When you say " precancerous calcifications", do you mean ADH or ALH, i.e. a condition with atypia?

And how was this diagnosed? With a stereotactic / core needle biopsy?

Without even considering the CHEK2 mutation, normally when atypical cells are found through a needle biopsy, an excisional (surgical) biopsy will be recommended to remove the entire suspicious area for further examination. This is done because in approx. 20% of cases, either DCIS (pre-invasive cancer) or invasive cancer will be found mixed in with the ADH or ALH.

Did either doctor discuss the option of you taking endocrine (anti-hormone) therapy to reduce your risk? This is often considered for high risk / precancerous conditions, again separate from the CHEK2 concern.

Hi Bessie,

Yes. I had a core needle biopsy in July. They are saying it’s flat epithial atypia.

Doctor 1 said it should come out. Brought up my 3 options after it’s removed : careful watching every 6 months alternating mri and mammo, tamoxifen, or double mastectomy to reduce my risk. I’m not too thrilled with any of my options and I feel there are pros and cons to each. I just dk how I determine the best, safest option. I have 2 young children and I constantly think about the stress of every 6 months. It’s taken a toll on my emotions these past few months already

Ah, you have FEA. That's different. Unlike ADH and ALH, there are questions as to whether FEA confers increased risk and should be defined as a pre-cancerous condition. From most recent studies, it is recommended that FEA be excised only when it's found in conjunction with ADH or ALH (and it's really the ADH or ALH that is presenting the risk).

Majority of flat epithelial atypia diagnosed on biopsy do not require surgical excision https://www.thebreastonline.com/article/S0960-9776(17)30584-2/fulltext

"Histological upgrade to malignancy was uncommon in lesions found on biopsy to be FEA. Non-operative management of biopsy-proven FEA can be considered in the absence of ADH and radiology-pathology discordance."

Flat Epithelial Atypia and Risk of Breast Cancer: A Mayo Cohort Study https://www.ncbi.nlm.nih.gov/pmc/articles/PMC44241...

"Our 35-year cohort has been followed for a median of 16.8 years. FEA appeared to have no independent impact on BC risk: subsequent breast cancer events in women with FEA were associated with the major categories of AH and PDWA, and the coexistence of FEA did not change risk within AH and PDWA subgroups."

Two thoughts. First, given that you have the CHEK2 mutation, although an excisional biopsy is not always recommended for FEA alone, it might make sense to (at minimum) have the entire area of calcifications removed, just to be sure that there is no ADH, since it is quite common to find the two conditions together. ADH, if present, could present a higher risk, and would possibly drive different decisions than the FEA alone.

Second, I think you have to decide what you want to do to manage your risk from CHEK2, separate from the FEA. That is the higher risk that you face. Then you can layer the FEA on top of that to see if it would change your decision.

it such a personal choice to make but if I could go back and make a decision which would prevent my breast cancer I would. I also have 2 young kids and it’s been a rough few months going through this.

I have the chek2 mutation and I am doing chemo currently and have a double mastectomy scheduled for 12/1.

Let me know if you have questions