Has Anyone Chosen Monitoring Instead of Surgery?

Hi there. Im a little confused. Why does your present doc have to refer you to a second doc? Is it an insurance matter? You have the right to get a second opinion with whomever you want, don't you? I feel like Im missing something. Are you being seen by a breast specialist?

The only people I've heard of who choose monitoring instead of surgery are those with pure DCIS and LCIS. Once it is invasive you must have surgery to get the cancer out. Not sure what your situation is from the description you provided. Good luck!

Hi imfine:

It sounds like so far the pathology findings of concern are: "atypical intraductal epithelial atypia" (an atypia) and "atypical lobular hyperplasia" (ALH). Please advise if that is not correct.

A further excisional or surgical biopsy is being recommended to exclude the possibility of malignancy in the vicinity -- which is a risk as noted by MelissaDallas.

Seeking a second opinion review of the pathology findings (independent review of actual slides), along with a second opinion from a breast surgeon regarding the proposed surgery is not unreasonable, especially as atypia is a finding where studies have shown a lower degree of agreement between pathologists, see e.g.,

http://jama.jamanetwork.com/article.aspx?articleid=2203798

Based on your location and reference to Sunnybrook, I take it you are in Ontario, Canada, contacted Sunnybrook and were advised they do not have time for second opinions (presumably in a high risk scenario?). I wonder if this would be true if you had a specific referral to a breast surgeon at Sunnybrook (versus cold call). . . In any event, you have requested information about breast surgeons at another Ontario, Canada breast center, preferably a center of excellence. Hopefully, someone will come along.

If you do not receive more replies here, you may wish to start a thread in the Canadian forum. It might be helpful to include ALH and Ontario, Canada in the title of a new thread.

Canadians Affected by Breast Cancer: https://community.breastcancer.org/forum/55

Best,

BarredOwl

Most women diagnosed with breast cancer felt absolutely fine and had absolutely no symptoms. Zero. Zilch. MAYBE a lump. Lots of them not even that. Often it is just found by a slight abnormality on a mammogram. Many of those women were doing "everything right," were otherwise perfectly healthy and felt great. Frequently there is no indication on imaging that invasive cancer is present, so "monitoring" doesn't necessarily work until it is far advanced.

I had no symptoms whatsoever before a mammogram showed an irregular mass in my breast. Heck, I my doctor even did a manual breast exam only 3 weeks prior and never felt it. It turned up almost under my arm, very high on the breast. It was about as big as a cherry, so obviously it had been there awhile, a few years I'd estimate. They just didn't catch that bit of breast in the mammograms. My cancer, although small, turned out to be a rather aggressive one which required chemo. I'm glad I didn't wait around until it got bigger. For me, waiting could have been very dangerous.

I think you must find a breast surgeon who is more responsive to you. It doesn't sound like there is a big rush to do it, but you need to get all your questions answered.

Hi imfine:

For second opinions in Ontario, Canada, in addition to Sunnybrook, Princess Margaret is often mentioned. You can use the key word search field to find mention of it.

BarredOwl