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pathology report
Hello, I received the path report from the stereotactic biopsy on my right breast, it reads: fibrocystic changes and intraductal hyperplasia with focal atypia.  Focal microcalcification.  Negative for malignancy in the available speciman.  The surgeon recommends another biopsy in 6 months.  My sister is a 10 yr b/c survivor (bi lat mass), grandmother on my mother's side b/c in her late 50s past away shortly after diagnosis in the late 1960s.  I have very dense breasts and 45 years old.  Many things I have read on the internet state an excisional biopsy is normally the next step.  I wondering why my surgeon would suggest a more conservative approach and where should I go for a second opinion?  an oncologist?  Thank you for any input.
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It's still somewhat controversial, but the vast majority of breast surgeons will surgically excise anything that comes back from a core biopsy with the word atypia in the pathology report (with the exception of 'radiation atypia' and 'columnar atypia').  The numbers of those lesions that actually get upgraded to cancers at surgical biopsy is relatively small (around 10%--probably much less for 'focal atypia') but most people agree it's not negligible.  Get the second opinion from a dedicated breast surgical oncologist at a university hospital who may be more likely to be aggressive than a general surgeon.  With your family history and mammographically dense breasts, I would persist until I found someone to do the surgical biopsy--or at least give you a good science based reason for not doing it in your particular case.
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