What should I expect in the future, prognosis-wise?

[esri12]

First of all, I think your forum is one of the best!!
These are the results of my excisional biopsy for a complex shadow that showed only on ultrasound (it is in the 12 o'clock area on the right breast, where I usually have a lot of cysts) ---Fibrocystic changes with fibrosis
-Micropapillary apocrine metaplasia, microcysts
-Duct ectasia
-Fibroadenoma-like lesions
-Focal sclerosis adenosis
-Scattered foci of usual ductal hyperplasia
-A focus of atypical lobular hyperplasia
-Rare focus of epithelial-associated microcalcification
-Negative for atypical duct epithelial hyperplasia or cancer

I am 45 years old and have a history of 3 biopsies for fibroadenomas and I have a lot of cysts and microcalcifications ( not in clusters or suspicious) and both my breasts have extensive heterogeneous dense fibroglandular tissue (by mammography).
I am really concerned about the atypical lobular hyperplasia.
My breast surgeon thinks atypical lobular hyperplasia is not pre- cancer but another surgeon I know from my country told me otherwise, and advised me on taking tamoxifen ( I still menstruate) and having regular whole tissue bilateral ultrasounds and not just in specific areas.
I decided to go to an oncologist who recommended a bilateral breast MRI (the results were negative) and I also underwent genetic testing (I am Jewish Ashkenasi) but I don't know the results, yet.
Should I have prophylactic removal of my breasts?
Is Tamoxifen more dangerous than helpful for me?
Sorry for the lenghty post and thank you in advance!!

[dld0604]

Hello.  I have recently went for a mammogram which showed an area of concern. I went for a biopsy which showed infilrating ductal carcinoma with non-comedo DCIS.  I underwent a lumpectomy with sentinel node biopsy.  My pathology was infiltrating ductal carcinoma, low grade with tubular features, lymph nodes were negative on frozen section, however I have atypical lobular hyperplasia.  Onc states that I have a high increase risk of developing a new tumor in either breast because of ALH.  I will begin tamoxifen after radiation therapy.  Does ALH increase the risk of a new recurrence of a new tumor, particularly after a diagnosis of cancer?

[surgeon]

None of the conditions you listed is agreed to be pre-cancerous. There is absolutely no indictation for either taking tamoxifen or for having prophylactic mastectomy. Of the various things mentioned, the atypical lobular hyperplasia is of some interest, but only because of the condition known as lobular carcinoma-in-situ. This is called "carcinoma" but in fact is felt by many only to be a marker for risk of cancer, and is often treated only by careful continued followup. Atypical hyperplasia is much less "severe" than that. So, whereas you indicate it frightens you -- which is very understandable, given the many consistent and inconsistent terminologies out there -- the fact is that it, at worst, is a marker for risk of getting something which is a marker for getting something else. And not everyone agrees it's a significant finding at all. So, where you are is where you were: a woman who ought to have regular screening, which to most experts would mean self-exam, professsional exams, and mammograms -- not MRI or ultrasound, unless specifically indicated.

[CCF-RN,MSN-rf]

Dear esril2:  First of all, atypical lobular hyperplasia does not turn into cancer. In technical terms it is not a "precurser lesion." Atypical lobular hyperplasia is considered to be a risk factor for developing cancer.  This information should be combined with your history (and risk factors) so a real determination can be made of your risk.  Then, recommendations can be made as to whether regular monitoring is appropriate or whether something more aggressive might be recommended.  Based on what you have said, bilateral mastectomy is probably not necessary or recommended.  Unless, you have other risk factors, tamoxifen may be too aggressive as well.  You should see a genetic counselor if you are concerned.  These are the folks best equipped to make recommendations based on risk.