Expert: Claes-Gustaf Nordquist, M.D. - 6/5/2010

Question
About a month and a half ago I (age 73) had a mammogram and a subsequent ultrasound. As the doctor was not satisfied with the results, he decided then and there to take a biopsy of a lump that he felt in my right breast and sent it for analysis.  A week later I was told that I had breast cancer and I had surgery a month later.  The lymph nodes that were extracted showed no abnormality and the surgery continued (sentinel node surgery).  A week later I was told by the doctor that the cancer had not spread and that a final analysis of the lump should determine whether or not it was "hormone sensitive", a condition that would require me to take a drug to prevent the cancer from spreading.  In addition I would also require radiation treatment.  Yesterday I was informed that the lump was precancerous and that there would be no need to take the drug that prevents the cancer from spreading but I will still radiation treatment.  I am confused.  Why was the diagnosis initially "breast cancer" and surgery performed and now a month later the diagnosis is "precancerous stage"?  I am not looking to find faults with the treatment or the doctors, I just want to get some clear and concise answers.  Can you please help?

Answer
To be absolutely sure to give you the correct answer I would like to read the pathology reports both from your biopsy and from your final surgery. You can copy them here. In biology as well as in its cousin medicine it is not always possible to give a clear cut answer like yes or no. There is a usually also a grey zone. You can have blue eyes or brown eyes. But you can also have green eyes, grey eyes and even mixed eyes, right? So also here. There are precancerous states that can over time develop into cancer. Sometimes there are difficulties in distinguishing between them. If I would dare a guess based upon what you have been told and told me and what is suggested as your treatment then what you have is a cancer in situ (also called cancer stage 0). That is in my opinion as well as in that of many others a real cancer - but there are also those who would not agree saying that it is a precancerous state. Cancer in situ means cancer in its site of origin meaning that it only exists where it originated it has not grown out of that site or spread at all. If so I would agree that radiation therapy is necessary now after surgery. You also need future check ups. It can be debated if hormonal therapy is necessary if your lesion has hormonal receptors. Some would suggest it. Others not. I personally would probably recommend it. But many other doctors would not accept that recommendation. That is where we stand. Good luck!


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