Calcifications recurring after radiation and while on Tamoxifen

Hello all.  I am new to the site, but couldn't have stumbled onto a more appropriate topic.  I was initially diagnosed with DCIS in my right breast in January 2009, had a lumpectomy in February 2009, followed by six weeks of radiation.  I started Tamoxifen in May of that year.  I, too, have both mammograms and either an MRI or BSGI (Breast Specific Gamma Imaging) each year -- the mammograms in December, the other test in June.  Other than a cyst that was discovered a couple of years ago in the left breast in a sonogram (which I don't normally have -- I was part of a clinical trial), my tests have all turned out clean.  Until today.  My yearly diagnostic mammogram is showing a small microcalcification in the surgical bed of my original cancer in my right breast.  One measly little spot and I'm finding myself right back where I was five years ago -- a bit scared and trying to control my emotions.  The radiologist recommended a "wait and see" approach -- they want me to come back in six months and have another mammogram in that breast (in addition to the other imaging I would normally have done at that time).  Much like some of you have indicated, the radiologist said that this could be the result of the initial surgery/radiation -- she called it a "fat necrosis," and said that it could happen several years after surgery.  They want to take another look in six months to see if the spot changes, if more spots appear in the area, etc. before they would recommend a biopsy. As you can imagine, my emotions are all over the place.  At times I don't know how I'm going to get through the next six months with this hanging over my head -- I want to know NOW.  At other times, I try to see the bigger picture -- they're being cautious, if there IS a problem, they will have caught it early (although the treatment ramifications kind of bother me, given that I've already had radiation in that breast), and there's always the possibility that it's nothing at all.  I'm trying to learn to live with the uncertainty that comes with being a cancer survivor -- knowing that even if this turns out to be nothing this time, it's likely that these kinds of things will happen again. (I'm 51 -- I was 46 when I was originally diagnosed)  Reading through the posts on this site has been very comforting.  Not only has it given me a better perspective on all this, but it's always good to hear from people who've been through it and come out the other side.  So I immediately signed up for an account, and will be checking back regularly.  Thank you all for sharing.

Very interesting thread.  Lane 4, I am so glad you had no further problems in 2011 with that scare. And SaraInVA you have nerves of steel to be able to wait six months.  I am not able to do that.  I had a biopsy for calcifications in the left breast in 2005 that turned out to be benign.  Then a substantial lumpectomy in the right breast in 2010 for a growth that looked like an almond on the chest wall; again benign. Then more calcifications found in the left breast in June of this year. So after being called back for more mammogram pictures; the radiologist sat me down and said to wait six months because she did not think it looked suspicious. She said if it were her she would wait. Well, I could not wait six months so I asked if I could please have a biopsy for peace of mind.  They agreed and sent me to a radiologist who does them and sure enough they found grade 3 DCIS that was both estrogen and progesterone negative.  I was sent to a BS immediately and had a double mastectomy four months ago.  I do not know if the outcome would have been any different if I had waited six months; maybe not. I wrote this only to share with you what my experience was after being told to wait.  Lane4 had a totally different experience.  It is so hard to wait when it comes to rolling the dice with cancer.  I wonder if a consult with a breast surgeon, your PCP or some other means of a second opinion might be a good thing?  I know this is not easy.

I had DCIS 4 years ago, and was just recently diagnosed with a recurrence. I am waiting to find out my surgery date for a BMX and DIEP flap reconstruction. This conversation about calcs on a mammogram is interesting. My routine mammogram in October found a cluster of pleomorphic calcs, and the biopsy showed ADH. My surgeon (just a general surgeon who did my lumpectomy 4 years ago), sent me to a breast surgeon at the Cleveland Clinic. When I met her, the radiologist in Cleveland took a look at my mammogram and found not one, but 3 different clusters of calcs. The previous radiologist saw 2 spots, and said one that was linear was vascular calcs caused by the rads 4 years ago. The new radiologist said it definitely wasn't vascular, and thought it was DCIS. They did a second biopsy on the larger calcs and found the DCIS recurrence, grade 2. Maybe the technology is better in Cleveland. I don't know, but they sure seemed more on the ball then the first radiologist/surgeon. An interesting thing to note... when I asked the general surgeon if we could wait 6 months and see if there was any change, he said if it is DCIS, it could sit there and not change anyway. There is no way to tell when or if it would change and possibly become invasive. Because of my history and the fact that the calcs were pleomorphic, clustered and linear, they thought a biopsy was in order.

Hi ballet - Interested in your post just now.  How did they uncover the fact that your recent biopsy WAS a false positive (am looking at those future possibilities)?  Thanks - P.

So glad it turned out well. xx

jmb, I agree, and I'm sorry that it has turned out this way for you, but also so glad that it was, hopefully, all caught in this pre-invasive state.  For most of us, the DCIS is, likely, a one time event.  It sounds like you are prone to develop the abnormal tissue, and taking care of it as both treatment and prevention sounds like the way to go.  Let us know how you do.

By the way, like Percy, who just posted her picture, yours is so beautiful as well.

I hope both of you can still have somewhat decent holiday weeks.  Happy New Year.

jmb5, my thoughts will be with you for your surgery. Your story scares me a bit, I won't lie as does this thread, but I guess it is the life of having had BC. We all try to put it in the past but most of the time, we are waiting for results on tests. My first mammo at the 6 month mark was clear. Hoping that my one year one will be as well as that is coming up next month. Hugs and best to you and all of us.

jmb - I'm having a similar experience. I had IDC (left) 12/8/09 and this year at my annual mammo, the diagnostic mammo and the radiologist said the calcs in my other breast (right) had increased in size and area and recommended biopsy. The results (12/10/13) were DCIS with microinvasion. I've been on Tamoxifen since 9/2009. My onc said he's a little miffed that the Tamox didn't prevent this. I'm scheduled for lumpectomy 1/16/14 and then on to rads. We may change from Tamox to an AI after rads. I don't drink or smoke, I exercise, eat healthy and keep my weight in check. No family history either. I'm scheduled for genetics counseling 1/2/14 but my surgeon and onc think the results will be negative. I'm not happy about dealing with this again. 

PS - I'll be changing my annual mammo to a different month. I can't take any more bad news in December~~~it makes everyone's Christmas a little subdued.

Gina

Wow this thread is interesting! As I am about to start radiation for high grade DCIS with microinvasion that was ER-PR-HER2+! So no Tamoxifen for me! I just don't believe it when the Drs say they got it all and there is very low risk of reoccurance! I guess they just don't know! It's so hard to believe its over when you hear of others with reoccurance or new cancers! I hope the screening will catch anything early enough!

Hi Maito, wow, so sorry that you have to deal with these incredible burdens simultaneously. I can't speak about the mastectomy side, except to say that mastectomy plus reconstruction with autologous tissue transfer (as in the "DIEP") is major surgery with a relatively long recovery period, even when everything goes smoothly.  So, you would "get this DCIS issue over with", but it's not necessarily an easier road, just a very different road, with reduced long-term risks of recurrence.  You should visit the surgery and reconstruction threads, and post your own there, if you haven't done so already.  Beesie also has a very comprehensive review of the pros and cons of mx vs. lx.

I chose the lumpectomy route, which involved three lumpectomies and definite cosmetic changes.  I was able to squeak by with the third lumpectomy and not get a mastectomy.  Again, that was my choice.  I did radiation, with no long-term side effects, and very minimal other side effects--no skin changes  and a brief period of extreme fatigue.  I chose not to do the Tamoxifen or aromatase inhibitors because of concerns about those side effects.  I didn't do an Oncotype test.  It wasn't offered to me because I had a large amount of high nuclear grade DCIS with necrosis, so that alone determined the need for radiation.  I wonder how I'd feel if I knew I had a high oncotype score, if that would affect my decision regarding the hormonals. So far, I'm happy with the decision.

Now, if you don't want to go through annual or biannual screenings with mammo, MRI, etc. and would potentially have a constant fear of recurrence, then maybe lumpectomy is not the way to go. Is the DCIS so extensive that lumpectomy is not likely to achieve clean margins?  Did you have an MRI to help determine if there is more disease present?  All these things bear on the decision.

Hi Maito, so you have wide margins (very!).  It seems, then, that the decision would be based on how you feel about continued monitoring over time, as well as concerns about radiation and hormonal therapy.  Most people (underline most), seem to get through radiation well.  You might be able to request the Canadian protocol, which is three weeks of radiation in a higher dose, but shorter treatment period than the traditional five week treatment.  That's what I had.  Then you could decide about the Tamoxifen, or try it and see if you do OK.  Many people do.  So, then it boils down to the question of anxiety about recurrence and wanting to put it all behind you.  The mastectomy plus DIEP is a big deal, so you would eventually be able to put it behind you, but again, it's a tough road.  I hope you have support from family/friends, and although we are only "electronic" friends, we can also support you.

Maito, if you really want to be over and done with everything, MX is not unreasonable, and a lot of women make that choice. It is a radical choice for DCIS, but in my opinion, not unreasonable. I was diagnosed with a DCIS recurrence recently and am having a BMX with immediate DIEP reconstruction in less than 2 weeks. I cannot have radiation twice, so mastectomy is really the only option. I have since learned that the radiation damage to the breast can compromise and limit reconstruction options. (This is part of why I chose DIEP.) I cannot have a nipple sparing mx because of the previous rads also.

There are lots of things to weigh, and frankly none of them are great options, but whatever you chose, you'll get through it and you'll have tons of support here to help you along the way. Here is the DIEP 2014 thread that you can check out. Some of the women there have recently had surgery, some are waiting to have it. They are a wealth of knowledge and support... http://community.breastcancer.org/topic_post?forum_id=44&id=816167&page=1