What Those “Suspicious” Findings Really Mean
It’s scary to know that something suspicious appeared on what you thought was a routine mammogram. If your doctor recommends a biopsy, you obviously want to hear that everything’s normal after all. But what if it’s not? The medical language that’s used in these reports can make things sound worse than they really are.
Here are common breast findings and what they really mean…
LOBULAR OR DUCTAL HYPERPLASIA
The lobules in the breasts are milk-producing glands. The ducts are passages that milk travels through to get to the nipples. Many women will eventually develop lobular or ductal hyperplasia. It means that there is an overgrowth of cells in one of these areas.
Is it a worrisome finding? Probably not, as long as the cells don’t appear atypical (see below). When researchers at the Mayo Clinic looked at almost 9,000 women who had had benign breast biopsies, about one-third had these proliferating cells.
Hyperplasia is not cancer. It typically does not increase a woman’s risk of getting breast cancer. I advise women not to worry about it.
This is a little different from the situation described above. Atypical hyperplasia (also known as proliferative changes with atypia) is not a cancer. However, women who have been diagnosed with this condition do have to take precautions.
As the name suggests, “atypical” cells don’t quite resemble normal cells. Atypical hyperplasia increases a woman’s lifetime cancer risk, even in the unaffected breast, making the risk four to five times higher than that of the general population. My advice…
• If the cells were discovered during a core needle biopsy (a sampling of tissue taken from the suspicious area), I usually advise women to have an excisional biopsy. It will remove the entire area that contains the abnormal cells. Editor’s note: You might want to obtain a second opinion on the biopsy results given the findings of a recent study (see “Beware: Breast Biopsy Results May Not be Accurate” below).
• Premenopausal women with atypical hyperplasia are advised to take the drug tamoxifen for five years. It will reduce their risk for breast cancer by about two-thirds. Postmenopausal women will get a similar benefit when they take raloxifene (Evista) or exemestane (Aromasin). Discuss possible side effects of the drugs, such as blood clots and risk for stroke, with your doctor.
• Screening guidelines from the National Comprehensive Cancer Network include annual mammograms and a clinical breast exam (a manual exam by a doctor) every six to 12 months.
LOBULAR CARCINOMA IN SITU (LCIS)
Don’t let the word “carcinoma” throw you. Some doctors prefer the term lobular neoplasia because LCIS isn’t a cancer—it is a risk factor.
The term “in situ” means that abnormal cells within the breast lobules haven’t broken through the lobule wall and migrated into adjoining tissues or into the bloodstream.
Yet there is a risk. Women with LCIS are more likely to eventually develop breast cancer. The risk increases by 1% every year. A woman diagnosed with LCIS in her 40s is about 20% to 25% more likely to get breast cancer within 15 years than a woman who never had it.
Some women feel that any increase in breast cancer risk is unacceptable. They might ask their doctors if they should have a preventive (prophylactic) mastectomy. It’s a difficult decision, particularly because the mastectomy would have to be bilateral (removing both breasts). Women with LCIS are just as likely to develop cancer in one breast as the other.
My advice: I don’t recommend mastectomy for most women with LCIS, with the possible exception of those with a strong family history of breast cancer or other risk factors. Better: Watchful waiting. Your doctor can monitor you closely. If a cancer does eventually develop, it can be treated quickly.
Get an annual mammogram…a clinical breast exam twice a year…and possibly take tamoxifen, raloxifene or exemestane. Women with LCIS who take one of these drugs can reduce their breast cancer risk by about 50%.
DUCTAL CARCINOMA IN SITU (DCIS)
Unlike LCIS, DCIS is a cancer. About 60,000 women in the US each year are found to have DCIS. The abnormal cells are confined inside the milk ducts and thus are not considered invasive. But if you’re diagnosed with DCIS, you have to get treated. Treatment options include a lumpectomy followed by radiation to kill any cancer cells that were left behind…or, in some cases, a mastectomy (with or without breast reconstruction). Your surgeon might recommend a mastectomy if the DCIS is extensive or multicentric (more than one tumor, often in different areas of the breast). Once the carcinoma is removed, you will need to be followed closely. There always is the risk for a recurrence, which is 5% to 10% following lumpectomy with radiation and 1% to 2% following a mastectomy.
If the DCIS is estrogen receptor-positive, taking tamoxifen for five years is recommended to reduce your risk for recurrence and a new breast cancer.
Source: Melissa A. Lazar, MD, assistant professor of surgery at Thomas Jefferson University Hospital and a surgeon who specializes in the treatment of benign and malignant breast disease at the Jefferson Breast Care Center, both in Philadelphia.
Beware: Breast Biopsy Results May Not Be Accurate
Breast biopsy findings may not be reliable when it comes to subtle abnormalities, according to a new study.
Researchers asked 115 pathologists to examine biopsy slides, then compared their diagnoses with those from a panel of leading experts who had seen the same slides. The panel of experts was made up of internationally recognized pathologists with highly regarded experience in research and continuing medical education on diagnostic breast pathology.
The outside pathologists were very good at diagnosing invasive breast cancer and agreed with the expert panel in about 96% of cases. For benign findings, they agreed with the experts in 87% of cases. When it came to diagnosing DCIS, they agreed with the experts about 84% of the time.
But with atypical ductal hyperplasia, the pathologists were in line with the experts only 48% of the time. They diagnosed atypia in 17% of readings where the experts had not and missed it in 35% of readings.
Source: Study led by researchers at University of Washington School of Medicine and Fred Hutchinson Cancer Research Center, both in Seattle, published in The Journal of the American Medical Association.