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Radial Scar - Observe or Take Out?

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I'm recently diagnosed with a benign radial scar. First seen on a screening mammogram as an area of "focal distortion." Called back for diagnostic mammogram and ultrasound. It persisted on the diagnostic mammogram as architectural distortion and a 0.7cm irregular mass was found on the ultrasound. The radiologist came in and told me I needed to get a biopsy ASAP and told me there was a 40-60% chance it was cancer. He said I was BI-RADS 4b. He said the only other thing it might be was a radial scar. Had a stereotactic core needle biopsy a week later. Results came back as: "fibrocystic changes to include columnar cell change, usual ductal hyperplasia, apocrine metaplasia, microcysts and a microscopic focus showing radial scar like features. There is no obvious evidence of atypia or malignancy. However, because of the presence of a radial scar and some architectural distortion demonstrated on the mammogram, evaluation by a breast surgeon with possible excisional biopsy is suggested." Radiologist who did the biopsy seemed to lean towards excision when he called to give me the results. Gyno referred me to a breast surgeon and said she'd like me to have it out soon. Met with the breast surgeon yesterday. She took her time to explain everything to me and told me that there is a very low chance that the radial scar could be cancer (3-5%). She said they used to take out all radial scars, but newer data says it's not always necessary. She seemed more concerned with my extremely dense tissue and other risk factors. She labeled me as high risk (TC score 23.3%) and recommended mammo and MRI in 6 months. She told me I could wait and see if there are any changes at 6 months or she would schedule the lumpectomy now. Left it completely up to me. She went over the lumpectomy procedure and it seems like it wouldn't be too bad. Scar will be small and hidden. She wouldn't have to take out much tissue, so no changes to breast shape. I'm leaning towards just getting it out. Any thoughts or similar experiences? I'd love to hear your advice.

Comments

  • maggie15
    maggie15 Member Posts: 1,000
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    Hi @chiamaria , There is controversy about how to treat radial scars which are an uncommon finding. Up until about 5 years ago surveillance was recommended but more recently an excisional biopsy (small lumpectomy) is often done to get a larger tissue sample. While radial scars are benign they grow in an environment that is favorable for cancer cells. Also, they can hide a tumor from imaging. From the published information there are malignant cells in the area anywhere from 10 - 40% of the time.

    I was called back for architectural distortion on a mammogram (most likely a radial scar) and had a couple of additional BIRADS 2 mammograms until suspicious calcifications showed up two and a half years later. I ended out having a 3.2 cm invasive tumor adjacent to the chest wall removed. There were numerous radial scars in the margins which is why it never showed on mammograms according to my breast surgeon. Had it been removed earlier it probably would have been DCIS (stage 0).

    There is a good chance that nothing concerning will be found but given my experience I would recommend the small lumpectomy now. All the best!

  • chiamaria
    chiamaria Member Posts: 5
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    Thanks @maggie15. Stories like yours are why I've been leaning towards just getting it out now rather than watching and waiting. I hope that you are doing ok now.

  • ichan
    ichan Member Posts: 39
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    @chiamaria what you explained is exactly my story. You can see my previous posts. The only difference is my breast surgeon recommended lumpectomy to remove it and she was right. They found a small 5.5mm of invasive ductal carcinoma grade 1 along the margins of the radial scar when they sent the tissue for pathology after lumpectomy.

    Both MRI and biopsy done before lumpectomy came back as benign. But after lumpectomy they found IDC. My world is upside down since then. I am going through radiation right now and will be on tamoxifen for 5 - 10 years. Please do your own research and do what feels right for you.

  • chiamaria
    chiamaria Member Posts: 5
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    Thanks @ichan. My gut has been telling me I need to err on the side of caution. I went ahead and scheduled my lumpectomy today. I'm scheduled for early January. Just want to get it out and know for sure. Hoping all will be clear. I'm young (47), healthy, and can heal easily from a minor surgery. No reason to take the risk and wait, especially considering my high lifetime risk. I read your posts and I'm so sorry for what you're going through. I hope your radiation treatments go well. Any tips you can give to prepare for the lumpectomy?

  • ichan
    ichan Member Posts: 39
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    @chiamaria my experience with lumpectomy was very smooth. There was minimal pain and I was able to manage with Tylenol. Anesthesia made me little nauseous. I took just two days off from work as mine is a desk job. The incision healed pretty fast and the margins were clear. But since my pathology came back with IDC I had to go for another surgery called sentinel lymph node biopsy to make sure my nodes are clear. They came back as clear. I am 49 so i had to go through 6 weeks of radiation to avoid recurrence in that breast.
    Yes my radiation treatments are almost done. In the final week of 6 weeks now. I am holding on for now. Thank you very much for asking.

  • moderators
    moderators Posts: 8,196
    edited November 2023
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    Hello, @chiamaria, and a warm welcome to you!

    We know that making these types of decisions can be really challenging, but it appears you've already taken steps in the right direction. Besides the helpful experiences and advice from ichan and maggie15, here are some articles from our main site and discussions that we thought you would find helpful:

    Hope this helps! Feel free to explore and let us know if you have any questions or if there's anything else we can do to support you.

    Sincerely,

    The Mods

  • chiamaria
    chiamaria Member Posts: 5
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    Wanted to share that I had my lumpectomy and the pathology report came back negative for cancer. So relieved. The surgery went well. For anyone reading and wondering about excisional biopsy/lumpectomy, my experience was good. My scar is small and hidden. My breast still looks the same (no dent). The surgeon readjusted tissue inside of my breast to fill any gaps. I only took ibuprofen for pain the first couple days after the surgery. The doctor injected some type of long lasting pain medicine into the breast that stopped the pain for the first 3 days, so no prescription pills. My surgeon took out 2 lesions. The first was a radial scar with microcalcifications as expected. The second was an unexpected intraductal papiloma with fibrocystic changes. The papilloma didn't show up on any imaging tests. My surgeon found it incidentally on her way to removing the radial scar. She said it was high risk like the radial scar and both of them increase my risk of future cancer. Going on a 6 month screening regimen of mammograms and MRIs. She said anything at all that they find will be biopsied immediately. She says I may also be a candidate for genetic screening. I've got to figure out how to worry less if this is going to be a regular part of my life.

  • maggie15
    maggie15 Member Posts: 1,000
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    Hi @chiamaria , Good news about the biopsy and the excellent cosmetic result! The genetic screening is probably a good idea even though most breast cancer is not related to family history.

    The increased screening can cause scanxiety but it's good to do it to catch anything early. It's kind of like preventative maintenance. It's better to service your car regularly than have your brakes fail on the highway. Hopefully future scans will be uneventful. All the best!

  • brettellen
    brettellen Member Posts: 1
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    Hi Chiamaria,

    im so glad everything went well for you. I wish you the best with all your future mammograms and results.

    I was diagnosed with a radial scar in December after a vacuum assisted core needle biopsy that showed no atypia or evidence of malignancy. My lumpectomy is scheduled for next week. I have been an anxietal mess for about two months. I will be happy to have it removed and get a more definitive diagnosis. My gut tells me there is no cancer but I am preparing myself for the possibility. im a little nervous about the surgery, but not as nervous as I was about having the Savi Scout inserted. My biopsy was very painful so I thought the Savi Scout would be too. It was not anywhere near as painful.

    Anyway, thank you for sharing your experience.

  • chiamaria
    chiamaria Member Posts: 5
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    brettellen I hope everything goes well with your lumpectomy surgery. Don't be too worried (I know it's hard). The lumpectomy was less traumatic than the stereotactic biopsy. I didn't have a wire or Savi Scout, because they implanted a seed during my stereotactic biopsy. I'm one month post op now and my swelling is gone. I do still have some firmness, soreness, and a slight indentation where they removed the radial scar and papilloma. I'm hopeful it will smooth out and look more normal as it heals. One thing I wasn't really expecting was that I had to go off of birth control for hormone replacement due to my increased risk. I had premature ovarian failure and have been on it since my early 40s. Was expecting to keep taking it until my early 50s. My breast surgeon also recommended Tamoxifen, but I haven't committed to that yet. I've heard there are lots of side effects…

  • moderators
    moderators Posts: 8,196
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    @brettellen, welcome to our community! We are so glad that you reached out to join us.

    It's completely normal to feel anxious about the upcoming lumpectomy. Is there anything specific you're doing to prepare for it? Below are some links you might find helpful in preparing for your lumpectomy:

    Lumpectomy

    Shopping/packing/to-do list for surgery + recovery

    Scheduled for Surgery in February 2024? Gather here to support one another!

    We hope this helps! We're looking forward to hearing how you are doing.

    The Mods