Lani, I need advice on this one

[Liz J.]

I am scheduled to have a second biopsy in less than a year on my remaining breast. I keep hearing that repeated biops can cause a cancer to occur. I don't know that I believe that, but it sems to be what everyone is saying. I am very "lumpy" in the remaining breast and I feel something in different places all the time. Both I and my surgeon are feeling one particular lump, but I know I feel more. Had mammo/sono last week and Thank God they were ok. What would you do in this situation?

Thank you.

Liz

[Lani]

"food for thought" based on my readings/conference attendance.

1) could you get an MRI of the remaining breast--it can show things not seen by mammogram or ultrasound and a few of the members of this board had
tumors that were not seen by mammogram or ultrasound

Insurance-wise, having already had breast cancer and having something abnormal felt in the breast which doesn't show up on mammogram or US
should be reason enough to have them pay for an MRI. If they balk, there are quite a few excellent articles on this citing familial bc and/or history of bc as reasons to proceed with an MRI. That said, try to go somewhere where they are good at reading breast MRIs.

2) you didn't say what type of biopsy they are planning--a needle or core biopsy or an excisional biopsy?

There are those who believe that any surgery bears the potential of increasing angiogenic factors which might "awaken sleeping beauty" ie dormant rarely dividing cancer stem cells in your bone marrow or elsewhere which are responsible for metastatic spread, and of course, it is metastatic spread which the biggest worry.

Two pieces of evidence point in this direction:a) the genetic profile of bc is similar to the genetic profile of inflammation in general and surgery definitely causes inflammation--that is how it gets you to close the wound, form scar etc. b) when they look at those patients who delay surgery long after discovering their tumor (for psychological, financial reasons or due to lack of proper medical facilities) they find that the peak of recurrence occurs X months after the surgery occured, not X months after the lump was discovered.(X depends on the type of bc and is shorter for her2+bc than for her2-bc).

That said, if your doctors tell you that you need surgery to determine if this is another cancer and/or to treat the cancer, it seems reasonable to ask them what is the smallest, least traumatic way of getting the answer/taking care of the problem ie, needle biopsy vs. core biopsy vs excisional biopsy vs mastectomy . (If the MRI is felt to be not worrisome and they advise waiting, you can always get a second opinion and see if you are comfortable with that--only you know how risk-adverse you are)

All the above is fine for me to discuss theoretically--but a breast surgeon, a radiologist specializing in breast imaging and/or an oncologist are the people whose expertise you should seek out in making this decision.

Hope some of this "food for thought" helped!

[Liz J.]

Lani,

Thank you for the info. I think I will talk to him about the MRI. He is planning an excisional biopsy. At times like this I regret not having had a bilateral mast back in '05. Again thank you.

Liz