Lumpectomy for ADH?

JDP-

ADH is one step below DCIS, which is stage 0, pre-invasive breast cancer.  I assume your biopsy was triggered by calcifications viewed on a mammogram, since you say you do not have a lump?  Usually a lumpectomy is recommended to A) make sure all of the area in question is removed and to verify it is indeed *only* ADH you are dealing with, and to ensure no DCIS is present...

My stereotactic biopsy revealed DCIS intermixed with ADH.  It can be difficult to tell the difference, and I got second opinions on the pathology.  I've heard the typical amount of tissue removed during a lumpectomy is about the size of a golfball (?) - I was a small B before, and after the first lumpectomy (located in my cleavage area) cosmetically, things looked pretty normal... (I required a second re-excision for margins, and the second chunk of tissue was what caused a noticeable "gouge").  If the area of concern is pretty small, they may take less tissue.  I'm a little surprised the surgeon did not give you any idea how much he would be removing....

I think recommending a lumpectomy in this case is pretty standard, but if you do not feel like your surgeon is adequately answering your questions - don't hesistate to get another opinion!  You need to trust whomever is going to be performing the procedure...

Good luck!

Mary

I had an area of ADH removed two years ago. It wasn't as drastic as the lumpectomy I'd had in 2002. Then this year I had ILC in the same breast as the ADH. Go figure.

Sheila should be responding to this--she had ADH, strong family history of bc, and chose bilateral mastectomies.

ADH is more of a "marker" for cancer. But it can be on the edges of DCIS. Did you by chance have an MRI?

Anne

JDP,

Before you panic too much, here are some facts:

ADH is a risk factor for breast cancer, but most women who have ADH will not get breast cancer.  According to the American Cancer Society, "About 2 in 10 women with atypical hyperplasia will develop invasive cancer within 15 years of their biopsy.".  http://www.cancer.org/docroot/CRI/content/CRI_2_6X_Non_Cancerous_Breast_Conditions_59.asp

Further down the ACS webpage, it mentions that conditions with atypia increase one's risk of BC by about 4 to 5 times.  What you need to understand is that this is relative to base risk, not average risk.  Base risk for all women is about 5 or 6 %.  Then individual risk factors get applied to the base risk for each woman, and that's how the average risk for all women ends up being around 12.5%.  So when all risk factors are included, 1 in 8 women (12.5%) will be diagnosed with BC.  By having ADH, your risk is about 20% - 25%, which is high risk vs. the average woman, but still means that 75% - 80% of women who have ADH won't ever get breast cancer. 

Now, as for the excisional biopsy, this is standard treatment for ADH.  That's because ADH and DCIS can sometimes be hard to distinguish from each other and sometimes go hand-in-hand.  Here's how breast cells progress from normal to cancerous:

normal cells --> ductal hyperplasia (not high risk) --> atypical ductal hyperplasia (high risk) --> DCIS (Stage 0 non-invasive breast cancer) --> IDC (invasive ductal cancer).   As you can see from this picture, although ADH doesn't usually progress to become DCIS, they do look a lot alike:

So when anyone has a needle or vacuum biopsy that shows ADH, as a precaution, most doctors will recommend a full excisional biopsy to remove the entire suspicious area.  This is because there is concern that the sample size from the needle biopsy may not have been large enough to distinguish between ADH and DCIS.  In the majority of cases, all that will be found is more ADH.  But in some cases (I believe about 10% of the time), DCIS may be found. 

I'm one of the 10%.  I was diagnosed with ADH from a needle biopsy but my excisional biopsy turned up DCIS.  But just like all of the women here, I'm in the exception group.  Most biopsies - 80% - turn out to be benign.  Those women usually happily leave this site.  This is a breast cancer discussion board, so the women who stick around here are the minority group who were diagnosed with breast cancer.  Please don't use our situations as a guide for what will happen to you.  The excisional biopsy is important to have, but the odds are very much in your favor that the nothing more than ADH will be found.

I hope that helps!  Good luck!

Thank you so much for all the information.  I had an excision biopsy for ADH on January 25.  I have to be followed closely.  Of course, I know that I am at high risk now.

JDP,

I have had one core biopsy go from ADH to DCIS on excisional, and one core biopsy remain ADH when the actual site was excised.  So presence of ADH does not definitely mean other undectected cancer is present.  Many surgeons will do the excisional when presented with ADH (but not all).  I had to ask for it and lo and behold there was DCIS in the second breast.

alphadog,

The pathology report from your stereotactic biopsy only puts you at a slightly increased risk for BC vs. the average population.  But add to that both your dense breasts and your family history, and your risk is higher.  And while atypical hyperplasia is not breast cancer, it can be hard to distinguish from breast cancer.  With only a small tissue sample from the stereotactic biopsy, you can't know with 100% certainty that there is nothing else there.  So I agree with you - I'd push for the excisional biopsy.  Hopefully in the end nothing more is found, but it's better to know that than to wonder.  Or worse yet, to think that it's only atypical hyperplasia and then find out later that there was some DCIS in there too. 

I just had 2 lumps removed and found out that one of them was ADH. They are now sending me to a onc. to see what I need to do to prevent BC. I'm at high risk already because my sister had BC.

Does anyone know anything about taking Tamoxifien?

I promised myself I'd post here after I found out really what was going on.  Not the way I wanted to meet all of you, but all of you have been a great help to me in a very frightening time.  On May 8th I got the dreaded call that my mammogram showed clustered calcifications in the left breast.  I underwent the stereotactic breast biopsy on the 21st and it showed Atypical Ductal Hyperplasia.  My Doc said it wasn't cancer, but a precancer.  Said a lumpectomy was necessary to rule out a DCIS hidding behind those calcs.  Had  lumpectomy, four days ago, got a call from the Doc this morning and all tissue was normal.  He said they probably got it all in biopsy.  Well, great news, but did I get a lumpectomy for nothing??  I really can't complain, the area was so small, I haven't lost any breast mass, no disfiguration, just a lovely inch and a half scar now!  So is lumpectomy really necessary for ADH?  I'd say do it, if asked for my opinion.  He removed all the tissue surrounding the calcs and hopefully don't have to worry about that area, again, although I'm at increased risk for bc, I know that.  Nobody in the family has had it.  Go figure.  Ladies, thank you so much for caring enough to post here and share your stories.  If I can help anyone in anyway with any questions, I will certainly post what I learned.  God bless all of you, you're great!

Maureen

I had a stereotactic biopsy in March that turned up ADH (spot on mammo revealed calcifications, which lead to the stereo).

The next step was excisional biopsy which was done in April.  That also revealed ADH, nothing malignant. 

I have an appt w/ an oncologist in a few weeks; I assume to discuss risks and possibly tamoxifen. 

I went thru the same thing a few years ago. I had a sterotactic biopsy for an area of calcifications which showed ADH. I then had an excisional biopsy (they dont usually use the term lumpectomy). There is a small chance that a cancer is co-located with the calicifications that the steroetactic biopsy missed. I chose to do under local anaesthetic (I dont do well with general). The surgeon didnt want to do it that way and had an anaesthesiologist there. I did fine with the local only and went back to work when I was done. I dont recommend doing it that way, unless you have a high tolerance for discomfort like I do. Luckily, I had no cancer. As soon as it healed, I started using mederma, and you can barely see the scar. They oferred me the usual tamoxifen since I have a 40% risk of breast cancer, but I chose not to do that,  Since I had my ovaries out pre-menopausally and havent had breast cancer, the surgoen told me it only provides a minimal benefit in my case.      

I have 2 areas of microcalcifications in my right breast & with Core Biopsy showed ADH. Oct 2, I'm having a lumpectomy to make sure there isn't any DCIS or worse.



The pathology report from the biopsy mentioned Columnar Cell Change, ADH, Flat Epithelial Atypia, microcalcifications.



Said there didn't appear to be High Grade DCIS or invasive breast cancer.



What are your thoughts? I'm 56 & have 2 sisters who've had DCIS - 1 grade 2/3 & left breast mastectomy......the other DCIS with lumpectomy appreciate any comments at all.

Jen---there's a 15-30% chance of something more serious to be found upon excisional biopsy, but that means a 70-85% chance nothing more serious will be found! So hang onto those numbers, they're huge! Praying you get good results soon.

Anne