My doctory just called me with the results of my biopsy. The report says APPROACHING the lowest grade of dcis. I asked my doctor if this means benign or malignant, and he said inbetween. I asked my doctor if I need a lumpectomy or a mastectomy and he said he doesn't know, and referred me to an oncologist. The report also says atypical ductal hyperplasia. Has anyone had the same result from a biopsy report ? Does anyone know if my findings will require surgery?
ADH is sometimes referred to as a "pre-cancerous" condition although it is NOT cancer. The standard treatment is lumpectomy with clean margins sometimes followed by Radiation and possibly Hormone Therapy. I'm sure the Oncologist will clear things up for you and advise you the best course of action in your particular situation. Regards ....
It's very hard to tell the ADH and DCIS apart. It's basically precancerous cells that could be approaching cancer. The oncologist will be the one to decide. If you have any relatives who have had breast cancer, your health, ect will play a part in what the oncologist decides. The treatment is your choice, it's always your choice. It may mean lumpectomy, it may mean radiation, maybe pills, you have to talk to your doctor about it, so to answer if the findings require surgery, it could be, but it might be, the oncologist should go over reports with you and together you'll make a decision of the best treatment for you.
You have already had a biopsy and have a diagnosis; there would not be a need for another biopsy but sometimes the term "excisional biopsy" and "lumpectomy" are used to mean the same thing. Radiation and possible Hormone therapy (if it is proven that the specimen is ER/PR positive) gives the best chance to prevent the development of breast cancer in the future. Regards .....
I think you got a similar result as I did---not the best, but not the worst either with an LCIS diagnosis. I've seen it labeled pre-cancerous, non-invasive and pre-invasive at various web sites. I had an excisional biopsy that found it, but it tends to be in multiple locations and often in both breasts, so just excision isn't always possible. Some women opt for bilateral prophylactic mastectomies, but I'm not at that point and maybe never will be. For now, vigilant screening is my only treatment. I could take tamoxifen at some point, but my hot flashes are just too bad right now so my oncologist didn't want me to take it yet.
ADH is treated differently for each individaul based on their own history and family history. Based on my research at various sites, sometimes it's only vigilent screening but usually it's lumpectomy to get clear margins and sometimes radiation and/or hormone therapy as japdip and Tinabudde indicated. Your oncologist is the best person to discuss all the options with and then you can make an informed decision on what's best for you. You can certainly get a second opinion, too, if you don't feel comfortable with the information you get or feel your questions aren't answered. The decision is always yours, but you want to base it on good, solid information.
As always, I wish you all the very best.
I went to a oncologist today. She said I need a lumpectomy. She said she is hopeful that the area she has to cut will be small enough that I don't need a breast reconstruction, but she won't know for sure till during the surgery. She said she won't know till after the surgery whether I will need radiation or not. Also, she said she won't know till then if I need tamoxifen. My family history is okay. Nobody in my family had had any type of cancer. I am not sure what an lcis diagnosis is. My diagnosis is atypical ductal hyperplasia. Marybai I am praying that you will get a negative pathology report.
I am worried about what my breast will look like after a lumpectomy. The calcifications that need to be removed are in the top part of my breast. Has anyone had a lumpectomy in that area? Has anyone had a lumpectomy and felt that the appearance of their breast hasn't changed that much. I would love to hear from those who had lumpectomy's to tell me about their experience.
Hi, again, Kate,
I'm sorry about not explaining LCIS---it's lobular carcinoma in situ, like DCIS, but in the lobes not the ducts. My understanding is that DCIS has the ability to become invasive, but LCS does not. However, along with all my other risk factors it puts my risk of invasive breast cancer at about 30%. That's why the oncologist said I was a candidate for bilateral prophylactic mastectomy. I understand your path report was ADH approaching DCIS.
As far as lumpectomies, I'm sure it depends on the surgeon, location and extent of excision,
but I've had four (they used the same scar for two)and except for faint scars, my breasts look pretty much the same as they did before. In fact, I had a breast surgeon and when I went to my oncologist, he said he expected them to look a lot worse based on my medical reports! I had to laugh! I'm fairly large breasted, so I'm guessing if a woman is small or very small it might make a difference. Mine were in the top and bottom of my breast on the left and the largest one was in the middle of the outside on the right. All were very easy and the recovery was quick---I went dancing the evening after the first two (done at the same time). I used very little pain medication at home. Everyone heals differently and has a different pain threshold, but I thought mine were a piece of cake. I was out for all or them, woke up in recovery, stayed about an hour then went home. Like I've said before, the wait for the path results was the worst of the whole experience.
It sounds like you have a good oncologist and I'm hoping that your surgery goes well and your
recovery is smooth and easy. Hopefully, it'll all be behind you soon.
PS:Marybai, I'm still hoping for benign results for you!
Hi ncmichigan and Kate,
I had good news today, my biopsy was benign. However, there are lots of microcalcifications that they need to watch, so I need another mammogram in 6 months. Since all of this has started I have been noticing how many patients I see that have breast cancer, and it is about 1 in 4 or 5. Of course, I see alot of older women that are near or post menopausal. All of them are cancer survivors. What is causing all of this? There is no consensus in the literature.
Much Love to everyone, and thank you for all of the support you gave me,
Hi, Mary I am very happy for you. Nc thank you for sharing your experience with me. Unfortunately I am small breasted, and that is why I am concerned, but hopefully it will be ok. I have a very high threshold of pain, and usually don't take pain meds, so I think the surgery will be ok for me. I am more concerned about the appearance of my breast after the surgery.
I noticed you started a third thread-lumpectomy. It really is so much easier if you continue everything on the same thread, especially for the women who answer here a lot. It gets really confusing when you have to answer in different places---I know I'm confused at what I said where! ( Of course, that could just be senility creeping in!) Usually japdip tells everyone this when they start a new thread, but I thought I would, too. Any of your issues or questions can
be answered in the same thread because they're all related. It's appreciated by all here.
As far as your concern, I think some small breasted women have had no problems with appearance after surgery---hopefully some of them will respond to you. You previously mentioned that your surgeon will be able to tell pretty much at the time---it seems like you'll just have to wait until then and try not to stress over it too much. The important thing is to reduce your chances of getting breast cancer and she's offered you reconstruction if it's needed, so you'll be OK.It sounds like you'll do fine during and after the lumpectomy, too. Like I said, mine were much easier than I anticipated.
I did read your lumpectomy post and you asked about the wire placement prior to surgery. It's sometimes called needle localization. A radiologist will do this so the surgeon knows exactly what needs to be removed. They use mammo or ultrasound films to locate the area, numb you up and then place a needle into the area. A fine wire is passed through the needle and through the lesion. The needle is removed but the wire stays and is removed in surgery. It sounds really scary but isn't as bad as it sounds. For my first one, I had my doctor prescribe a little Valium the night before and morning of the procedure and I did fine. The radiologists and staff are extremely kind and caring from my experience. My first lesion was palpable so they located it easily with ultrasound and by feel. The second one was for microcalcs in two areas, so I had to have them placed while sitting up in a mammo machine and that was a little rougher. I nearly fainted and really felt like a "wuss" but the doctor said that happens about 50% of the time. It was really anxiety more than pain, plus they kept telling me not to move, so I think I stopped breathing so I wouldn't move! Again, they were extremely kind and compassionate and it was as easy as they could make it. Since there are different types of neele locs, I would recommend talking to your surgeon so you know exactly what to expect---I really believe that patient education is so much better than just "doing" something to the patient without their knowledge.
I honestly thing you'll do just fine. Please keep us advised on how you do, OK? (But please keep it on this thread for continuity)
Wishing you all the best, as always,
Thank you SO MUCH for sharing your good news with us---I'm SO happy for you! I know you'll get your recommended follow ups and hopefully, after this experience , you 'll be more positive and hopeful about the results. I know that it's impossible not to worry some, but it's still best to take one step at a time and not jump ahead too much. I get mammos and MRIs every six months and of course, I worry some until I get the results, but I know I can't change "what is" by worrying. I hope you'll do the same and IF another biopsy is needed, you'll be OK with it.
Of course, I hope your screenings continue to be just fine!
As far as the number of breast cancer cases, I'm not an expert by any means, but will let you know what I've found in my research. I'm sure you know that the risk factors are many: age, ethnic background, family history, no pregnancies, diet & alcohol, obesity, environmental factors, dense breast tissue, proliferative changes and some I can't think of right now.
I've read there's an increase in incidence but a decrease in deaths from cancer---that's good news. The statistics can be misleading, too. For instance, we hear a women's chances are
1-in-8 in her lifetime. But here's how that actually works out:
At age 20: 1 in 2500
At age 30: 1 in 233
At age 40: 1 in 63
At age 50: 1 in 41
At age 60: 1 in 28
At age 70: 1 in 24
At age 80: 1 in 16
At age 90: 1 in 8
The numbers are still too high, but better than the 1-in-8 we hear.
The expansion of screening to more women and better screening equipment like digital mammography and MRI means more women will be diagnosed and that's also good. Hopefully, the cancers will be found early when they're highly treatable. There are great advances in all types of treatment for breast cancer, too---surgery, chemo and radiation.
Certainly and sadly, some women will still die from breast cancer, but there is always hope
now and for the future.
Here's an excellent article that I found very helpful from the Susan G. Komen Foundation regarding breast cancer odds:
http://www.bookofodds.com/content/view/print/484595. I hope it's also helpful to you.
Didn't mean for this to end up so long, and maybe it isn't anything you didn't already know, but
I just wanted to try to answer your question.
I'm wishing you health and happiness in the future and that you'll come back here any time you
need help or support.
Thank you so much for your advice and sharing your experiences with me. I got a second opinion yesterday, and she too said I need a lumpectomy. She said I should get it before Sept. 1. She said she did not think I will need breast reconstruction, so I am happy about that. So, now my concern is that they will find dcis. From the looks of my calcifications my doctor thinks that they might find low grade dcis. So, then I will have to pray that the lumpectomy will leave clean margins so that I won't need a second surgery. My doctor did say that if they do find dcis that it will be very treatable. I am just praying the lumpectomy biopsy will have the same result as this one with the diagnosis being adh. If it remain adh I won't need radiation or hormone therapyy, and I am praying for that. Nc I saw your chart regarding the odds for a women getting breast cancer. Do you know what those odds are with a diagnosis of adh.
ADH & LCIS are considered proliferative changes and do increase your odds of getting breast cancer, but you would need to talk to your oncologist about your own personal odds. As I said, all of her different risk factors are taken into consideration in assessing a woman's specific risk,
so these statistics don't really mean much to an individual. I think we all know of women who have a number of risk factors and never get breast cancer and someone else who has none and still gets it. The best advice is to get screened as often as your doctors recommend and make changes in lifestyle that you can control (alcohol use, weight control, not smoking, exercising and avoiding HRT) and don't wory about what you can't control (age and ethnic background, breast density, family history and genetics). I hope this is a little helpful to you.
I'm also hoping you get clear margins with your lumpectomy and that they don't find DCIS. Wishing you all the best and take care,
I should have clarified that---taking hormone replacement therapy longterm is a risk factor. I think there was a very recent study that said HRT for women to relieve menopausal symptoms for less than 6 years is safe, but the longer HRT is used the higher the breast cancer risk.
Coincidently, my LCIS was diagnosed exactly seven years after my total hysterectomy. I had been on estrogen only for severe symptoms because I was not even in peri-menopause when I had the surgery even though I was over 55 at the time. Of course, I went off it immediately after diagnosis and my symptoms are horrid again. The hormone therapy japdip was referring to that's sometimes used for ADH and LCIS are actually anti-estrogen drugs that interfere with the effects of estrogen on breast tissue. I hope I didn't confuse you with my previous answer.
Does anyone know if you have to wear a sports bra after a lumpectomy? My doctor told me to bring one to wear home from the hospital. Does anyone know if medicare will pay for a sports bra to leave the hospital with?
If the DR. told you to wear a sports type bra after surgery then you should definitely wear one. It will offer extra support which in turn will lessen the discomfort. Sports bras are not all that expensive (not more than a regular bra actually) and NO, Medicare would not pay for one. Medicare does pay for bras after a Mastectomy that are worn with a breast prosthesis and these are purchased from Medical Supply Stores. You can get a regular sports bra almost anyplace. Best of Luck with your surgery and recovery.......
I've used a sports bra bra after my lumpectomies and since if your doctor recommended it, like japdip, I'd say you should follow their recommendation. You need something soft, without wires and not super tight but supportive. On one of my lumpectomies, they actulally gave me a kind of "disposable" soft bra, but not at every one. Because I usually wear an underwire, I bought an inexpensive soft bra at KMart and it was really cheap but worked great. I would recommend whatever you get has hooks either in back or front and isn't one of those stretchy- over- the head type, because lifting your arm right after surgery isn't a good idea. A button down the front top is also a good idea for going home after surgery. They may or may not give you some ice packs in recovery, but they are great to decrease any swelling and to keep bruising to a minimum, so I'd ask for one if it's not given. You don't say where you're from, but any decent medical center will have them.
Good luck and I'm sure you'll do fine with the surgery and recovery. Please let us know how you're doing if you wish.
All the best,
Thank you for letting me know. I too normally wear an underwire. How soon after the surgery can you wear your normal bra? I live in Santa Monica, Ca., and there is a very good hospital here. I am going to get a 3rd opinion next Monday, and then I will schedule my surgery after that. Getting support from you means the world to me. Thank you so much.
I would check with your surgeon for a guideline and it depends on where your incision is. I had one very low on my left breast so it was a few days. With one on the upper area, I wore one the next day. It's pretty much all in how comfortable you're feeling.
I'm very glad to be able to provide support, but I also need to spend time with other members with questions. I do this when I have time and I may not always be free to answer, so please don't think it's anything against you if I don't get back to you. I think your major issues are resolved so you should be OK with the surgery. You'll be at a good medical center, it's really a relatively minor procedure and usually goes quite smoothly. I'm hoping that for you.
Hi Kate, hope you breeze through it. My mother is 82 and had a masectomy Aug 18 last summer, then Jan this year a lumpectomy but it for benign tumors they wanted to be sure there was nothing under the mass. She did great and you will too. Day 1 is hard but you'll be in good hands and fine, mom went home after the lumpectomy and just slept the anesthesia off, she was good the next day only took some ibuprofen tho they gave her pain meds. Let us know how it goes. hugsss.
I had my lumpectomy today, and so far all is well. The wire localization was a little troublesome, but not too bad. The surgery ended 3 hours ago, and so far I don't feel any pain. I will find out the results of the biopsy on Tuesday or Wednesday.
I am so greatful. I had the surgery 8 hours ago and I never had any pain. the area of my surgery was very small, so I am very happy about that. As I mentioned earlier I will find out the results of the biopsy Tuesday or Wednesday. I won't be surpsised if they say it is dcis, but I am praying that I don't need hormone therapy or radiation. I despise side effects so I very very raley even take pain medication, so these procedures would be problematic for me. I thank God that I don't have invasive breast cancer. Hugs to all who are experiencing bc problems.
So happy to hear that you are having an uneventful post-op period. All over except a little more waiting which we all know isn't easy. Don't forget that side effects aren't a problem for everyone so you may not have any severe effects if you do require the post-op therapies you mentioned. You must always weigh the benefits against any side effects that you might experience so don't make any quick decisions. Take care....
It's good to hear your surgery was relatively easy and you're recovering well. I'm glad the excision was small, too. We'll all be hoping for the best with the final path report.
I continue to wish you well,
I just found out the results of my biopsy, and the news is not good. I have dcis and invasive ductal cancer. My doctor said the tumor was very small .4 cm and that is good news. I will need to have another surgery because the margins were not clean, and although my dr said there is less than a 1% chance that it is my lymph nodes, I need to have a sentinel node biopsy. My exact biopsy report says infiltrating ductal carcinoma, well differentiated, 0.4 cm. Associated major component of ductal carcinoma in situ, low to intermediate grade with focal luminal necrosis, papillary/micropapillary and solid/cribform type. 1cm. Invasive and in situ carcinoma is present at the medial-posyerior margin. Dcis is also present within 5 mm of anterior margin. If anyone has had similar results please tell me about it. I am worried about this second surgery Will they get clean margins this time? Will my breast look ok after this surgery. Please let me know, I really can use support. Thank you.
I am sorry to hear that your pathology report returned worse news than was expected following your biopsy.
Unfortunately this is fairly common, since a needle biopsy only obtains a tiny sample and although a core biopsy produces larger samples, neither can fully represent an entire area. (This is why an excisional biopsy/lumpectomy is so important.)
It is good news though that your IDC is quite small and that the cells appereed well-differentiated. Usually a second surgery is able to obtain clear margins unless the malignant area extends into a difficult place to reach (such as close to the chest wall).
I hope all goes well the 2nd time around, including the sentinel node biopsy.
Does anyone know if the size of my tumor 0.4 cm is considered small. My doctor says it is but I am not trusting anything right now. It is well differentiated which is good news. associated ductal carcinoma in situ low to intermediate nuclear grade. Does anyone know what this means? I am very concerned about invasive and situ is present at the medial-posterior margin and dcis present within 5 mm of anterior margin. I would like to hear from others who has reexcision surgery. Did you have clean margins the second time. I would also like to hear from others who had a sentinel lymph node biopsy. Was it painful? Did you have much discomfort after the surgery? My doctor said that since the tumor is so small it probably did not spread to the lymph nodes. Does anyone know anything about the size of my tumor in relation to it spreading to lymph nodes? I can use all of the support i can get. I am feeling very overwhelmed, and I am sorry if this post seems too overwhelming.
We completely understand how overwhelming it is to get a dx of BC, so no need to apologize!
Yes, as I mentioned above, a 0.4 cm tumor is considered quite small as invasive tumors go. (In everyday measurements, it would be less than 1/4 of an inch.)
Cells are rated on a contiuum from normal to well-differentiated to moderately differentiated to poorly differentiated. The colser to normal cells are, the better. (Cells at the other end of the contiuum are likely to grow and spread more rapidly.)
There is generally more concern about spread to lymph nodes when the tumor is 1 cm or larger. However, spread to a lymph node is not always correlated with size. That's why the sentinel node biopsy is still needed.
I'm sorry to hear about your diagnosis also, and I know it's very upsetting, but please try not to panic. The goal now is to get clear margins and determine what additional treatment will be needed. It is indeed a very small tumor and it sounds like the odds of it being spread to the lymph nodes are very small also. Your surgeon should be able to tell you approximately what the breast will look like after the additional excision and also explain what the sentinel node biopsy will be like. I haven't had one so I can't share any experience with it. Please try to stay positive and take one step at a time. I'm sure it's hard, but you just need to do what you have to do to treat what sounds like a highly treatable cancer.
I'm sure we all hope all goes well with the second surgery and that there's no spread to the lymph nodes. I'm wishing you a good outcome when all is said and done, so please hang in there.
Hi Kate, it's pretty small, which is excellent! Anything under 1CM usually does not tend to spread, it's stage 1 which is the best stage to have. They usually do the sentinel node as a matter of routine but I'm betting it will be clear. Mine was clear, and my mothers was very aggressive cancer 7mm and hers was clear too. The smaller the size the better and yours is pretty small.
It'll be ok you will get through this and you'll be stronger for it. Cancer is a strange thing, it's scary as heck but once you have it or had it, after you get through the surgery you are stronger and really appreciate things much more.
I don't know as they would opt to treat you with chemo or radiation, if it's estrogen positive you might just be a on a medication that cuts the estrogen, I take lupron, my mother is on anastrazole, not sure if I spelled that right I'm pretty tired on the way to bed when I saw your post. hugss, tina
Hi butterfly2222, Again thank you so much for your support. My biggest fear is that it has spread to my lymph nodes. You mentioned that lymph node involvement is not always correlated to size? What else is it correlated to?
Hi tinabudde, Thank you so much for your support. I can use all of the support that I can get right now. I am scared about it spreading to lymph nodes and I am praying I won't need chemo. I am trying to think positive but it is difficult right now.
My doctor said that it is very unlikely that the idc has spread to my lymph nodes, but it is difficult for me to trust anything right now. My tumor size right now is 0.4cm, but since the idc is still in one of my margins the tumor size could in fact be larger. My doctor doesn't think that it will be found to be much larger after the re-excision. Does anyone know if this will be true? Doe anyone know if my doctor based her opinion of the liklihood that it has spread to lymph nodes, on the size of my tumor, on the grade which is a 1, on the fact that it is well differentiated? In other words what factors on a pathology report would determine the liklihood that the cancer has spread to lymph nodes?
The tumor size and Grade 1, well-differentiated cells in your case are in your favor regarding whether the lymph nodes are affected.
To answer your earlier question to me (a couple of posts back), other factors that can contribute to early spread are: the type of the BC (HER2 + and TNBC are generally more aggressive than hormone receptor positive, HER2- tumors); the Grade (3-Poorly differentiated, for example); and for lack of a better term, luck! (We recently had someone with an 8mm tumor that had spreasd to a lymph node, for example).
BTW, it was mentioned above that your BC is Stage I, but actually the Stage cannot be determined until the results of the sentinel node biopsy is back, and if indicated, other tests are conducted.
My pathology report does not say anything about hormone receptors. I asked my surgeon about this, and she said we will find out next time. Is it unusual that this pathology report does not say anything about it? The only thing I know about my type of cancer is that it is infiltrating ductal carcinoma along with dcis. Yes I am aware that my stage of cancer can't be determined yet, but so far based on size my doctor said it is stage 1. I realize that could change if the snb is positive.
The receptor tests are commonly done on the tissue/tumor obtained in the lumpectomy/excisional biopsy, but because they knew you were going to need additional surgery to obtain clear margins, they may have decided to wait.
It doesn't really matter at this point in your case. (I was just speaking in general terms, in answering your question about what factors can affect possibility of spread.)
Has your surgery been scheduled yet? I hope it's not too far off, because all the waiting tends to increase the worrying, as well as often making the person feel helpless and overwhelmed.
No, my surgery has not been scheduled yet. I am not all that pleased with my surgeon and I am looking for another doctor, and of course I want a second opinion. If anyone knows of a fabulous breast surgeon in the L. A. area please let me know. Thank you for your support butterfly.
The best way to find the best surgeons is by word of mouth. I strongly urge you to ask everyone you know who they would use or who they've heard is wonderful. I would then want to speak to those women personally to get the best info.
Dr. Alice Police or Dr. Colleen Coleman. Both work out of HOAG hospital. I've not used them but know of women from my FORCE website who highly recommend them. These women have a genetic mutation that raises their risk of BC tremendously and they used these surgeons to remove their breasts and had plastic surgeons do immediate reconstruction all at the same time. They reduced their odds of BC and also got the optimum outcome from reconstruction doing it at the time of bilateral mastectomies.
Good luck with any choices you make moving forward.
I feel much better psychologicaly today. I went to a great medical oncologist. Dr. Johnathan Goldman, a Harvard graduate who is warm, wonderful and caring. He is in Santa Monica, Ca. He recommended a very good surgical oncologist, Dr. Gregory Senofsky, who I am going to on Monday. I am hoping to get my re-excision surgery and snb asap.
I have a few more questions. Has anyone had the 5 day radiation? I think it is called mammosite. If so, was the balloon put in at the time of the surgery? Is it painful? Does anyone know the side effects as opposed to 6 weeks of radiation? Does medicare cover it? Also what are the benefits of having an mri before re-excision surgery? Will it help in getting clean margins? My final question is today my Dr. told me that I am er and pr positive and her negative is this good or bad? Thanking you all for bearing with me.
Sorry I only had time for a rushed answer last night, but I figured it was better than NO answer...
A few things to keep in mind about MammoSite: It is more expensive than standard radiation treatments; it can only be used in certain cases (unifocal invasive tumors of certain types, below a certain size, when there is no lymph node involvement); and although it is growing in popularity, there is not yet conclusive research to prove it is equally as effective as standard, full-breast radiation.
Here is information based on a Dec 2010 report in the Journal of Clinical Oncology:
A new radiation treatment for breast cancer is becoming increasingly popular despite lack of good evidence, at least among well-insured Medicare patients, U.S. researchers say.
According to claims data, use of the therapy, which irradiates only a portion of the breast instead of standard whole-breast radiation after lumpectomy, climbed more than 10-fold for those patients between 2001 and 2006.
While gold-standard clinical trials of the newer treatment are still missing, two other events did coincide with steep increases in its use: approval of a device used to deliver the radiation in 2002 and Medicare reimbursement in 2004.
"It brings to the front the issue of when we should enact a new technology," said Dr. David J. Sher, an expert in radiation treatment, who was not involved in the new study. "What the paper shows it that it really is done in the absence of evidence."
The National Cancer Institute says that more than 200,000 American women will get breast cancer in 2010 and about a fifth will die from the disease.
After lumpectomy, up to 40 percent of women see the cancer return, but that number can be reduced to about 10 percent with external-beam radiation of the whole breast. Common side effects are swelling and redness.
In contrast to whole-breast radiation, which usually takes several weeks to complete, the new partial-breast treatment lasts less than one week.
One example of the so-called brachytherapy approach is MammoSite, a device marketed by Massachusetts-based Hologic, and used on more than 50,000 women so far, according to the company.
It consists of a small balloon, which is inflated in the cavity left behind after the tumor is removed. The balloon then delivers high-dose radiation to the parts of the breast most likely to develop new cancers.
Although the idea is promising, Sher said, there aren't any large studies that have compared whole-breast radiation to this treatment. He said one such study was ongoing, but in the meantime, both efficacy and side effects were up in the air.
The new findings, published in the Journal of Clinical Oncology, are based on data for nearly 7,000 older women who had radiation treatment after having a breast tumor removed. All had private health insurance in addition to Medicare.
Ya-Chen T. Shih of the University of Texas MD Anderson Cancer Center and her colleagues found that from 2001 to 2006, the use of partial-breast radiation alone after breast surgery rose steadily from less than one percent of cases to 10 percent, at the expense of whole breast radiation.
It appeared that wealthier women were more likely to get the new treatment, the researchers found, and it is unclear if the results extend to other women.
In an earlier study comparing the cost-effectiveness of different radiation treatments, Sher found MammoSite was unlikely to be cost-effective compared to whole-breast radiation. "MammoSite is significantly more expensive," he said.
According to Shih, whole-breast radiation therapy costs about $13,000 and breast brachytherapy about $23,400.
Until more evidence becomes available, Sher said, "women should know that the standard of care in managing (cancer of the) breasts is whole-breast radiation."
"There are tens of thousands of women who have been treated with whole-breast radiation and they have done very well," he added.
Ladies, I had a biopsy this week for microcalcifications in left breast. I had endometrial cancer 4 years ago so I'm hoping my results will be benign. I'm wondering if anyone has experienced fatigue prior to BC diagnosis, as that's my only complaint for the past few months. I don''t have energy anymore and I'm an active person.
Appreciate any input......thanks. I get my biopsy results in 5 days.....
A suggestion: You will be more likely to get replies if you start your own thread by posting a new question. People tend to overlook a question tacked on to the end of an old thread, because they assume it's just an additional reply to the original poster.
Hi, Yes, I too have experienced fatigue prior to my bc diagnosis. I will pray that your biopsy result is benign. I know how worrysome the waiting period is to get the pathology report, so take good care of yourself. Hugs!
I am concerned about hrt. I won't be able to take aromatasin because of my bone density test and the side effect of bone loss. I won't be able to take tamoxifen because of the side effect of hair thinning. I once had the hair condition telegon effluvium which causes the hair to thin. It is cured now and I do not want to go through that again. It looks like the only hormone replacement therapy I will be able to take is Evista. Is anyone taking it and what are your side effects like?
First of all, a clarification: The drugs you referred to have nothing to do with "HRT." HRT stands for hormone replacement therapy, and consists of estrogens and progestins, either alone or in combination. They are most commonly given to treat symptoms associated with natural or surgical menopause. They are usually contraindicated for women who have had BC.
The medications prescribed for women with hormone receptor positive BC, such as tamoxifen and the AIs, are instead intended to REDUCE the estrogen that can otherwise fuel ER+/PR+ cancer. They are referred to as anti-estrogen therapies or hormone-suppression treatment. They have been shown to reduce the risk of recurrence.
Evista is not a breast cancer treatment drug, but it can be used to help prevent cases of invasive estrogen-receptor positive breast cancer. It does not reduce your risk of recurrence for invasive breast cancer.
Here is a link to a discussion of Evista, including possible side effects:
Before you reject any of these drugs out of hand, please keep in mind that with them, as with any medications, everyone reacts differently, and not everyone experiences all of the listed possible side effects. Often the only way you will know if you can tolerate a particular drug is to try it (unless you have a health history that would make it pose a serious risk).
In some cases, there are ways of managing side effects. For example, to counteract the bone loss, bisphosphonates or alternative drugs used to treat osteoporosis are sometimes prescribed, and/or natural alternatives to reduce bone loss can be implemented.
No one, of course, is happy if a drug makes her hair thin, but on the other hand, hundreds of thousands of women still choose to undergo chemotherapy, which in many, if not most, cases will cause them to lose all of their hair, because it may save their lives...
I am wondering how badly I will feel during and after radiation treatments. I heard that my skin won't feel good and that I will feel exhausted. Are there other side effects? Usually I have a high threshold for pain. How exhausted will I feel? Well I have trouble doing my chores? Will I feel the exhaustion immediately when starting? How long does it take for the side effects to go away? Will they stop with the last treatment?
As with medications, reactions to radiation vary from one person to another.
Tiredness can be a side effect, but many of our members have continued to work during their radiation therapy. (Had an early tx each day, then went on to work.)
The skin can feel "sunburned" but there are lotions than can be applied after each tx (but NOT before!) and some good prescribed topical medications are available if there is a more severe reaction such as blistering . I'm sure the radiologist's office will have handouts with all of the instructions and suggestions that will help you get through this.
We've had lots of posts in the past by members who have had radiation, helping others to know what to expect, so if you put "radiation side effects" or something like that in the "search this community " box at the top of this thread, to the right, I bet you'll find a list of many past threads on that subject.
A suggestion: Try to taking things one step at a time, if you are feeling overwhelmed by considering all that you are, or might be, facing.
I went to see a great breast oncologist surgeon and a great radiology oncologist today. My surgeon scheduled an mri for Wednesday, and I have another appointment with him on Wednesday to get those results. . I am having re-excision surgery and a snb on Monday Aug. 1. My radiology oncologist said assuming we don't find anything else I will have 4 weeks of radiation. So 20 sessions all together. I asked my radiology oncologist if he thinks I need ht, and he said assuming nothing else is found that I don't need it. I would still need to get clearance from my medical oncologist. I feel better emotionally after seeing both doctors.
Does anyone know why my radiology oncologist would have decided on 4 weeks of radiation for me and not 6 weeks? It will actually be 3 weeks and a week of boosts for a total of 20 sessions. Besides seeing my radiology oncologist today I also saw my surgeon, and I was more focused on asking him questions. I forgot to ask my radiology oncologist why 4 weeks and not 6. Of course, I will be seeing him again before the treatments begin, so I can ask him then. I was just wondering if someone on here knew why or if they had 4 weeks instead of 6.
To answer your questions:
I've had several breast MRIs and can tell you they're not bad, but that can vary from individual to individual. An IV contrast is used, so they'll put in a small needle and tube that locks off into your vein (no IV bag of fluid---it's called a Heplock). About halfway through the MRI they flush it with saline to be sure it's still in the vein and open, then attach the contrast syringe and inject it. Also, there's no such thing as a right or left breast MRI, they always do both. That's because you'll lie on your stomach on a special table with your breasts hanging down between two holes. I've never had sterotatic , but I think it's similar to that. They give you earplugs and you're slid into the machine feet first. There's no pain, but there can be discomfort related to positioning. I first had my arms stretched straight out in front of me and because of shoulder problems, I did have a pretty painful shoulder during the MRI. You can't move at all and the test can take 45 mins or so, so by the end of it, I was very uncomfortable. At other MRIs, the techs positioned my arms differently and it was much better. Another issue is claustrophobia, which can be controlled with mild sedation (Valium for example) if you have someone to drive you there and back. Nausea from the IV contrast usually isn't a problem for most women, but it was for me. I resolved that by getting the earliest morning appointment and not eating at all before the MRI. They require you not eat or drink two hours before, but I found if I had eaten and had a later appointment, I'd get nauseous. The biggest problem with that is that I was breathing deeply to avoid puking, and that caused motion on the films---I had to repeat the whole test, and I wasn't happy about that. Overall, it's a relatively easy procedure and if there happens to be any issues, they can easily be resolved. You should talk with your doctor ahead of time regarding any questions or concerns you might have.
I've never had a drain with any of my excisional biopsies. As far as I know, it isn't necessary with a lumpectomy but this is something to definitely ask your surgeon.
I don't know about the radiation---maybe someone else has some information. Again, you need to talk with your radiology oncologist.
You'll need to contact your insurance company regarding a lift to the other breast. It may be covered as "reconstruction" related to BC, but they can answer that for you. With my three excisional biopsies there was never any lift done.
Hope this is helpful. Good luck with your surgery and snb. I'm hoping for the best.
There are laws/regulations that govern insurance coverage for women who need breast repair, reconstruction, etc., r/t BC. Since your surgeon is the one who proposed the lift of your other breast, I'd check with his office about the insurance coverage. I imagine they'll have to get it pre-authorized.
A surgical drain is a small tube put in at the time of surgery to drain off fluid that would otherwise accumulate in the cavity created by the surgery, causing pressure and swelling. The drainage is measured each day until it slows to a low level, then it is "pulled" leaving only a small hole that closes over and is hardly noticeable. (The drain is a good thing to have--just read some of the past posts by people whose surgeons didn't use one, and they had to repeartedly have fluild aspirated by a needle!)
Radiation oncologists use their expertise to decide exactly what treatment plan to prescribe for each patient. Apparently 20 txs are what he decided was best for your particular case. You could ask him how he reached that #, or just trust his professional judgment.
Hi ncmichigan, I won't take sedation for the mri, because I hate side effects from medication. You do have me worried about nausea. They said nothing to me about not having anything to eat or drink 2 hours before. They told me to drink a lot of water the day before. My mri is scheduled for 10 am. I am going to call them when they open at 7:30 am to discuss nausea. Just like when you have anesthesia for surgery maybe they can add something to the iv to make sure you don't have nausea. Thank you for letting me know.
I had more bad news today, and I am worried sick. I had the mri, which wasn't problematic except for nor being able to move for 30 minutes. I had an appointment with my surgeon to discuss the results of my mri, He told me there was a problem area in a different spot in my breast. He had me take additional mammograms and an additional ultrasound. The radiologist told me that they didn't find anything, but this shadow on my mri could be dcis or it could be a vein. He said it would have to be closely monitored, and I would need another mri in 6 months. I am scheduled for my re-excision which my surgeon is now calling a larger lumpectomy, and a snb on Monday. I was so panicked that I couldn't remember whet the radiologist told me my options are. I think he suggested a mastectomy now or closely watch this suspicious area on the mri. Have you heard of this? A shadow that comes up on the mri, but mammograms and ultrasounds show nothing?
I'm also sorry to hear about your additional concerns, Kate, but panic doesn't help or change the situation. Take a deep breath, then try to follow bb's excellent suggestion back on July 23rd. Get your questions together and then follow up with both your surgeon and your radiologist on what's recommended. I've had things show up on MRI that weren't on mammo or US because MRI is more sensitive for certain things especially in women with dense breasts like bb said. According to the information below from the web site www.uptodate.com, DCIS is NOT one of them. Mammo & US are much better at detecting DCIS than MRI, so it could very well be a vein.
I have several 4mm. or less areas of enhancement, along with a 6mm. lesion in the left and and a 5mm. probable lymph node in the right that the MRI radiologists have been watching every six months since Feb. '10. I have no doubt that if these were anything suspicious, the radiologist would recommend biopsy. It's always difficult "watching & waiting" but we do what we have to do. You said you have great doctors, so put your trust in them and address all your questions to them then follow their recommendations. They know your individual medical issues much better than any of us here and will cater your treatment to you as an individual.
In addition to bb's good information, I found this:
"Breast MRI — Magnetic resonance imaging (MRI) uses a strong magnet to create a detailed image of a part of the body. It does not use x-rays or radiation, but does require injection of a contrast agent into a vein. Breast MRI may be recommended to aid in the diagnosis of breast cancer in selected situations. MRI is not recommended to detect breast cancer in most women because it is not as good as a mammogram for certain breast conditions, such as ductal carcinoma in situ (a type of noninvasive or early breast cancer). In addition MRI testing is more likely to identify suspicious findings that turn out not to be cancer (false positives). "
God bless both of you. You two always make me feel better. Yes my surgeon and the radiologist consulted. We all decided that the best course of action is the re-excisional surgery and sentinel node biopsy and then another breast mri in 6 months to monitor that shadow problem. Hearing that the shadow is usually not dcis and about false positives has made me feel better. I am sorry to panic after hearing bad news. Thank God I am not stage 3 or 4, but in other life situations I have had my share. Well sure enough I have another worry tonight. The surgeon who did my lumpectomy said on re-excision she was going to just take a small amount of tissue and my breast would look fine. She doesn't have as much experience as my new surgeon and she never even ordered a breast mri. My new surgeon said instead of calling it re-excision that he is going to do a wide lumpectomy and my breast will look considerably smaller. I am small to begin with so the appearance of my breast is of concern to me. He said if I am unhappy with the appearance he would get a plastic surgeon for me to fix things up. I told him about limited insurance and he said no problem he will get a plastic surgeon who is a colleague to do it with the insurance I have. I am sacared about the appearance of my breast, even though my tumor is 4mm I am concerned it spread to lymph nodes, even though doctor said it is a remote possibility, and I am scared margins won't be cleared this time, although that is what my new surgeon specializes in. My surgery is Monday I should get the path report on Thursday and the 3 day waiting period will be hell. Nc and butterfly thank you for your continued support I can't begin to tell you how much it helps me, and how much I appreciate it. Lots of hugs to both of you!!!!
No need to apologize for "panicking," cancer is a very scary disease!
The important thing right now is to try to get ALL of the cancer; appearance is important, too, but can be dealt with later, as your surgeon pointed out.
You mentioned "having had your share in other life situations." This leads me to believe you are stronger than you think.
Courage does not mean NOT being afraid, it means taking your fear, rolling it up in a lttle ball, putting it in your pocket, and doing what has to be done.
My impression of you so far is that, yes, you get very anxious about certain things, but then you go ahead and deal with them. Look at all you've coped with and gotten accomplished in the less than 2 months since you got the pathology report from your biopsy that launched you on your breast cancer journey!
Your impression of me is correct. I do tend to panic about certain things, but then I do what needs to be done. Normally I am resilient, but cancer has thrown me for a loop. Your post has made me feel comfort from a friend, and thank you so very much for it.
While all of this is VERY scary, please use your energy to try to remain strong and positive and work at beating this disease. If you've made it through other life challenges, as we all have, you have to believe you'll make it through this one, too. It is what it is, and you just have to deal with it one step at a time. We wish you all the best with your surgery and we're hoping for a good report at the end of it. Hopefully, continued monitoring will show the shadow to be just that.
Sending you a hug ( ),
I had my wide lumpectomy, re-excision and snb yesterday. I am feeling ok, just a little bit of discomfort. I won't get the pathology report back until Wednesday or Thursday, but I have two pieces of good news. My surgeon did a preliminary test for lymph nodes, and he said mine were negative, Thank God. He also told me that he talked to the head of my hospital's radiology department, and he said the head of the department said it probably is nothing. I didn't get to discuss this further with him, because he told me this right before surgery. I have anxiety waiting for the pathology report, but I am going to stay positive thinking about the good news I have received so far. I will update again when I get the pathology report.
Thank you again for your support. I will post again when I get my path report. I am a little sore now under my arm, but I guess that is to be expected. I am also feeling some slight nerve shocks in my breast area too, but I guess that is to be expected also.I hate to take pain meds, but my doctor forced me to take a pain med in recovery yesterday, because my blood pressure skyrocketed to 190. He said it was so high, because of the pain. Today with the discomfort I have I am not taking any pain meds, and I hope that is ok for my blood pressure.
It's good to hear the surgery went well and the snb was negative. It's good to hear that the MRI shadow isn't something to worry about, also. I'm sure they'll keep a close watch on that area. The pain you're experiencing sounds normal following your surgery. I'm a retired nurse and even if you hate pain meds, I'd definitely recommend you take them as prescribed, at least for a day or two. You can cut back a little if they knock you out too much, but if the pain isn't relieved you really need to take the dose prescribed. It will help the blood pressure for sure. Also, the only way your doctor will know if the pain is normal or not is if it's NOT relieved with the usual pain meds. If it's not, then you need to follow up with the surgeon to determine why not.
I'm hoping for a good path report and speedy recovery.
Hi nc and butterfly, I thank you both so much for your intelligent advice, and I have great news to tell you. I just came home from an appointment with my surgeon, My nodes are definitely clear, my margins are clear, and I am a stage 1. Thank God. I can't thank you both enough for your support. I will need to do radiation and possibly hormonal therapy, but I feel so blessed to just be stage one.
Thank you so much. Your support has meant everything to me. While I was totally consumed with fear, you told me to be positive, and with your help I tried. I can't thank you enough, and I wish you the best that life has to offer. In my hour of darkness you and ncmichigan were there to ease my fears. Thank you!!!
I am considering to refuse to do hormonal therapy. My medical oncologist wants me to do it. My radiation oncologist said it is not necessary in my case. I know that I am er and pr positive. What I don't know is the percentage of how positive I am. Would the percentage make a difference in me requiring ht? I checked nccn and it said with a tumor less than .05 cm., grade 1, and no lymph node involvement I might not require it. Also, after 2 lumpectomy's I will require plastic surgery. Do you know if fat grafting or an augmentation with implants would be best?
First of all, let me say how happy I am to hear your good news about your path report! I know you must be really relieved and I'm happy that bb and I were able to provide you support---that's what we're here for.
I'm not sure, but it sounds like you're refusing anti-hormonal therapy because one doctor says you don't need it. Are there other reasons for refusing? If not, what does your breast surgeon suggest? If two out of three docs recommend it, I'd certainly consider it. I know
there are side effects to consider, but some women have very little if any side effects. it seems to me that it's at least worth a try if it means preventing a recurrence of your DCIS.
If the side effects are severe you could always stop, but it would certainly be worth a try at least. You might want to consider a second opinion on it from another radiation oncologist and make a decision based on all the opinion.
I just read something today on WebMD re: fat injections after breast cancer.I tried to copy the we site info here but couldn't. Here's the article title and if you type it in at WebMD, I'm sure it'll come up:Fat Injections: Safe for Breast Reconstruction After Cancer?
Study Suggests Technique Known as 'Lipofilling' Has Low Complication Rate
It sounds like it's relatively new and mostly done in Europe. I'd discuss it with your plastic surgeon to see if it's even available and an option for you. If not, I I would think he/she would be your best source for all possible options and the pros and cons of each. From what I have read here, the cosmetic results are much better with your own fat/tissue, but it isn't always possible for all women. If it were me, I'd research it and check it all out and then go with the recommended option that has the best possible results with the least risk of complications. Just carefully review it all before deciding which direction to take. Sue Young has some great info on reconstruction and I hope she'll also fill you in on it.
Of course I wish you all the best in making your decision and hope it all works out for you.
You bring up a good point regarding ht could possibly prevent a recurrence of dcis. I need to find out if my medical ocologist was basing his decision on my idc tumor or if he was basing it on my dcis. I am going to see my surgeon tomorrow, and get his opinion of whether he thinks I require ht. You mentioned that some women have little or no side effects. My doctor said that armidex or femora have less side effects than tamoxifen. Do you know which of the two armidex or femora has the least side effects?
Thank you so much for the info regarding breast reconstruction. I will study it. Also, when I see my surgeon tomorrow I will see what he recommends and which plastic surgeon he recommends. You and butterfly have been a blessing for me. In my hour of darkness you were both there to help, and I can't thank you enough!
From what I've read tamoxifen is used more often to prevent recurrence of DCIS and the AIs (aromatase inhibitors) are used more often for preventing recurrence of IDC. You'd have to ask your doctor's if one or the other is best for both. However, I did read that Arimidex seemed to do slightly better at prevention than Femara but Femara had fewer side effects. There's also Aromacin, but I'm not sure if that's another option for you. Did any of your doctors mention the Oncotype DX test? It's supposed to give them an idea of what your risk of recurrence might be. I know it's helpful in determining if chemo is necessary or not, but I'm not sure if it's helpful in determining which drug is best. It may be something to ask your doctors about at least. I hope this is helpful to you and doesn't just confuse the issue even more.
I'm sure you'll find a good plastic surgeon and good luck with that part of your treatment.
My doctor has mentioned starting with Femara. I am taking a bone density test today to see if osteoporosis is a problem. The side effect I am concerned about is hair loss or hair thinning. Di you know women who have experienced that as a side effect from taking ht? The reason I am concerned is that I once had Telogen Effluvium and it causes hair thinning, and I don't want to go through that again. My doctor's did not mention the onco DX test. They probably did not mention it, because they said that I do not require chemo. I will ask my medical oncologist about it. I am going to see a plastic surgeon today, and I am looking forward to getting started with that part of my treatment. As always you have been very helpful. Thank You
After all that I have been through I am finally going to get a prize. I went to see a plastic surgeon today, and 1 month after my radiation is completed I am going to have implants for both breast and breast lifts. I start radiation next week. Again thanks so much for your support!
I 'm glad to hear you've found something positive in your situation, and like bb, I wish you all the best. I hope the radiation goes smoothly and the reconstruction does, too, so at least something good will come out of this long journey.
In an old thread, Sue Young55 made these comments: "There is no reason to go around with burns like that. Ask your doctor to prescribe Silver Sulfadiazine. The very minute your radiation is complete each day, apply it liberally to your burns. Slather it on!! But, before you go for your radiation the next day, make sure you are crystal clean and have no residue on you. It works like a dream! Remember to keep applying it until the burning stops in a week or so after radiation, or maybe sooner."
zouzi shared this information: "Healingwell advised me to apply Aloe Vera after each session. My oncologist didn't like that very much and would tell you not to apply anything! But I did. I made sure that before each session, that I showered and made sure that the breast was completely clean. The markings don't disappear and if they fade, the nurses keep remarking again. After my 15th session my skin started to suntan and become a little itchy, but the Aloe Vera and later Aveeno baby cream helped a great deal! My sister, on the other hand, had burns on her skin because she had 36 sessions, and never used any cream at all."
You should, of course, run any of this you might want to try by your radiation oncologist.
Other members have recommended: Biafine (which may also be too expensive), Vigilon (a patch to put on an area where a burn is starting to appear, also expensive), Oat Beta Glucan ("ordered by CVS pharmacist, about $50 per tube, but well worth it"), Radioplex (a prescription gel) and My Girls' Radiation Cream ("all natural ingredients")--no cost info on the latter two.
I hope you enjoyed your vacation. Thank you for the link to the article regarding fat transfer. I had my 4th radiation treatment yesterday. Yesterday I noticed that my skin is starting to look darker. I am going to have 11 more regular treatments, and one week of boosts. Yesterday my RO ld me that the average person gets 1.8 radiation, and I am having 2.8. So I am getting a stronger dose of radiation in less days. I sked him how this would affect side effects, and he said I will do better. I am very concerned, because my skin is starting to look darker after only 4 treatments. Which creams for radiation do you think are best?
I believe the darkening is normal, kind of like a suntan.
Blisters or burns are also common, but more painful, so some kind of radiation cream or gel is recommended. I haven't had any personal experience, so I can't say what might be best. The radiation oncology nurses/techs probably get the most feedback from pts, so you might ask them.
Glad you've gotten started, because you are that much closer to finishing! :-)
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