ADH after DCIS and Radiation Therapy

Dkgs--I haven't had your situation.  I'm due for my annual mammo in May.  When I had my stereotactic biopsy last June, they found ADH only, no DCIS.  It is the second time I had the diagnosis of ADH.  When I went for the excisional biopsy (aka lumpectomy #1) which is the standard procedure for ADH, they found extensive DCIS.  So, you most likely have to have another lumpectomy to be sure there isn't a recurrence of the DCIS adjacent to the ADH.  Best of luck.  Sorry you have to face this so soon after your treatment.

Hi there: So sorry that this has come up so soon after your DCIS experience.

As Ballet mentions, surgeons generally want to do a wire-guided excisional biopsy with an ADH diagnosis to make sure that's all it is.  However, I was able to get my surgeon to agree to an MRI before further surgery and the MRI didn't find anything too alarming and so she agreed to wait and do another MRI in 6 months to track any changes. You might also consider getting a second opinion on the pathology slides.  Another pathologist might not think you have ADH at all in which case you could wait another 6 months, or they may in fact "upgrade" the diagnosis to DCIS, in which case, surgery would be the way to go for sure.

There is some controversy with regard to what is better to spot DCIS/calcifications.  MRIs have proven to be more effective overall in detecting breast cancer in general, but my surgeon argues that in cases where suspicious calcifications have been found on mammo, it may indicate that for that type of patient, the mammo might do a better job of detecting trouble spots.  I know that Bessie and others have had experience where far more extensive areas DCIS was found via MRI than  on the mammo, so I think asking for an MRI before making a decision to either watch and wait or re-excise would be wise.

Good luck to you!

Hi Dkgs,

Best of luck in this process.  It must be a bit daunting to happen so soon.  About whether someone suggested a mastectomy to me, actually my first "lumpectomy" in July was the excisional biopsy required after getting the ADH diagnosis.  They found multifocal DCIS to all margins, so no clean margins.  Went to a different hospital for the rest of my treatment, and had two more lumpectomy surgeries, achieving wide margins by surgery #3.  The second surgeon always posed the choice between lumpectomy and mastectomy at each stage of the game (as had the previous surgeon), but I wanted breast conservation unless that proved to be impossible.  I was uncomfortable with having an implant (would have only done one breast and no pmx on the other).  I was happy after the third surgery, that I didn't need mastectomy.  I've had that breast surgerized a lot, though, because I had three previous excisional biopsies on that breast, so now six surgeries.  Surprisingly, it looks pretty good after radiation for some odd reason, where it hadn't before.  I was warned about cosmetic defects (which were there), but the tissue changed after rads.

Your situation is different, because, potentially, you will be having surgery on previously radiated skin, and that's tougher. But you gotta do what you've gotta do.  Best of luck.  I'll be thinking of you.

that was my story,they kept finding "new califications" on post rad mammogram, so have had 4 surgeries and a sterotactic on the right breast but my last mammogram in feb was clear

My mammograms have always come back saying they can't see anything on my mammogram and then they warn "heterogeneously dense breast tissue reduces the sensitivity of mammogram, talk to your doctor".  My DCIS was found as a palpable mass.  I now get yearly mammograms (even though I think it is a waste of time) and, at least for a while, yearly MRI (though right now I am getting 6 month MRI's to follow something suspicious, but likely benign).  When I had my MRI before my initial lumpectomy it was used to decide how much of the breast I would likely have left after surgery (so I could choose between lumpectomy or MX) it ended being a little over-sensitive, as I likely could have had a smaller area taken out, if we didn't care about ADH (since I had ADH on the margins of my lumpectomy, which was never thought to be problem) --- I am forever grateful I took my chances on lumpectomy instead of MX, the area was large enough that my team was mixed on whether or not the lumpectomy would be doable, my surgeon is a magician! 

I really feel for you women who have multiple biopsies after your initial diagnosis.  It would get tiring for sure. Best wishes to you in whatever you decide to do in the future.

prairies

Joined: Oct 2014
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A few seconds ago
prairies wrote:

I have just been diagnosed with invasive breast cancer and DCIS.
Also ADH was found in the "uninvolved breast parenchyma. Underwent
lumpectomy and scheduled for radiation next week. In reading your posts
from 2012, I have great concerns about the continuing DCIS you each
experienced after radiation. It is now 2 years out and I would
appreciate hearing how things went for you and also your age at initial
diagnosis. (I also had lumpectomy and radiation in the opposite breast
17 years ago.) Thanks!