Confused about pathology report - ADH

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KatyH
KatyH Member Posts: 27

I had a surgical biopsy on April 29th.  I am relieved that the results came back B9, but I still have some questions about the diagnosis.  Can anyone help me understand this better?  The surgeon seemed to say that it was good news, but it puts me in a higher risk group for BC in the future. So far I have been told that I need to come back for a new baseline mammo in 3 months then I will have to do annuals mammos and clinical BEs and monthly SBE.  I am 45 years old, married and still on the pill.  I asked him if I need to stop taking the pill and he said he will discuss that with a colleuge and let me know what to do about that when I go in June for a follow up on my incison. 

Here is what the path report says:

- Atypical Ductal Hyperplasia, few small foci, with focal central necrosis and microcalcifications.

- Background of fibrocystic changes, with stromal fibrosis, multiple foci of adenoisis, microcyst formation, and apocrine metaplasia.

- Mild duct hyperplasia, usual type.

Comment:

There are three foci of duct epithelial hyperplasia ranging from mild to moderate, with mild distension of ducts.  Nuclei have nucleoli and in some areas there are relatively well defined cell borders.  Focally, there is central necrosis and there are a few areas of microcalcification.  Nuclear atypia is relatively mild and atypia is not sufficient to warrant a diagnosis of carcinoma in situ.  One duct demonstrates infiltration by macrophages and associated inflammation.  No definite in situ carcinoma is found.

I know this is a lot of information, and I know that y'all are not doctors.  But if anyone understands what this means and can help me I would appreciate it.  I did ask the doctor, but he pretty much read it to me and said I don't have cancer but I should consider this a wake up call and be vigiliant about screening from now on.

Thanks,

Katy

Comments

  • farmerlucy
    farmerlucy Member Posts: 3,985
    edited May 2013

    I had both ADH and ALH. My BS said he wouldn't be too concerned about just ADH. But since I also had ALH he sent me to a genetic counselor.

  • txmomof2
    txmomof2 Member Posts: 131
    edited May 2013

    I don't know anything about the report, but I do feel that that little birth control pill fueled my breast cancer.  They told me to immediately get off of it when I was diagnosed (at 35).  You may want to think about getting off of it and trying something else whether your dr says to or not. 

  • KatyH
    KatyH Member Posts: 27
    edited May 2013

    Thanks farmerlucydaisy.  That does make me feel better.  And txmom, I have been thinking about getting off the pill for a couple of years now.  I'm just looking for a good alternative birth control.  I have been talking with my gyno about having surgery this summer, but now that I've had this biopsy I don't think I can afford it.

  • bdavis
    bdavis Member Posts: 6,201
    edited May 2013

    Katy... At 35 I was diagnosed with ADH and at the time, they told me that my chance of cancer was 4-5 greater... The plan was yearly mammograms and watch and wait. 13 years later, I was diagnosed with cancer. Not a great plan. In retrospect, I should have taken tamoxifen which would have reduced my risk by about 45%. And in my opinion, birth control will only make matters worse. But that is for a doctor to say.

  • KatyH
    KatyH Member Posts: 27
    edited May 2013

    Thanks for your advise Betsy. I have been considering getting off the pill for a few years. I called my gyno today and they are recommending essure. I'm not sure what to do now. I don't know anyone who has done that so I guess I'll have to look into it. I do want to stop taking the pill though. This breast cancer scare has convinced me of that.

  • bdavis
    bdavis Member Posts: 6,201
    edited May 2013

    Not sure what essure is... I would definitely ask your doctor about tamoxifen... and perhaps see an oncologist for just a baseline appt. ADH is benign, but is considered a pre-cancer. I can't say what percentage actually become cancer, but taking a cancer drug like tamoxifen can reduce that risk tremendously.  I wish I had.

  • KatyH
    KatyH Member Posts: 27
    edited May 2013

    I'll ask about the tamoxifen.  No one has mentioned that to me.  The essure is a type of female sterilization but isn't as invasive as having your tubes tied.  I want to get off the pill, but I also do not want to get pregnant so I have to figure out something to do that will be safe for me.

  • bdavis
    bdavis Member Posts: 6,201
    edited May 2013

    Tamoxifen is the most widely suggested thing to do when diagnosed with ADH. My oncologist many women decline because its a cancer drug, and they don't have cancer, but if I could do it again, I would take it.

  • vmudrow
    vmudrow Member Posts: 846
    edited May 2013

    I was sent to oncologist for ALH - who wanted me to take Tamoxifen - so make sure you ask about that.

  • beacon800
    beacon800 Member Posts: 922
    edited May 2013

    Your report is good as there is no cancer and nothing bad enough to characterise the abnormalities as very high risk.  Yes, there is an increased long term risk of cancer when atypia is present. 

    If it were me, I would get off the pill asap.  You will definitely want to follow the high surveillance plans recommended.  Tamoxifen is an idea.  If you stop the pill and simultaneously start tamox, you could really feel some big side effects like hot flashes and so on.  Tamox has some negatives too and you will want to review your medical history before you take it. 

  • KatyH
    KatyH Member Posts: 27
    edited May 2013

    Thanks.  I am planning to get off the pill and I have been thinking about getting off it for a couple of years.  I just really do not want to get pregnant in my 40's. And I have been nervous about me or my husband having surgery plus cost is a factor.  But I did find out my insurance will pay for the essure which is an in office procedure that blocks the tubes.  I'll ask about the tamoxifen too, but I am a little worried about screwing up my hormones too  much.  I appreciate the input.  I'll be talking to both the surgeon and my gyno about it.

  • momoschki
    momoschki Member Posts: 682
    edited May 2013

    I was on hormonal birth control (NuvaRing) when dx'ed with ADH and my oncologist wanted me off. Chose not to take tamoxifen due to prior endometrial thickening issues and cataracts-- oncologist was not adamant about my taking it, as he said it would only decrease my personal risk by 4%. Now that menopsuse seems to have finally set in ( I hope), considering Evista.

  • Beesie
    Beesie Member Posts: 12,240
    edited May 2013

    Edited to remove my comment about the previous post because the Mods have removed that post.  Thank you to the Mods!

  • Sherryc
    Sherryc Member Posts: 5,938
    edited May 2013

    Katy I was diag with ADH and at the time my BS gave me the option to do mammo's every three months and watch and wait or have a lumpectomy and remove and then yearly mammo's.  I was 34 at the time. I asked him if I was his wife what would he want her to do and he said lumpectomy so I did.  14 years later I was diag with IDC.  I had very dense fibrosystic breast.  Your pathology reads alot like my first and another B9 that I had when I finally gave in and had a BMX.  My best advice is to see an oncologist and see what their opion on it all is for you.

  • Southernangel
    Southernangel Member Posts: 133
    edited May 2013

    I had the essure put in 4 years ago. No problems, easy, doesn't hurt and depending on your income and state you can go thru your health office and they will pay for it. Very simple procedure, if you want permanent i would reccommend it. My best friend got it a year after I did and she hasn't had problems with it either.

  • KatyH
    KatyH Member Posts: 27
    edited May 2013

    I have made an appointment for a consult for the essure and as of now I am planning on getting it.  It is good to hear from someone who had it and didn't have problems.  I don't know anyone who has had it done so that makes me kind of nervous.  But I am ready to be done with hormonal bc.  Thanks to everyone for their replies.

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