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This page contains
information regarding situations in which a
biopsy has been done, whether for a lump or
other abnormality on exam, or for an abnormal
mammogram, and the biopsy shows “abnormal cells”
but does not show cancer.
I had a biopsy, and it
showed one of the following— pre-cancerous
cells, atypical ductal hyperplasia, ADH,
atypical lobular hyperplasia, lobular carcinoma
in situ, or LCIS. What should be done now?
The term
“pre-cancerous cells” might be used for
different situations. There are some benign
cells that are more heaped up and irregular than
normal breast cells, which are considered to be
an indication that a woman is at higher risk for
developing a cancer. There are a few such
categories, atypical ductal hyperplasia (ADH),
and atypical lobular hyperplasia (ALH) or
lobular carcinoma in situ (LCIS). Although
these findings are not cancerous, the
possibility of finding a tiny cancer nearby is
high enough to consider a larger surgical
excision of surrounding breast tissue, if these
cell types are seen on a core needle biopsy.
Though estimates vary, the possibility of
finding a nearby hidden cancer in this case is
probably about 10%.
The term “lobular carcinoma in
situ” requires a little more explanation.
Although the name includes the term carcinoma,
lobular carcinoma in situ (LCIS) is not really
cancer, but rather a noninvasive condition that
increases the risk of developing cancer in the
future. LCIS, also known as lobular neoplasia,
occurs when abnormal cells accumulate in the
breast lobules. Each breast has countless milk
producing lobules, which are connected to the
milk ducts. In LCIS, the abnormal cells are
often found throughout the breast lobules, and
both breasts are affected about 30 percent of
the time.
Although we don’t think that LCIS
itself becomes breast cancer, about 25 percent
of patients who have LCIS will develop breast
cancer at some point in their lifetime. (By way
of comparison, for women in general, the risk of
having breast cancer in their lifetime is about
12%.) This increased risk applies to both
breasts, regardless of which breast is affected
with LCIS, and in those who develop cancer, it
may be either of the lobular or ductal type.
If any
of these abnormal cell types are seen on a
biopsy in which the sampling was done with some
sort of needle (core biopsy, or stereotactic
biopsy), in most cases a surgical excision
should now be done, to get a larger sampling of
tissue. In about 90% of cases, there will be
nothing more significant seen, and no other
treatment would be needed. But in about 10% of
cases, some cancer “seeds”, or actual invasive
cancer may be seen, which will require
additional treatment.
This
surgical excision can usually be done as an
outpatient. Many surgeons still do what is
called a “wire localization” procedure to help
them know what breast tissue to remove. At
DeKalb Surgical we rarely need to resort to this
additional step, since our experience with
ultrasonography allows us to more directly
identify and remove the appropriate tissue. The
use of ultrasound instead of a wire is much
easier, simpler, and less expensive for the
patient.
There is reason to
consider taking a medication to prevent
the development of cancer if you have had a
biopsy showing these atypical cell types. This
sort of treatment is called “chemoprevention”.
There are two drugs available for this type of
treatment, tamoxifen, and Evista. Studies have
shown that by taking either of these drugs, once
a day, for five years, that women at higher risk
for developing breast cancer can decrease their
risk by about half. Not all women choose this
option, but it is important that you are at
least aware of this option. Both drugs have a
list of possible side effects, and one needs to
balance the value of the potential benefit
(decreased cancer risk) versus the risks
(possibly experiencing one or more of the side
effects).
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