calling gurus--pre-cancerous needle biopsy

[sassy]

I will be talking with someone this weekend that had a needle biopsy report of pre-cancerous cells.

What is the prevaling school of thought on procedures and/or treatment? What questions can I recommend she ask when she meets with the onc on Tuesday?

I want to be able to give her a good sense of direction and you guys know best!

Thanks for your help!

[StephN]

Sassy -
Normally the words would be "atypical cells." If there is already a lump somewhere, it can be cancer as was in my case.
What made them do the needle biopsy?

My needle biopsy (of a lump I found) turned up "atypical cells" because the needle did not hit the actual tumor (it was small) but some "atypical cells" were in the surrounding tissue. Next I had a core biopsy, which showed the very same result. My tumor was closer to my chest wall. Finally an excisional biopsy was done which included a mass in which my tumor was embedded. I had to go the whole route to get my final diagnosis.

This is a link to the types of biopsies:
http://www.cancer.org/Treatment/UnderstandingYourDiagnosis/ExamsandTestDescriptions/ForWomenFacingaBreastBiopsy/breast-biopsy-biopsy-types
I hope she is seeing a SURGEON who can go the next step and order further testing and/or imaging. A breast MRI may be a good screening method for this lady.

Here is what Mayo Clinic says on their web site:
"Atypical hyperplasia is thought to be part of the complex, multistep process by which breast cancer develops. The process begins when normal cell development and growth become disrupted, causing an overproduction of normal-looking cells (hyperplasia). Atypical hyperplasia occurs when the excess cells stack upon one another and begin to take on an abnormal appearance. The abnormal cells can continue to change in appearance and multiply, evolving into noninvasive (in situ) cancer, in which cancer cells remain confined to the area where they start growing. Left untreated, the cancer cells may eventually become invasive cancer, invading surrounding tissue, blood vessels or lymph channels."
In my case there was already a tumor that was affecting neighboring tissue.

Here is a link to Dr. Susan Love's explanation, with diagrams.
http://www.dslrf.org/breastcancer/content.asp?L2=3&L3=2&L4=1&SID=162

[Becky]

Also, in addition to Steph, are they atypical cells with or without hyperplasia. Atypical cells without hyperplasia need to be watched but aren't nearly as concerning as with hyperplasia. But remember - the next step in most cases is DCIS and then a stage one cancer. However, she should insure that it isn't more than that now.

My own biopsy was inconclusive. The tumor was removed because my breast surgeon said that my tumor looked like cancer and we shouldn't have biopsied - just did a lumpectomy and get it removed. She was right.

[NanaJoni]

I opted for a bi-lateral mastectomy last year and then, as we sometimes do, was second-guessing my decision after the surgery. I had two tumors in my right breast and was so afraid of the cancer that I just wanted to remove any possiblity of a recurrence. Then I got a phone call from my surgeon when she got the pathology reports - my left breast had "extensive atypical ductal hyperplasia". The surgeon said she felt sure that I would have been back to see her in as few as five years out ,having to go through the entire surgery, chemo, radiation thing again. She actually said "You dodged a bullet and made a good decision". I wouldn't think that normally there would be any treatment for ADH - just vigilant monitoring for any changes. Considering the complications I've had with the surgeries, chemo and radiation having the prophylactic mx of the left breast may have been a life-saver (one good guardian angel I've got).

[Mtngrl]

At the same time I was diagnosed with IDC in my left breast a biopsy of some calicifications in my right breast showed atypical hyperplasia. Then a breast MRI confirmed the cancer in the left breast, none in the right. They were going to do surgery to remove the atypical cells in the right breast at the same time as the lumpectomy or mastectomy of the left, but I ended up being diagnosed as Stage IV from the get-go, so no surgery. At the time the surgeon told me they just don't know which precancerous cells might become cancerous.

[sassy]

Thanks for your responses, ladies!

I will know more when I have an opportunity to speak with her directly. I don't know how much info she has at this point either. I just know she is in a scarey place right now (as we all remember well) and I hope to be a help emotionally and educationally.

[Jackie07]

I would suggest that she get a BRCA testing done and talk to a genetic counselor if she's had cancer history in the family. Besides the BRCA genes, she needs to consider the HNPCC cluster (or Lynch syndrome) if cancer of the colon, endometrium, uterine, or ovarian, etc. has been recorded in her family.

The story of Nancy Brinker's Sister (Susan G. Koman) haunts me whenever I hear 'pre-cancerous' diagnosis. She had begun her first mammogram at a fairly young age because of this type of 'suspecious' results. Her life would have been saved if proper action had been taken...

My family doctor thought I was being hypochondriac when I insisted on having a prophylactic hysterectomy/oophorectomy. After the surgery, we were told (by the surgeon) that there was hyperplasia seen in the uterus already...