Radial scar question?

A 6 mo. follow-up mammogram is being done to see if there are any changes to the area in question. The doctors want to compare what is seen on the first mammogram to what shows on the 6 mo. follow-up mammogram. Sort of like comparing apples to apples. They are looking for changes.  Mammograms and MRIs are different tests and may not highlight or focus on the same thing.

Hi Danielle,

Im not sure if you are at high risk. The scientific community never seems to come to firm conclusions on anything leaving us all to wonder and make the best decisions with the information we have. For me personally-- i was just diagnosed with breast cancer stage 1a and i found out i had a radial scar in both of my breasts. Maybe these were indications i was headed for trouble, maybe not. I had a bilateral prophylactic mastectomy and the radial scars were found along with fibrocystic changes and some other benign things after my mastectomies. 

mammos never showed these radial scars which is sorta scary to me because my breasts were so dense that they couldn't even see the radial scars. if i were you, i would discuss with your doctor if you have dense breasts and how dense. i know a lot of young women have dense breasts, but some have denser breasts than others. i am assuming that if they were able to see your radial scar then mammos might be a fine diagnostic tool for you, but as for me, an mri confirmed my stage 1 breast cancer. if i had had one before my diagnosis, it might have picked up on my breast cancer when it was just beginning to grow. my breasts were so dense that mammos didnt do the trick for me until it had grown to 1cm. i didn't know any of this until i was diagnosed though unfortunately.  

i don't think you should worry because it may not increase your risk, but i would also be vigilant and seek a doctor who knows more about radial scars and breast cancer risk 

I'm sure that a lot is not known, but this paper found an incidence of 0.84%risk of cancer/yr in a group of women with radial scar or complex sclerosing lesions, vs about 0.32%/year in the general population. http://www.ncbi.nlm.nih.gov/pubmed/21684716

This paper did not find that radial scars increased the breast cancer risk in women with or without proliferative disease. http://www.ncbi.nlm.nih.gov/pubmed/18297395

In this paper, over about 20 years, women with radial scars had about a 7% incidence of breast cancer compared to 5.5% of controls.http://www.ncbi.nlm.nih.gov/pubmed/16502407

'High risk' is a relative term.  I have seen papers that say that some women with a certain BRCA 1 or 2 mutation have up to a 90% lifetime chance of getting breast cancer. (I would certainly classify these women as being at high risk.)   I have classic LCIS, and I have seen papers that opine that LCIS is the highest risk lesion seen under the microscope.  I was given approximately a 30-40%chance of getting breast cancer in my lifetime. (There are other unusual types of LCIS which probably provide a higher risk.)   I have read some articles that claim that radial scars are a high risk situation, yet I'm sure some women with a deleterious BRCA 1/2 mutation (with a lifetime risk of up to 90%) would feel rather strange being classified in the same category as someone who had a 5 or 15% lifetime incidence of breast cancer. 

However, I have seen some academic papers refer to conditions such as a radial scar as 'high risk'.  So the term 'high risk' is relative.  I am *not* trying to discount your fears.  When you have a condition that is unusual, you don't know if and how this might change your life. 

As far as surveillance is concerned, you may expect to be closely monitored for the next several years, but, when your breasts 'quiet down', I would expect your monitoring should quiet down too.  They would increasing your monitoring during the first few years after your radial scar diagnosis to make sure there isn't something worse going on in your breasts.  (Breast cancer is normally quite slow growing -most breast cancers have been in the breast for some 7-10 years before they can be detected by ANY means.)  The NCCN guidelines state for women with LCIS and opt for monitoring, they recommend yearly mammograms and twice-yearly clinical exams (with no ultrasounds or MRIs).  http://nccn.com/index.php  After my LCIS diagnosis, I got monitored (i.e. some sort of imaging) every 6 months for about 2 years (and I had 2 subsequent biopsies-both nothing worse than LCIS).  After that point, my breasts quieted down, and I've only had twice-a-year clinical exams and yearly mammograms. (I have never had a breast MRI.)

I think women should be monitored regularly, and you should certainly make sure your doctors know you do have a history of having a radial scar.  I would recommend that you follow your doctors' recommendations for monitoring.  Once I got several years' of imaging and clinical exams with no findings it became more plausible that there really was the possibility that I would never get bc.

I had a radial scar removed in 2012. It had been assigned a BIRAD 5 rating on 3D mammogram and follow-up ultra sound, and even though I had a core biopsy, the results were discordant-- the benign finding did not match up with images. So, I had an excision all biopsy where they determined it was a radial scar. I was being followed up by breast specialist at 6 months after a diagnostic 3D mammogram and then at 1 year. I thought she was going to cut me loose, that I would go back to regular screening, but my doctor feels that my breast are lumpy, dense and that I am moderately high risk for developing BC. I am glad that she is being vigilant. I'm trying to understand my risk and act accordingly. For me that means yearly 3d mammograms (I am 46), which did catch the concerning lesion, as well as breast exams by an experienced breast specialist.

Karecare,

I am sorry to hear that that breast surgeon said you had a radial scar based on imaging alone. It should have been biopsied way back when simply because they can look like cancer. 

Sounds like you had some medical professionals let you fall thru the cracks. Yours is an unusual story based on what I noticed here on BCO. I have never heard a woman being Dx-ed with a radial scar based on imaging alone. I am so sorry to hear that this was your experience

I was originally diagnosed with a radial scar and 4 years later diagnosed with stage II breast cancer.  So yes, take every precaution they give you and be very vigilant in watching this in the future.  My radial scar did show on mammogram and was excised.  The cancer did not show on mammogram, only on ultrasound.  So, if possible always get both ultrasound and mammogram.  I have recently progressed to Stage IV mets to the bones.  I don't want to scare you as this is rare.  Just be very careful!  God Bless

hi Petite,

I think radial scars have a pretty low rate of malignancy- less than 15%. They do tend to look like cancer on mammograms, but so does adenosis sometimes. The adenosis is what got me my biopsy the first time. I think if your biopsy comes back positive for radial scar they generally remove them. Like you noted, even when they are benign they can obscure other stuff.

I wanted to join in this discussion about radial scars. I'm learning all that I can about them too and what they indicate for increased risk.  Yesterday I received benign results from a biopsy of micro calcifications, plus an incidental finding (found by pathologist, not imaging) of a radial scar.  I have "extremely dense tissue".  My BS is recommending that I have the whole radial scar removed  (the last biopsy was targeting the microcalcs and just happened to pick up some of the radial scar cells).  I am scheduled for a wire-guided excisional biopsy at the end of March.  Another hurdle, but I trust my BS and from all that I'm reading, removing the radial scar is indeed the most prudent course of action.  My BS tells me that if the biopsy of the radial scar is clear, then I can go back to routine annual screening. 

Alicki, nothing is recommended for it. It is a benign condition.

Hi Hazel, did you have your radial scar removed, or any response to your post? I have just been diagnosed with one - 1.4 x 1.5 x 1cm. I'm 10C and I'm wondering exactly the same thing about the impacts of surgery. Thanks, Julie.

Hi MelisaDallas,

That's really helpful - thank you.

I just had one removed on June 1st. They took a golf ball sized area out even though the radial scar was microscopic. Surgery took about an hour. I actually just did local anesthetic (twilight) and was home in just a few hours. Recovery was much better than I thought. Not much pain at all. Surgeon recommended a sports bra for several weeks (even sleeping) to reduce chances of abnormal swelling on that side. Hardest part was having the wire put in an hour or so before. That wasn't particularly pleasant but was not any worse than the biopsy a few weeks before. Good luck.

Ozarkgirl, try searching for "complex sclerosing lesion" also. That is another term for radial scar

ALH:Atypical lobular hyperplasia

I have had 2 radial scars removed, 5 years apart. Same breast, different spots. Praise the Lord, neither was cancer. They took a pretty big chunk with the first one, but it filled in and today you can't tell.