Lumpectomy after being diagnosed with atypical hyperplasia?

GardenGirl808 · May 2013

Aloha! I just had my routine mammogram last week, and a few very small microcalcifications were found clustered together. A needle biopsy was performed the next day, and they found atypical hyperplasia. My ob/gyn referred me to a breast surgeon, and explained that I'd need a lumpectomy to remove the abnormal tissue and to make sure no cancer was hidden nearby. I'm 53, still have regular periods, have a higher than average (but not terrible) family history of breast cancer (one cousin died of breast cancer at about 50, and an aunt on the other side of my family died of breast cancer when she was around 70--but she refused chemo and just had a mastectomy). I've been planning a big family trip to Europe for the past year. I've been SO excited! We're booked on a flight in one week. We have family in Germany and planned to stay with them part of the time, so we're scheduled to be gone for 8 weeks.

The problem is, of course, that it's extremely unlikely they'll be able to do the biopsy before I'm scheduled to leave. Of course my health is more important than this trip, but I really don't want to have to miss it if waiting a few weeks isn't such a big deal. I'm seeing the surgeon on Wednesday, and of course I'll do whatever she says, but I can't help worrying about it. I"ve read so many excellent, thoughtful and informative posts here--I'd really appreciate your feedback. Thanks in advance, and good luck to all of you out there who are worrying as well!

MelissaDallas · May 2013

Most breast cancer is slow growing and has been there for years before it is big enough to be detectable. I feel fairly sure that it will be fine with your surgeon to put off your excisional biopsy for atypia but you do need to check. My initial mammogram was the first of November and by the time I had all the additional testing it was May before I has my excisional one.

Understand the difference between an excisional biopsy and a lumpectomy. A lumpectomy is to remove a confirmed cancer with clean margins. An excisional biopsy is to further investigate an area of concern and to see that there is nothing more serious lurking. That is what you are having.

leaf · May 2013

I totally agree with MelissaDallas.

BTW, from the stats you give, your family history may be lower than what you imagine. I have a history of post age 50 breast cancer of : paternal grandmother (with no daughters), 3 maternal aunts, and 1 cousin. Plus one cousin premenopausal. The genetics counselor (NCI certified program) gave me a risk of having a deleterious BRCA mutation as about 3%, the risk of an 'average' Ashkenazi Jewish woman. This risk is higher than the usual incidence in the population of about 1:500. http://www.yu.edu/jll/genetichealth/core-efforts/genetic-testing/hereditary-breast-and-ovarian-cancer/ But at my NCI-certified center, they didn't even have a place on the family history chart to report cousins.

Different studies differ, but in this study, the 'upgrade' rate for ADH was 5% to IDC and about 15% to DCIS. http://www.ncbi.nlm.nih.gov/pubmed/22878619 In another study, the 'upgrade' rate was about 20%http://www.ncbi.nlm.nih.gov/pubmed/21861212

Do check with your surgeon, but I bet its OK to wait. For me, I got my 'suspicious mammogram' in late October, and I had my excisional biopsy in late Jan.

DocBabs · May 2013

When I was first diagnosed with ALH I was given the choice of waiting 6 months and repeating the mammo or doing an excisional biopsy. I asked the radiologist what would she do and she said she'd do the surgery . So I did and that's when they found LCIS.Since everyone agreed that neither of these conditions is cancer , a three year period of close monitoring began. The actual surgery itself is no big deal and should not interfere with your plans.A day or so of rest afterwards was all that I needed. If it were me I'd think positively and get it done. Hopefully the results will be in the benign realm.

Beesie · May 2013

I don't think that waiting to have the excisional / surgical biopsy until you are back would be any problem at all. Of course you should talk to the surgeon about that, but I'd be very surprised if you heard otherwise.

As Melissa explained, the objective of this surgery is to see if anything more serious than the atypical hyperplasia is lurking. The atypical hyperplasia itself doesn't need to be removed - it's the just the risk that something else might be mixed in with it that is driving the recommendation that you have the excisional biopsy. And as leaf explained, the most likely result (~80%) is that nothing more serious than the atypical hyperplasia will be found. The next most likely result (~15%) is that DCIS may be found. DCIS is pre-invasive, Stage 0 breast cancer. When DCIS is diagnosed, most doctors tell the patient that while all the DCIS in the breast should be removed, there is no rush. Many women with DCIS wait 2 - 3 months before surgery. So adding it all up, there's a 95% chance that you have nothing more serious than DCIS and there is no urgency.

Then there is the 5% risk that invasive cancer might be found. But as Melissa said, most breast cancer is very slow growing and in fact is thought to have been in the breast for anywhere from 3 years to 10 years before it becomes large enough to be detectable on screening. So considering this, an extra 2-3 months presents little if any risk.

Talk to your doctor. Hopefully he will agree that the delay is no problem. If so, then schedule the surgery shortly after your return. Then go off and have a wonderful trip! And don't spend any time worrying - remember that the odds are very much in your favor that this will turn out to be nothing serious.

momoschki · May 2013

Just agreeing with what everyone above had said-- when clustered micro calcifications were found on my routine mammo over 2 years ago, I think it took about a month before I had the excisional biopsy. So, as others have indicated, yes, check with your doctors, but I wouldn't imagine that a delay of a couple of weeks would matter much.

KatyH · May 2013

I just had an exisional biopsy after having microcals on my mammogram. They found ADH, but no cancer. When I was scheduling the surgery the surgeon said it would be ok to wait 3 or 4 weeks to schedule it buy he didn't think I would want to wait 6 months. I would talk to your doctor but I think their is a good chance she'll say that is fine. As others have said breasted cancers are usually very slow growing. And there is still a very good chance your lunpectomy will be b9.

ballet12 · May 2013

Gardengirl,

My stereotactic biopsy also showed ADH. I knew that I was going on vacation and also that surgeons often recommend no swimming for at least a month post excisional biopsy, so I scheduled the excisional biopsy for around 7 weeks after the core biopsy. Since this was the second time I'd received an ADH diagnosis, I assumed that's what would be found on the excisional biopsy. I wasn't too worried about it. I'd lived with ADH for 17 years already. Well, my small amount of calcs did turn out to be near a large amount of DCIS. I still don't regret waiting. I had a great summer. If I had had a crystal ball and knew the DCIS would be found, I think I would have selected a different surgeon (a surgical oncologist instead of a general surgeon--and ultimately did switch to one), but I don't regret the wait.

farmerlucy · May 2013

I agree that waiting should not be that big of a deal. In my part of the US it takes a while to get on the surgery schedule anyway. Also, you'll want to know if you have ADH or ALH.

ballet12 · May 2013

Farmer, were you told (in the past) that the ALH was higher risk than the ADH? In another post, you stated that when you had both diagnosed together, they had you do a genetic consult. I actually had both ADH and ALH, and no special surveillance was recommended for either. If anything, they seemed to focus more on the ADH than the ALH. I always wondered about the ALH, because it seems to me that it might put me at slightly higher than average risk in the contralateral breast (DCIS in diagnosed breast).

farmerlucy · May 2013

Yes - both the BS and the genetic doc said ALH is more insidious because it is a marker for BC in both breasts. I also have the high risk family. The genetic consult was only a few hundred dollars even if insurance didn't cover it, and it was well worth it. IMHO i think you should see one.

DivePuppy · May 2013

I agree with MelissaDallas that waiting is probably OK. I just wanted to mention that my breast surgeon performed a lumpectomy on me when my biopsies were inconclusive. Turned out to be ADH. I have had two incisional biopsies as well.

NY_Lisa · May 2013

I was also diagnosed with ADH. I got the news 3 days before I had to have a partial hysterectomy! So the surgeons agreed that my body needed to heal from Surgery #1 first. It was a 6 week period. I would say go & enjoy yourself! Then you can come back & take care of all of this. It's been strongly recommended that I begin to take Tamoxifen for 5 years due to my increased chances of getting bc in the next 5 years. I filled the prescription 6 weeks ago but haven't mustered up the guts to start taking it. I know I want to but the thought of turning into a cranky, weight-gaining, sweating mid-life woman keeps me from starting!! Hmmmmm...wonder why? lol! I'm 45 & will do anything to decrease my chances. It's just getting started. That's the hard part!! I wish you much luck & enjoy your trip! ~Lisa

ballet12 · May 2013

Thanks for your comments regarding ALH, Farmer Lucy. I was already tested for brca (negative). My ALH was diagnosed 17 years ago, and the only thing that has come up since then is the DCIS in the same breast. So, now I'm trying to figure out whether I still have added risk in the other breast. The DCIS-treated breast has had radiation (as well as three surgeries with wide margins, now). So, deciding on whether to do hormonal therapy (Aromasin) to essentially protect the other breast. My family history isn't extensive (just mother--and brca neg). RO thinks I should do the hormonals due to family hx. MO says it's up to me. Now going to see BS for yearly follow-up and see what she has to say. I'll ask about the ALH and if it is still relevant so many years later, as a predictor. Normally one wouldn't ask the bs these questions, but mine is actually a prominent academic researcher in dcis.

farmerlucy · May 2013

For what its worth, my onco score was 3 for the 1.1 cm IDC, so hormonals make very little difference (2%). My onco said she wouldn't be so concerned about the specific IDC that was found, but that she really wanted me on tamoxifen because of my family history. Not really sure I understand what she is saying (perhaps she is talking about something that was not found in pathology! EEK!) but in any case I am happy to be on it now. It was a real mind trip for me this past year not being on it and knowing I wasn't doing all I could do. Now I feel this sense of peace. The future is out of my hands. This is just how I feel. Others may not feel the same. Hugs and Blessing from 10 miles south of Moore OK! So so sad!

ballet12 · May 2013

Praying for the people in Moore, OKla. Yes, very sad.

Lumpectomy after being diagnosed with atypical hyperplasia?

Comments

Categories