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Is surgery necessary for atypical ductal hyperplasia?
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Is surgery necessary for atypical ductal hyperplasia?

A stereotatic breast biopsy determined I have Cribriform ductal hyperplasia approaching atypical ductal hyperplasia.  The surgeon recommended surgery to remove the calcifications in the area. The other option is monitoring the condition with mammograms in six months.  My maternal grandmother had breast cancer when she was in  her 70s. No other family history of breast cancer exists.  
Do I opt to go for the surgery or wait? The surgeon assessed the risk of this being cancerous as below 10%. The concern was that ADH can increase risk of breast cancer and also these cells can develop into cancer. Am I correct in that?
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13 Comments
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25201_tn?1255584436
ADH termed a pre-cancerous condition and the standard medical care is to remove the area and sometimes further treatment is recommended following the surgery .... depending on the Pathology report on the tissue removed. I suppose if you have been given the option of waiting then there may be no harm in it ... I personally would choose the surgery whether I had any family history or not. You are correct ... it is NOT cancer but does increase your risk of developing cancer in the future. Having said all that, it is still your decision to make and if you're having doubts then by all means seek a second opinion ... we are always entitled to one and if often helps with these difficult decisions ....
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Avatar_n_tn
Thank you for the information.  The info I am finding on the internet is also pointing to having the surgery. I don't want to act out of fear and permanently scar my body, but there is fear either way!

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25201_tn?1255584436
I doubt that you would be left with much of a scar as a result of the surgery you're talking about. My fear would be greater leaving it alone than of a minimal scar but it's still a decision that only you can make.   Best Wishes ....
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Avatar_f_tn
I feel that it is important to go forward and remove suspicious areas fairly soon, as this is the only way to be sure that there are no other cancers lurking nearby. If the results are benign, then you have peace of mind. If they are not, then you have a better chance of treating any problem areas early, resulting in preservation of breast tissue and an increased chance of survival.

I have had several excisional biopsies over the years, the most recent on 9/22/08, and the scarring is usually undetectable over time -- I can't even find scars from old surgeries years ago, although my most recent surgical scar is still settling down and in the process of fading.

Please let us know how things go for you!
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Avatar_n_tn
Thanks for the advice.  I have decided to go for the surgery. It is scheduled for Dec. 16.  Everything I read and all the people that have been in my situation say the same thing....get it out now and that in the grand scheme of things it was not that bad.  I am not really  worried about an actual scar.   It is more overthinking the whole thing and second guessing any decision that I make now that effects the future.  No crystal balls here!
Thank you.
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Avatar_f_tn
Good for you! We'll be thinking of you on the 16th.
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Avatar_n_tn
I had the same surgery for the same reason about a year ago.  The scar is fading and there is a tiny indentation that wouldn't be noticable at all if I were not so small breasted.  The excisional biopsy was actually much much easier for me that the core needle biopsy.  I was partially awake and joking with my surgeon on and off during the surgery.

I would like to encourage you, however, to be vigilant about follow up.  It is now a year later and I have 3 new areas requiring biopsy.  Given that I have a family history of breast cancer, I feel hormonal therapy (Tamoxifen) should have been considered/discussed after my first breast biopsy.  Unfortunately, I had two additional surgeries immediately after my breast biopsy (not on my breasts) and got distracted and didn't research what options I should consider given my breast biopsy results.  (I was told I only needed follow up mammos every 6 months nothing more)

So I will be sending positive energy your way and feel good about being able to caution someone going through something similar so they get the very best follow up care they possibly can.

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Avatar_n_tn
Thanks for the information and the encouragement about the "easy" surgery. It helps to know that people have gone through it without incident.

My doctor did mention hormonal therapy as a possibility. That is something to address after the surgery and biopsy results.  I looked up Tamoxifen and it is not without side effects, some of which may not be worth the risk of not taking it at least in my case.  For you, things happen and don't happen for a reason and who knows what may or may not have been had you had hormonal therapy.  Good luck with the next biopsies.
There has to be a better way to find out these areas they see on these amazing mammos, etc are benign so women don't have to go through this all the time.  Apparently when you have it once, you are at risk for more.  Thanks and good luck.
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Avatar_f_tn
I just had a lumpectomy this past September for atypia hyperplasia and I was told it is one step away from cancer, as cells progress along from abnormal(atypia) and I was asked if I wanted to take meds ie Tamoxifin (tamoxifen), and I declined even though atypia hyperplasia and my other factors doubled my risk ....so I can tell you I am very glad they found it and removed it and I think you would be wise to do the same.  Good luck. Madge
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Avatar_f_tn
Thanks for your encouragement and reminders about staying vigilant with followup. Although I have been lucky with benign results so far, I too have a family history of breast cancer and atypical cells that were removed with the latest excisional biopsy.

On my recent SCN biopsy, there were columnar cell changes and flat epithelial atypia. After excisional biopsy, there were only a few atypical cells left but also ductal hyperplasia. (My excisional biopsy was also much more comfortable than the SCN biopsy!) I know the next step is DCIS ... yet my surgeon feels everything was removed and I am OK to return to regular 12 month mammograms. There was no mention of hormonal therapy (I am a premenopausal 46 y/o), and I relaxed my guard.

I will, however, take your advice on board and look at other diagnostic options such as MRI, and for sure will ask for diagnostic mammos from here on out! I will also consider a second opinion. Thanks so much for sharing.

Lynnie1227, keep us posted on your results after the 16th! We're rooting for you.



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Avatar_n_tn
Thanks for all the info good wishes this site sent my way. Apparently they worked!
I had the excisional biopsy on dec. 16 and all is fine. The doctor removed the atypical cells and the results came back negative for any malignancy and atypia.  Big sigh of relief! Amazingly there was no pain. The incision is quite long, over two inches, but healing quickly. The same was true for the stereotatic biopsy painwise.  You were all right saying I would feel better knowing the atypical cells were removed.  Apparently they were approaching atypical ductal hyperplasia and in the cribiform stage. He said it was the smallest and earliest anything could be detected.

My doctor recommended digital mammo in six months and then regular yearly mammo after that. He also recommended breast MRI yearly.  I am ok with that bur am thinking I am setting myself up for more benign biopsies and surgeries in the future. I guess that is ok considering the alternative.

He also did a risk assessment which I also did myself on the National Cancer Institute's site. I fall in the 3% risk of getting BC in five years. Not a very high risk to me altho the doc put me in the borderline high risk category.  He suggested tamoxifen therapy to cut the risk in half. Right now that is not the route I want to take since the side effects of the therapy are too much for me to risk based on my risk of getting cancer. I will take my chances there and monitor yearly.  He agreed.

So thank you again for your advice. I wish you all the best too.
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Avatar_f_tn
Hooray! Congratulations on your good news, that's great. And thank you for sharing your recommended follow-up plans -- it's really helpful to know what women are being advised to do for their different situations.
Best wishes, and happy holidays!

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Avatar_n_tn
HI Braveheart and all the rest,
I too had ADH and two micro calcification clusters and had them removed two years ago. I have been fine since then. I credit my normal breast tissue to a good diet and exercise routine since the surgery. I have 4 cups of green tea daily, 1 tablespoon of organic flaxseed oil, 1000 IU of Vitamin D, almonds, lots of fibre (psyllium husk) and really try to cut back on sugar and white carbs, while doing some form of good exercise daily. I also recently started taking DIM by Nature's Way, which is supposed to significantly diminish breast and cervical cancer risk. Also good for men to reduce prostate cancer risk.
Also, beware of mamograms. Read Dr. Mercola's website for the dangers. 1 rad of radiation can increase breast cancer risk by 1% and the radiation is 1000 times greater than that of a chest X-ray. Also, the tight compression of the breast can cause cancer to metastasize if it exists. Consider thermograms as an alternative. They detect cancer 10 years prior to any other screening method. I am opting for one MRI and one thermogram per year.
Hope this helps.
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