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Nov 28, 2012 11:14AM
, edited Nov 28, 2012 11:18AM
Kimmer, your mother's situation is actually very familiar to me, and to many others here. DCIS usually does not present in the form of a lump and most of us who've been diagnosed with DCIS, or sometimes with early stage invasive cancer, started off the process when calcifications were discovered on our mammograms.
DCIS is a pre-invasive cancer. What that means is that the cancer cells are confined to the milk ducts. As the cells multiply, as cancer cells are prone to do, rather than form a lump (which could be difficult since the cells are confined to the tight space of the milk duct), the cancer cells instead tend to spread out within the ducts. Calcifications are a by-product of the cancer cells and it's the calcs that show up on a mammogram. Calcifications are actually very common - about 50% of women get them at some point in their lives - and most often, the calcs were caused by something completely harmless. There are lots of reasons why calcs can form and most aren't serious at all. But it's when calcs appear on a mammogram in a pattern that seems to mirror the pattern of the ducts of the breast, i.e. in a cluster or a linear formation, that those calcs are considered suspicious.
Suspicious calcs need to be biopsied because they might be a sign that there is cancer present in the ducts. But 80% of biopsies on suspicious calcs turn out to not be breast cancer. Most are completely benign but a portion of those that are not cancer might instead show some type of atypia, usually either ADH (atypical ductal hyperplasia) or ALH (atypical lobular hyperplasia). These conditions are a pre-cancerous stage of abnormal cell development. Most women with ADH and ALH never develop breast cancer but about 20% - 30% do. And since all cancer cells don't evolve at the same pace, a finding of ADH or ALH from a needle biopsy sample could indicate that there might be something more serious, either DCIS or early stage invasive cancer, also lurking. This is why it's usually recommended that an excisional biopsy (also called a surgical biopsy) be done to confirm the diagnosis and to ensure that there is nothing there that's more serious than just the atypical cells.
Approx. 20% of excisional biopsies after a finding of atypical cells in the needle biopsy do come back with a more serious finding. I fell into that 20%. My needle biopsy showed ADH. My excisional biopsy showed more ADH, plus DCIS plus a microinvasion (the tiniest possible amount) of IDC (invasive cancer). Since this is a breast cancer discussion board, you'll find lots of us who fell into that 20%. But 80% of these types of excisional biopsies find nothing more than the original ADH or ALH. Hopefully that will be the case with your mother.
If that is the finding, then she will be considered 'high risk'. Particularly with the experience of her sister, it will be worth talking to her doctor to ensure that she is in a high risk monitoring program, and to discuss whether any preventative treatments, such as Tamoxifen, might be advisable.
Hope that helps!
Dx 9/15/05, DCIS-MI, 6cm+ Gr3 DCIS w/IDC microinvasion, Stage IA, 0/3 nodes, ER+/PR- “No power so effectually robs the mind of all its powers of acting and reasoning as fear.” Edmund Burke