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Pathology report-approaching dcis

Hi,

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?
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25201 tn?1255580836
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 ....
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Avatar universal
Hi,

After researching this a little I found out that the next step would be excisional biopsy, and that a lumpectompy and radiation is not always required. Has anyone had these findings?
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1686908 tn?1307193790
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.
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25201 tn?1255580836
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 .....
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Avatar universal
I am so happy for you kate. This is great news. I've had 1 patient with this diagnosis and she went for lumpectomy and tamoxifen, she was ER positive.
Mary
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Avatar universal
Hi, Kate,
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.
nc
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Avatar universal
Hi,
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.
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Avatar universal
Hi,

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.
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Avatar universal
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.
Hugs,
nc
PS:Marybai, I'm still hoping for benign results for you!
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Avatar universal
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,
Mary
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Avatar universal
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.
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Avatar universal
Hi, Kate,
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,
nc
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Avatar universal
Hi, Mary,
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.
Hugs,
nc



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Avatar universal
Hi,

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.
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Avatar universal
Hi, Kate,
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,
nc
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Avatar universal
Hi,

Are you saying to avoid hrt (meaning hormone replacement therapy)?
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Avatar universal
Hi, Kate,
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.
Take care,
nc
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Avatar universal
Hi,

Thank you for letting me know.
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Avatar universal
Hi,

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?
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25201 tn?1255580836
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.......
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Avatar universal
Hi,

Thank you so much for letting me know.
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Avatar universal
Hi, Kate,
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,
nc
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Avatar universal
Hi Nc,

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.

Hugs
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Avatar universal
Hi, Kate,
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.
nc
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