below has mammograms of different types of calcifications.)

http://www.radiologyassistant.nl/en/4793bfde0ed53

(This is NOT to detract from J9W's advice. Hunt down Bessie's posts.  Bessie knows her stuff, writes very clearly, and is a very big asset to this site. )

Yes, the concern about seeding. Seeding *does* occur in some cancers.  Does seeding occur in breast cancer?  The simple answer is probably it can happen, but it is rare.  If you are concerned about this and you do have breast cancer, then consider either getting the needle track removed during surgery and/or having radiation (a standard treatment for many breast cancers.) 

Yes, *if* you have cancer, it has been shown that core/needle biopsies can move cancerous cells around. (Its in the washings.) But HOLD ON - read the rest of this.

The issue is not whether the cancerous cells move around.  http://www.ncbi.nlm.nih.gov/pubmed/17674195  The issue is if these cancerous cells continue to LIVE and GROW in their displaced location.

Most women who get breast cancer  (even those who have invasive breast cancer) die of something else.   For DCIS women, if all they have is DCIS, then it can't metastasize - its all contained in the basement membrane.   Almost all women (at least in more developed countries) are now diagnosed via biopsies. 

It is much more difficult to answer a question if a particular women's breast cancer, after a biopsy, lived and grew.  If you do get regrowth in the needle track, how do you know it was from the biopsy, and wasn't there previously, or thrown off by the tumor at some other point in time?

Yes, seeding probably does occur.  Some papers call it 'rare'.   But the simple fact that this was relevant enough for a single case to be reported in Pubmed shows that it does not occur frequently. http://www.ncbi.nlm.nih.gov/pubmed/19701680 There are (something like) millions of breast biopsies that are performed in the developed world each year.

This paper found NO increased morbidity from women who had core needle biopsies, although the data are limited. http://www.ncbi.nlm.nih.gov/pubmed/19167175

You don't have any way of knowing what is in there without the use of a needle or knife.  The VAST majority of people say that the risk is worth the benefit. For almost all breast cancers, you can't get diagnosed without a pathologist looking at a piece of tissue under the microscope.  (The only possible exception I know of is inflammatory breast cancer, and you don't have the symptoms for that.) You can't remove a piece of tissue without a needle or knife.

I'm no expert on DCIS (I don't have it),but my impression is that most women with DCIS get an excision plus radiation. (On my excision, I had about 2 tablespoonfulls of tissue removed.  Obviously, this varies from person to person.)

  If you have multiple spots of DCIS, or after multiple unsuccessful attempts for clear margins, they recommend mastectomies.

If  I am wrong about this, I hope someone will correct me, or add more.

Leaf 

I have a question for you. You have indicated your research suggests that breast cancer may spread through seeding during the needle biopsy.

The operative word here is MAY.   I am using a strict logical definition here.  It is theoretically possible that all the air in the room in which you are sitting may travel to the other side of the room.  Thus you may die of suffocation. This is an astronomically low chance, but it is still a chance, thus it may happen.   I'm not saying that the possibility of seeding in breast cancer is this astronomically low.  I don't think its possible to put any firm numbers on how many 'seeding' breast cancers there may be.

I've seen maybe less than a dozen cases in reading Pubmed that there are cases that *may* have had seeding.  I think all of the (possible seeded breast)  cancers I have read about are invasive.  (By definition, if you only have DCIS or LCIS, it is contained in the lumen of the duct/lobule/possibly the cells lining the inside of the nipple.)  Its quite difficult to tell the origins of the cancer cells.  Even in invasive cancers, in one tumor there several different cell types - in other words, as far as I know, not all of the cells in a single tumor are genetically identical.  

I am not an expert on metastasis or seeding: besides my lack of knowledge,  it is a complex process.  Seeding is difficult to study.  In fact, here is a reference to an abstract that says that some now think that some breast cancer cells can not only metastasize, but also seed the primary tumor. http://www.ncbi.nlm.nih.gov/pubmed/21522121   If true, this would make it very difficult to tell whether a recurrent cancer was seeded by a biopsy, or 'naturally seeded'.

I suspect (but do not know) that they don't know.  Some papers seem to opine that *excisional* surgery may create more micrometastases than *needle biopsy*. 

You may want to read the last several paragraphs of this 2007 study. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2001103/?tool=pubmed

This study looked at using radiofrequencies along the needle track during biopsy. http://www.ncbi.nlm.nih.gov/pubmed/21045831

This 2010 article opines that tumor cells turn up in the bloodstream  very early in breast cancer progression. http://www.ncbi.nlm.nih.gov/pubmed/19662651

This article opined that circulating tumor cell *concentration* correlated better with survival than did cirucaling tumor cell presence. http://www.ncbi.nlm.nih.gov/pubmed/19242121

This 2006 paper opines

Frequently before but regularly during surgery of breast cancer, epithelial cells are mobilized into circulation. Part of these cells, most probably normal or apoptotic cells, are cleared from the circulation as also shown to occur in benign conditions. After resection even if complete and of small tumors, cells can remain in the circulation over long times. Such cells may remain "dormant" but might settle and grow into metastases, if they find appropriate conditions, even after years. http://www.ncbi.nlm.nih.gov/pubmed/17002789

I presume that these people had a biopsy before surgery.  I don't know if these circulating epithelial cells could be from the biopsy, or if they could be 'natural seeding'.

Hope this helps.  (Sorry I have to go to bed now.)

Leaf 

Thanks for all your research. Hope you slept well. I found the article "Seeding of epithelial cells into circulation...." especially interesting, as they actually measure the levels of epithelial/ CA cells before surgury/ biopsy and after. Unforunately this does support my own views that the biopsy and/or surgery can also lead to the transmission of breast CA. I guess there is no way to determine if  transmission happened because of the biopsy, or was a natural course of the cancer.

I hope that the medical system will take this into consideration when doing these testing on women with breast cancer. For me--- I will take off the other breast off if anything shows up. 

I know the anxiety people suffer when advised they have breast cancer, even if it is only DCIS. I had a mastectomy, and my only regret is not taking them both off. 

Had I not had a mastectomy, I would have had a reoccurance, as there was more DCIS in the breast than the MD suspected. I would have then risked it becoming invasive and I would have needed chemo. By taking the breast off, didn't need radiation, another bonus. ( nothing to radiate)

I didn't take Tamoxifen even though the tumour was estrogen positive, because again I took the breast off, and the risks of side effects of the Tamoxifin outweighted the benefits. ( another bonus)During my research I found out that estrogen positive tumours are less aggressive than progesterone tumours.

I wish everyone well in their own decisions, on their own treatment. I only suggest that everyone research their own cancer to determine the true risks and prognosis. I have found this forum to be one of the best sources for information on the subject, and I have referred many women to it. 

A special Thanks to Leaf.. you really go that extra distance to provide information. 

Debby

First, try (if you can) to not jump the gun until you get your results. A lot of micro-calcifications are benign. It's very likely there's nothing wrong.

"You're right, I have done some research and I'm worried that with such a large area affected that the DCIS will either be agressive or IDC."

DCIS can be very large without being aggressive. Mine was over 10 cm, but only grade 2 (out of 3). I think it just likes to spread out . That said, I think you have a greater chance of a micro-invasion with a large area of DCIS, but a micro-invasion is not a very different diagnosis and wouldn't really change your treatment or prognosis much.

"How did your surgery go and did you have a choice of type reconstruction? I am quite ample breasted and worry that surgery will leave me lopsided."

There are various types of reconstruction - there's a whole forum for that topic, with lots of examples. I went with the traditional implant. I was also pretty big (bigger than I wanted), and so I got a reduction and lift on my left side to keep things even. If you went with a uni-mx, you will probably find there is some lopsidedness, but for me at least nobody could possibly tell when I'm in clothes, or even a swimsuit.

I don't have DCIS or ADH; I do have classic LCIS, ALH, radial scar, and DH (ductal hyperplasia, not atypical ductal hyperplasia.  Its the 'atypical' part that puts one at measurably higher risk.)  I was diagnosed in late 2005/early 2006. 

LCIS is a different animal than DCIS.   (Most oncologists do not consider classic LCIS as 'cancer' , although just about everything about LCIS is controversial, including the classification and name.  There is also this even stranger 'animal' called PLCIS, which has some aspects of both LCIS and DCIS.)  I had 2 biopsies a year after my initial diagnosis; benign; nothing worse than ALH/DH.   I'm finishing up my 5 years of tamoxifen this fall.

Scilla - certainly! this is by far the hardest part. Once you have your treatment plan you will have a PLAN - and act on it - and you will begin to feel more in control, and to hopefully go with the flow and just get on with it, as we have all done ( we had to!)

Arlene

scilla 

Hang in there. This is great place to vent. We all know that awful feeling you are having. I actually would shake when I thought about the DCIS I had. The dream will be over, and as mentioned by others DCIS is still the "better" cancer to have. Even invasive cancer can be beat if you are on it early. The only cure to your feeling is information about what you have, and as others have said get a plan in place and followup with it.( be aggressive with the specialists you meet, write down questions, and don't leave without the answers, then research their answers to see if it works for you)  Remember you are in control, you are an equal partner in your care, understand your options, and understand why you are making a decision, and don't make a decision for yourself just because someone tells you to do it...it has to feel right to you. Time helps too. the further you get away from your cancer the better. My surgery was 3 years ago, nothing since, it gets betters with time. I even went on a great vacation a few months after my MX( again my choice to deal with DCIS)( I am a nurse). I was back to work in 4 weeks. Those who have a lumpectomy and radiation take a little longer, but the radiation oncologists like to get you started quickly, so if this is your choice you will be fast tracked in this direction by your surgeon. A couple of months you will good as new. 

Plan that vacation for the fall, it will do you a world of good, it did for me. And remember to live. I have lived more since I was diagnosed, than ever before...start today....

I was diagnosed with DCIS on March 25th of 2011.  I had my BMX on April 8th,  I was back to work 4 weeks later.  I had a sentinal node biopsy before my mastectomy and no nodes were involved.  I had intermdediate to high grade DCIS that was multifocal.  I opted for a BMX.  I am glad I did.  I will be having my nipple surgery July 15th.  Please keep us informed of your results.  This is hard....I know.  Pray alot...

Hi Scilla - I've written you several times over the last few days, and every time I wrote I  erased my letter - too long, too preachy, - nothing I said seemed to help. But the answers you've gotten today are good, and I'm so glad other people wrote. so many bits of good advice.

Today I was driving on the highway, had to pass 2 big trucks - while going past, as always, I tried not to look at the giant wheels, so close, so loud, that could crush me. Had to concentrate on one thing - the road in front of me, and pass them. and then, relief. and I thought about how you feel now - and it's like you're going along beside those great big threatening wheels - so the thing to do, is like everyone said, get your plan and act. and then, instead of being befuddled by those wheels (your fears, projections into the future) you'll concentrate on just one thing - YOU. and the road directly in front of you. one day at a time.

I don't know why it happened to me, but when diagnosed I felt awash in love for my poor body, especially my breast, who, so innocently and not even knowing, had a big hooligan party going on inside! Poor breast! it, you, did nothing wrong! so love, love, love yourself, and use all the great suppport of those around you for your springboard. The way I see it, this is your "job"now, and like all jobs, you'll do the best you possibly can.

Will your husband be with you tomorrow? sounds likely. if not, then a nurse?  I've no advice about questions to ask - it's a bit different in Canada - I simply met my team - surgeon, nurse, hospital resident - I loved that, a team, of which i was a part, all working together.

think of those wheels - they are depression, negativity, catastrophising, they deflect you and do not help your body heal (and boy do I know about that, having had many bouts of depression and anxiety in my life.) Just keep pointing your light straight ahead, don't get distracted, and go girl go!

And let us all know what happens tomorrow, and about the options for your plan

Just looked at my ruler. You are supposedly 13cm? well, my dear, I was 15cm (later found to be only 10 cm)and I'm still here and going strong. so there!

Hugs!

Arlene