Next steps after they found ALH on core biopsy

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eot28
eot28 Member Posts: 40

Hi there,

I have a very strong family history of BC (both sisters diagnosed in their 40s - one with IDC and one with IBC and the only female on my dad's side (my aunt) with BC in both breasts at age 40 and then 41). My personal history is that I started getting biopsies at 22 and am now 45. Most of my biopsies have been since about age 35 and all biopsies I have had up to this point have been the same - fibroadenomas. My latest biopsy showed sclerosing adenosis and a 'rare focus' of atypical lobular hyperplasia <1mm. On the report it recommends surgical consultation for next steps. But the surgeon's note said no surgical follow up needed (I'm guessing since it's small?). They have referred me again to the high risk clinic (where I assume they will recommend Tamoxifen).

Anyway, for a couple of years, I have been strongly considering PBMX due to my strong family history. I told myself if I ever got a diagnosis of ALH/ADH it would be my last chance sign to get the PBMX before it's cancer. Has anyone with ALH/ADH and strong family history decided to go with PBMX instead of Tamoxifen? I am not thrilled about the idea of Tamoxifen because I have a ton of uterine fibroids and I just feel like it would be replacing my BC worry with worries (although very rare) about uterine cancer/endometrial cancer, blood clots etc. not to mention the mood swings, hot flashes and blood clot warnings.

I am a major hypochondriac with panic/anxiety disorder so I am pretty much in a constant state of worry about this. Any advice anyone has would be so helpful! Also if you have any tips on finding the right surgeon who has a decent bedside manner but also did a great job with surgery and minimizing the pain (I am of course worried about post-mastectomy pain syndrome too). Also I'm leaning toward no reconstruction because I don't do well with surgery and I just feel like the risk of complications etc. would add to my hypochondria. Thank you!

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  • Ddw79
    Ddw79 Member Posts: 533
    edited April 2016

    I know how you feel . My story is different but similar in many ways. I haven't opted yet for the double PMX but I feel like I'm sitting daily on a powder keg waiting to explode.


    Genetic testing may help you make these decisions. I did this online on my own no doc or insurance involved through Color Genonics. Came up negative for 29 genre tested. All maternal family members died of either breast or ovarian cancer... BRCA1. Ashkenazi Jewish ... No break in the line. It was/ is a no brainer

  • eot28
    eot28 Member Posts: 40
    edited April 2016

    Thanks so much. Yeah I had the 49 gene panel done (positive for another mutation not related to BC yet though one sister with BCalso tested positive for that unrelated gene too).

    They just haven't discovered the gene yet for my family's BC I think.

    I'm sorry you're going through a very similar thing. Ughh no easy answers I guess. Thanks again for your post!

  • farmerlucy
    farmerlucy Member Posts: 3,985
    edited April 2016

    Gosh - I could have written your story. Scary family history with earliest onset being 27 yrs. Twenty years of high risk screening. I always said if anything came up I'd have them removed. ADH and ALH did come up. PBM but with the outcome no one wants to hear. A hiding IDC was found in the final pathology. Besides complete devastation I was soooo angry and embarrassed that I "let" it catch me. My next thought was "oh why, oh why couldn't it have been DCIS?" No mutations in 19 gene panel. My BS sent me to a genetic counselor after they found the ALH/ADH. He gave my a 50% risk.

    It's all good now. I was so hoping get out from under the shadow of BC that I lived under my whole life. Not possible now, but then again, I faced the monster and he's just not that scary any more. He may be able to take away some things, but he can't take away the 55 great years I've had.

  • eot28
    eot28 Member Posts: 40
    edited April 2016

    Oh I am so sorry farmerlucy to hear your story. It's such a difficult choice to do the PBMX - I always wish I had a crystal ball (don't we all). It's hard when you don't have a diagnosis of anything yet to make that decision especially when the medical establishment is generally against it and it's really a decision you have to push for. Now that I have ALH I still feel like it's this fairly 'wishy-washy' area where it's easy to fall into denial in some moments. It feels like this race to not let it get us while at the same time it's so incredibly hard to make that decision. A few months back (before the ALH came up) I had decided that I'd just deal with it if I got cancer (a period of denial because I couldn't make the decision). Now that I have the diagnosis it's come up at a really difficult time (literally got the pathology report last Friday and just started a new quite stressful job the following Monday). And now I'm in a really tough spot of trying to process this all while at the same time being new in a job etc. Timing stinks. But I also know in my gut I have to deal with this sooner than later and your story makes that all the more apparent to me. I'm so incredibly sorry that they found IDC after you made the brave decision for the PBMX. I know that has been one of my biggest fears too. It's all so incredibly unfair.

    You are so brave and strong for going through all of this. I thank you so much for sharing your story. And helping me to feel more confident in this decision. I teared up when I read your post and it really helped me feel more convinced than ever about this decision for the PBMX. I'm just so sorry that the monster C was hiding in there. Sending you positive healing thoughts and thanks so much again...

  • farmerlucy
    farmerlucy Member Posts: 3,985
    edited April 2016

    Thank you- eot28 - it really is all good. Funny, it took getting cancer to lose much of my fear of it. My case is not the norm, most women who choose this route get a good report. I tell you though - the absolute best feeling inthe world was waking us from surgery "knowing" I'd outrun the beast. One thing I learned on these boards is that tamoxifen can reduce breast density. I might not have chosen the mx if I knew they could see something besides all white on the screening. No one wants to take the drug, but it really is amazing in what it can do. There is a lovely lady on these boards AWB who took it preventively for lcis plus family history and is now taking an AI preventively. She has done really well on it.

    We ladies who know something is going on are in a very lucky minority. A good friend of mine from these boards had a surprise dx after a PBM (Again not common, but the similar dx has made us lifelong friends) commiserated with me that we are the luckiest unlucky people in the world.

    Hang in there. Continue to be your own best advocate. Get those MRIs and ask for all reports! Take care. I'm here if you need me.

  • eot28
    eot28 Member Posts: 40
    edited May 2016

    Thanks so much again farmerlucy. You are an inspiration to me. That quote really hits home "the luckiest unlucky people in the world." I can't imagine how difficult that was to get your pathology results after going through so much decision making for the preventive surgery. But at least you have your sense of humor in tact :). Thank you so much again for all of your help and sharing your experience with all of this. I'll keep you posted on what happens - I'm meeting with another surgeon tomorrow to get their input. Toughest decision ever but my gut leans toward the preventive surgery (at least today).

    All the best to you and take good care - thanks again :)

  • Ddw79
    Ddw79 Member Posts: 533
    edited May 2016

    I'm pretty sure that Anne, like me, is now taking Evista. I don't know if Evista reduces breast density . I also have dense breasts. What I wonder sometimes is: who doesn't have dense breasts ? Seems like it's very common for everyone , not just for people on these boards

  • Momof6littles
    Momof6littles Member Posts: 184
    edited May 2016

    eot28, I know how you feel. My doctors want me to try increased surveillance for a while before I decide BMX. But this past 2 months have been so difficult. I have a young family and it certainly has not been good for family life. We are all on edge. My mom died the first year of our marriage, so my husband knows what it's like and supports any decision I make. But with doctors resisting, it's hard to feel confident in a decision for surgery. My risk was calculated at 67%.

    So I wanted to say I understand the difficulty of the decision. It's so personal. The fear of cancer lurking around the corner is hard to live with. I wish you the best with all of this. May you find peace.

  • eot28
    eot28 Member Posts: 40
    edited May 2016

    Thanks so much Momof6littles. Yeah it sounds like we are really in a similar boat. My gail model risk is 68% too. I met with some surgeons today and they were very accepting of the surgery option. So I am strongly leaning toward it. I'm so sorry that you lost your Mom when you were just married. I can only imagine how difficult that must have been/is - and how that impacts your anxiety as well, let alone the grief of it. And having small children has got to make this decision all that more impactful. I don't have children and it's hard enough as it is.

    I have now met with surgeons at 3 different hospitals over the past 3 years and honestly have had slightly different reactions from all of them. I wonder if you could try another hospital to get another surgical opinion or maybe you have already? With LCIS, strong family history and that risk assessment, I bet you could find a surgeon that would see your side of it. I think the hardest part is coming to the decision for yourself and then trying to find a surgeon that understands, is the next step. But I know it's not easy. And it's really hard being in this 'gray zone' without a known genetic mutation connection - we're kind of not part of the main group. So they sometimes don't know what to do with us.

    Uggh.. it's so difficult. I wish you all the best and let me know if there is anything I can do to help. I see you're in Indiana - I'm in the west coast so I haven't met with any docs in the mid-west. But I'm guessing you've met with doctors in Chicago maybe? I wonder if you've tried Northwestern?

    Hang in there with this and let's keep in touch. Would love to keep each other going through this process... Thinking of you.


  • eot28
    eot28 Member Posts: 40
    edited May 2016

    Thanks Ddw79 - yeah, I wonder the same thing about dense breasts. I feel like everyone I talk to, even outside of these boards, has dense breasts too. Uggh.

  • Momof6littles
    Momof6littles Member Posts: 184
    edited May 2016

    Yes, eot28, this whole thing has brought back lots of difficult memories. My dad died from pancreatic cancer a year after my mom died. I spent the first couple years of marriage thinking I was going to be the next one. Not really rational, but I already had a lump they were watching, so I felt like a time bomb. They decided to remove the lump because of family history and it was a benign fibroadenoma. After that I decided to stop living in fear. I had my base line mammo at 33, and was told I didn't need to come back until 40 (which was not the best advice). Now, here I am. Back for my first mammo and its all starting again.

    Some of the problem is that the doctors all started with worse case scenarios. I was called after my biopsy that it was carcinoma in situ, early cancer, probably just a lumpectomy and radiation and tamoxifen. But they needed to do more staining. Then I was told no, it's LCIS, not DCIS. We still want it out. But go for genetic testing. And then they laid out the surgeries they would suggest if I was positive. They really thought I would be positive. So I spent weeks of waiting, preparing mentally for surgery, only to be told now that I'm negative and they don't want to do anything but watch and wait. So, while its good news that nothing worse is there right now, it's a bit of a pulling the rug out feeling.

    Before I found out my lifetime risk, I was told that I should look on the bright side of the number. Look at the % likelihood that I won't have breast cancer in my lifetime. Ok. There's a 33% chance I won't have invasive breast cancer. Not so encouraging.

    Anyway, I don't want to hijack your topic. Thanks for letting me vent. Let me know what you decide. I'll keep in touch as things progress. I'm still waiting to hear about a reread of my films.

  • Ddw79
    Ddw79 Member Posts: 533
    edited May 2016

    I remain mystified about the dense breasts. I haven't met one women who doesn't seem to have these. According to the NP there is new US equipment that they use to image dense breast tissue

  • eot28
    eot28 Member Posts: 40
    edited May 2016

    Momof6littles, I know what you mean. They like to tell you to look at the % chance you won't get invasive cancer in your lifetime. And last night I was thinking 'ok there's a 32% chance I won't get it.' And yeah that doesn't feel so good. Especially when you know your family history. I hope and pray you get some clarity when they do a re-read of your films. It will be great to keep in touch and it's so helpful to know that someone is going through a very similar thing (though I really wish you weren't going through this at all :(.

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