Topic: First timer worried about next step

Forum: Not Diagnosed But Worried — For those who are experiencing symptoms or received concerning test results, but haven't been diagnosed with breast cancer.

Posted on: Nov 13, 2021 01:32AM - edited Nov 13, 2021 02:45PM by bbymom

Posted on: Nov 13, 2021 01:32AM - edited Nov 13, 2021 02:45PM by bbymom

bbymom wrote:

I've gone through 3 mammograms, an ultrasound, and a core needle biopsy on 2 sites in the last 4 months and am meeting with a surgeon next Thursday to discuss excision of the abnormal breast tissue. It's a lot and a bit overwhelming and I'm kicking myself for delaying the mammogram for so long.

Background: My mom had breast cancer (DCIS caught early) but my mammograms have been clear until this year (I'm 49) when 6 calcifications showed up clustered in one quadrant of my right breast. They initially recommended one biopsy but changed it to two and those were both done 4 weeks ago (6 cores each). The pathology report showed several abnormalities but no cancer, and the medical imaging report recommended a breast MRI (but said that it will be left to surgeon's discretion to obtain if it is felt to be clinically relevant) and that excision was recommended.

Is excision necessary if there is no cancer in all those samples? Would an MRI be helpful as part of the decision? If I proceed with the excision, would it be recommended to just remove the biopsied calcifications or all 6? Getting almost a whole quadrant removed seems so much! Sorry for all the questions. I think I'll proceed with it for a peace of mind and because one of the sites aches from time to time and did almost all day today, which I don't think is a good sign, but am really worried about the risks and what I will look like. I heard that invasive procedures can sometimes aggravate the cancer, if there is any.

Any insight, additional information, or advice would be greatly appreciated. I'm new to all this and it's a bit overwhelming.

Here is the pathology report in case that helps:

Site A: 3 mm span - Focal Atypical Ductal Hyperplasia (ADH) and Flat Epithelial Atypia (FEA) with associated calcifications - Atypical Lobular Hyperplasia (ALH) involving radial scar and surrounding breast tissue - Small intraductal papilloma, completely contained in core, and background proliferative changes

Site B: 12 mm - At least Atypical Ductal Hyperplasia (ADH) with associated calcifications

Thanks so much

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Apr 6, 2022 03:05AM rah2464 wrote:

Bbymom sorry you find yourself with some involved margins. I assume since the surgeon is recommending moving to radiation that there is no chance to remove the affected areas? Sounds like this area was close to the chest wall? Sorry to hear about the seroma I hope that goes away pretty quickly for you. Mine took about a month to resolve fully. If your compression bra doesn't put enough pressure on that area, you can add medical pads ( i used some abdominal ones) and place right over the seroma.

Might be worth it to get a second surgical opinion if this is a surgeon that doesn't just specialize in breast surgery. I would definitely want to consult with an MO to get a comprehensive treatment plan. The good news is that there is no invasive component, which eliminates any need for chemotherapy. You may want to consult with more than one radiologist in order to get the most effective radiation treatment plan.

As to the evaluation for the left breast, I would have a discussion about a breast MRI, which can provide more comprehensive imaging.

Dx 5/23/2018, IDC, Left, 1cm, Stage IA, Grade 2, 0/4 nodes, ER+/PR+, HER2- Surgery 6/27/2018 Mastectomy; Mastectomy (Left); Mastectomy (Right); Reconstruction (Left): Silicone implant; Reconstruction (Right): Silicone implant Hormonal Therapy 7/27/2018 Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone)
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Apr 6, 2022 10:58AM quietgirl wrote:

I’m not sure this is going to help or not but basically I had same/similar surgery lumpectomy for DCIS. Mine is not near the chest wall but my radiation scheduled was 15 while breast followed by 4 targeted sessions. So not that completely different than yours. In the end it will be the RO who makes the decision on how much radiation makes the most sense (I was given a 3 to 5 week window by the surgeon and the RO was the one who developed the plan of 19 days). The MO met with me before radiation started to discuss prescriptions/plans of action after radiation was over (since you are ER positive that is probably going to be something they talk to you about).

Like I said I am not in the exact same situation but similar enough to say it sounds like you are on a similar path but the radiologist and a medical oncologist will probably give you more information to round out your treatment. If any of the practices you are using has a patient/nurse navigator that can be a helpful person to reach out to if it gets overwhelming.


Surgery 2/7/2022 Lumpectomy (Right) Radiation Therapy 3/9/2022 Whole breast, Radiation boost: Right breast Hormonal Therapy 4/18/2022 Arimidex (anastrozole) Dx DCIS, Right, 3cm, Stage 0, Grade 2, ER+/PR+
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Apr 16, 2022 05:44PM bbymom wrote:

Hi Ra2464 and quietgirl, fortunately they did get clear margins with the second lumpectomy but I still have some unremoved calcifications as they two outliers were 12cm's apart. (I'm now thinking I should have just done a mastectomy instead of that second lumpectomy... it's just so hard to know!). I did see a radiation oncologist last week and they recommended whole-breast radiation due to the larger size DCIS (~3.9cm in total), my family history (my mom also had DCIS), and my age (49). They also recommended 5yrs of Tamoxifen hormone therapy as I'm ER+. I'm expected to start radiation within the next 2 weeks. @quietgirl, yes, it sounds VERY similar. I wonder if they ct scan results will affect the original number of 15 sessions - I may end up even more similar to your plan. How was your radiation, if you don't mind me asking? The cancer centre is 30-45 mins away with a very busy parking lot so I'm considering taking the time off (short term disability) as I'll be missing close to half a day of work as-is plus I hear the fatigue can be bad.

Thanks again for your help!

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Apr 16, 2022 05:55PM bbymom wrote:

Thank you moderators for the link - I will definitely check out all these resources. Thank you!

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Apr 16, 2022 07:18PM - edited Apr 16, 2022 07:18PM by quietgirl

  • the most annoying part of the actual radiation for me was the position although most days it's only about 10 minutes on the table. Arms stretched over the head is just uncomfortable. The thing I wish I had done differently was moisturizer better I was great for the most part but not as great on the side and towards my underarm. That ended up being the area that was the most tender and with peeling skin. I don't think there is a thread just now in the radiation forum for April but if you are starting before the end of the month or you are starting in may you might want to start one and I'm sure you will find others who at the same place in their treatment so you can go through it together.
Surgery 2/7/2022 Lumpectomy (Right) Radiation Therapy 3/9/2022 Whole breast, Radiation boost: Right breast Hormonal Therapy 4/18/2022 Arimidex (anastrozole) Dx DCIS, Right, 3cm, Stage 0, Grade 2, ER+/PR+
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Apr 18, 2022 08:07AM salamandra wrote:

Taking time off during radiation was one of the best things I did for myself during treatment, and worth every penny of lost income. If you can afford it, I recommend it. It gave me something nice about that stressful time, and took off a lot of hassle and pressure.

Dx at 39. 1.8cm. Oncotype 9. Dx 9/19/2018, IDC, Right, 1cm, Stage IA, Grade 2, 0/3 nodes, ER+/PR+, HER2- Surgery 10/18/2018 Lumpectomy; Lymph node removal Hormonal Therapy 11/1/2018 Tamoxifen pills (Nolvadex, Apo-Tamox, Tamofen, Tamone) Radiation Therapy 12/3/2018 Whole breast: Breast Hormonal Therapy 12/19/2019 Fareston (toremifene)
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Apr 18, 2022 09:32AM mle42 wrote:

Bbymom, it's great news that they got clear margins on the second surgery! R.e. radiation, I had 33 sessions. I kept working for the first half - more or less 1/2 time, since my mornings were spent driving to and from the radiation center - then went on leave for the second half. I could have kept pushing through and worked the whole time, but I had the flexibility to take the time off at work, and am very grateful I did. Radiation can definitely sap your energy, and without working I could focus what energy I did have on taking care of myself instead of spending it at work. Be aware that side effects from radiation (including fatigue) often continue for about a week after your last radiation treatment before getting better, so if you do take time off work, give yourself an extra week at the end if you can.

Dx 5/17/2021, IDC, Right, 3cm, Stage IIIA, Grade 3, ER+/PR+, HER2- Surgery 10/25/2021 Lumpectomy (Right); Lymph node removal (Right): Sentinel Radiation Therapy 11/30/2021 Whole breast, Radiation boost: Right breast, Lymph nodes Hormonal Therapy 1/1/2022 Arimidex (anastrozole) Targeted Therapy 2/17/2022 Verzenio Chemotherapy AC + T (Taxol)
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Apr 18, 2022 08:38PM bbymom wrote:

Quietgirl – Thanks for the info and the heads up about arms stretched over the head. An old rotator cuff injury has been bugging me lately so I better get back on my exercises! I also skimmed through the March 2022 radiation chain and love that idea, thanks! Hopefully I'll get my start date soon.

Salamandra and mle42 – Thanks so much for sharing your experience. I'm a single mom so am worried about juggling everything while still working. I will talk to HR tomorrow to find out more and try to take at least some time off at the end. Thanks so much!

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Apr 20, 2022 08:35AM cathy67 wrote:

bbymom,

Thanks for sharing you experiences, those helped me a lot! From my 1st mammogram 10 years old, I was called back due to calcification. All the six months follow up with diagnostic mammogram, sometimes together with ultrasound, till the cancer diagnosis in year 2019. Now I just got another biopsy order, and will see my family doctor for the ultrasound report to get details. Nightmare came back again, I was so deeply depressed these days, but your post told me it is so precious that we got chance to catch it earlier. Yeah, I feel a bit relax, thanks and wish you a smooth radiation journey.

I am from richmond, I did radiation in bc cancer center, everybody there is so nice. I took skytrain there myself, yeah, I got a bit nausea sometimes, no big deal. I gained a few lbs after 1 month radiation, cause I always a restaurant to award myself after treatment.

We have a bc women thread, are you interested to join?

https://community.breastcancer.org/forum/55/topics/779734?page=312#idx_3111

Best wishes!

Cathy

Oncotype 6, Dx 08/06/2019, IDC, Right, 2.1 cm, Grade2, 1/1 nodes,ER+/PR+, HER2- Surgery 9/9/2019 Lumpectomy; Lumpectomy (Right); Lymph node removal Hormonal Therapy 11/20/2019 Arimidex (anastrozole) Radiation Therapy 11/26/2019 Whole breast: Breast, Lymph nodes
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Apr 21, 2022 04:03PM bbymom wrote:

Cathy67, I am so sorry to hear about your cancer diagnosis but glad it was caught early. This stuff sure plays with our emotions but I know statistically speaking we have great odds of living a long, healthy life if it's caught and treated early. That's what I'm holding onto!

I'm in Burnaby and will also be going to the Vancouver BC Cancer Centre so thank you for that feedback! I got a tiny bit nauseous during the ct scan from the feeling of movement with my eyes closed so I do worry that may be a problem for me. We shall see... hopefully it's something my body will adjust to quickly.

Thanks for the BC women thread... I will definitely join! :)

Thanks again!

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