Atypical Lobular Hyperplasia-minute focus what's the relevance

Hello ladies, I just wanted to know what I shoud do about my ALH.  My BS wants a MRI and to remove it,

my biopsey came back B9 with ALH.  Is this dangerous if I just leave it alone and do mamos twice a year instead of once. 

Confused

Unfortunately, they can't reliably remove all ALH.  Why?  Because ALH (and LCIS) are normally found on biopsy incidentally when they are looking at something else.  Often (not always), a mammogram will show suspicious microcalcifications.  Often (not always) in the people that get diagnosed with ALH or LCIS, the ALH or LCIS are found not precisely at the site of the microcalcifications (or other abnormality they find), but adjacent to it.

They know that LCIS is often multifocal (in other words, there are usually multiple spots of it in a breast), and is often (not always) bilateral, meaning it occurs in both breasts.  I assume this is the case with ALH too.  (I have both LCIS and ALH.)  So, if they were going to try to 'remove all the LCIS and ALH', they would have to sample every part of both breasts (to find the parts that were normal and which had ALH or LCIS), which, in effect, is a mastectomy.

In addition, they don't know if the ALH and/or LCIS is the 'bad thing' that is happening in the breast.  What does that mean?  It means that of the women that, after a diagnosis of LCIS, go on in future years to get invasive breast cancer, the invasive breast cancer is often (not always)  in an area that looked totally normal on imaging, *not* at the areas that have known LCIS.  So that's why they think that *some* LCIS is not actually a precursor to breast cancer, but is a marker for something else that puts you at an increased risk of breast cancer.  If you were magically able to remove all the LCIS spots and leave the normal spots in the breast, we may have decreased the breast cancer risk, but maybe not so much.  They can't do this experiment, of course, because we have no way of knowing what areas in the breast have ALH or LCIS without biopsying them.  They have done experiments to see when invasive breast cancer is diagnosed at the same time as LCIS, if the two are genetically related.  Sometimes they are, but sometimes they are not.

BTW, if you choose to do 'watchful waiting' (i.e. followed closely), you may, or may not, just do mammos.  For LCIS, which is normally thought to be of higher risk than ALH, the NCCN recommends once yearly mammograms, and twice-a-year clinical exams, and that's it.  That's what I get, and I have classic LCIS and ALH.http://www.nccn.com/files/cancer-guidelines/breast/index.html#/60/

There is a wide variety of opinion as to the increased risk of ALH.  If you have a weak family history (in other words, don't meet the usual guidelines for BRCA testing http://www.uspreventiveservicestaskforce.org/uspstf05/brcagen/brcagenrs.htm#clinical), then the usual opinions are that the lifetime risk of breast cancer for a woman with ALH is *roughly* say 20% (as opposed to 13% lifetime risk for the 'average' US woman.)  I have seen estimates of anywhere between '10% and 60%' for me, with my ALH and LCIS.  (My weak family history includes bc in one paternal grandmother, 3 maternal aunts, all postmenopausal, 2 maternal cousins, one premenopausal.)

No one can make a decision for you.  It is your body, and it not only depends on your specific circumstances, it also includes how much anxiety each of the choices entail for you.  Each choice entails upsides and downsides.  There is no rush to make your  choice.  There is no one good choice that fits everyone's circumstances.

If out have a mastectomy & reconstruction it would make having the lump out look like a picnic in the park. Talk about all kinds of painful things to make you faint...you should read extensively in the reconstruction & mastectomy threads before you even consider something so drastic for something very, very minor.



The type of excisional biopsy they would do would be much easier than the stereotactic & you will be sedated where you won't be aware of what they are doing.

Have fun, and best to you too.

He recommended that knowing you had the vein surgery?

I had a pulmonary embolism when I was very ill from ovarian cancer and the oncologist will not let me take Evista because of the clotting risk.  They have offered me Aromasin which does not have the clotting risk, but I am still thinking about it.  Not sure if it is available to premenopausal patients.

For now I believe I am going to just stick to close monitoring and not worry about it so much.  In reality, most women with my condition don't get breast cancer.  You can have a talk with your doctor and ask what your ABSOLUTE risk difference is.  If it is just a few percentage points, then it would seem reasonable that the risk from clotting is too high for the few points in breast cancer risk reduction that tamoxifen would provide.

Hi concernmom,

Consider this a wake-up call that you need to get very healthy, very much right now. If I were in your shoes, I would do all of the things that those who get diagnosed wish they had done before they were diagnosed.

That would include eating a lot of cruciferous vegetables (broccoli, cabbage, kale, brussels sprouts, cauliflower and WATERCRESS (seriously, read the studies on this one)), plus garlic, onions, leeks, kale, cooked white-button and crimini mushrooms, green tea, organic red raspberries. There's a handy chart here that shows anti-cancer activity of different vegetables against different types of cancer. It's easy to see some common threads:

http://www.chrisbeatcancer.com/wp-content/uploads/2013/01/Anti-Cancer-Vegetables-Study.pdf

Cut out refined sugar and refined carbs. Instead, consider making most of what you eat anti-cancer. If you want to treat yourself, there IS now healthy, delicious dessert. Check out Hail Merry chocolate Miracle Tarts, they are absolutely awesome and extremely rich so you will NOT crave other crap. Switch to organic dairy, and consider eliminating red meat or switching to clean, grass-fed organic meats. Get enough Omega 3 fats (flax oil and other sources), iodine and Vitamin D. It seems like a daunting checklist but if you switch gradually over a few months it'll just become a habit. There is delicious organic whole wheat pasta (I like bioNaturae) that is great with garlic/olive oil/butter or tomato sauce/organic parmesan.

Consider rebounding on a trampoline as exercise if you think it sounds fun; like swimming, it exercises almost every part of your body and is great for the lymph system. For me, it's also a good excuse to blast great music and MOVE.

Try to get enough sleep. Consider the 20 steps here:

https://herbdocblog.com/book-view/12/

And enjoy your life!

Hi concernmom,

I don't know offhand but this thread seems to have some information:

http://community.breastcancer.org/forum/47/topic/748410?page=2

It seems you need to consider any family history plus the ALH. Having it removed does not sound like a terrible idea.

Just make sure you try to slam the door on it afterward :-)