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Breast Cancer/Hyperplasia & Evista

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Question
QUESTION: I see that you are in Sweden and maybe drugs are different there. I'm in the US.  I had a breast biopsy with the diagnosis of hyperplasia, which was described somewhat as pre-cancer.   I was advised to start the drug Evista and not to worry about blood clots.  However, www.evista.com and the website for the maker (Lilly) discuss blood clot issues.   

If I take Evista, how could I protect myself from clots?  Could I frequently check my prothrombin time like users of blood thinners do?  Could I take a blood thinner?

If I don't take Evista, and eventually have more biopsies, I was told that the scarring would make it difficult to read future mammograms.   

Thank you.

ANSWER: To be able to answer your question if you should consider Evista treatment or not I do need to read your biopsy report. You can copy it here.


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---------- FOLLOW-UP ----------

QUESTION: I don't know how to get the biopsy report to you.  I have a paper copy, but no means to scan it.  So I'll type what it says here.

Final Pathologic Diagnosis
  
1. Breast, left, needle localized excisional biopsy:
 A. Usual ductal hyperplasia.
 B. Sclerosing adenosis.
 C. Biopsy site changes.
 D. Microcalcifications are present associated with otherwise unremarkable lobules.
 E. No residual atypical ductal hyperplasia is seen.
 F. No evidence of ductal carcinoma in situ.
 G. No evidence of invasive carcinoma.
 
2. Breast, left, lateral margin, excision:
 A. Changes most consistent with biopsy site changes.
 B. No atypical ductal hyperplasia is seen.
 C. No ductal carcinoma in situ is seen.
 D. No evidence of invasive carcinoma.
 
Clinical History
Left breast AHUOQ.

Gross Description

Part 1 - Source of specimen labeled "left breast biopsy, short suture superior, double deep, long suture lateral."  Received in formalin is a 4.0 x 3.8 x 3.0 cm single fragment of yellow lobular soft tissue with a double suture denoting deep, a short suture denoting superior and a long suture denoting lateral.  The specimen is inked as follows:
 The deep surface is inked blue.
 The superficial surface is inked black.
 The superior surface is inked orange.
 The inferior surface is inked green.
The specimen is serially sectioned from lateral to medial to reveal a 0.8 cm firm cystic biopsy cavity located towards the inferior surface centrally.  There appears to be surrounding hemorrhage.  The specimen is submitted entirely from medial to lateral in cassettes 1A to 1L.
 
Part 2 - Source of specimen labeled "lateral margin, stitch on true margin." Received in formalin is a 3.5 x 2.5 x 1.0 cm yellow lobular fragment with a stitch denoting true margin.  The margin surface is inked black.  The specimen is serially sectioned to reveal yellow lobular homogenous cut surface with no discrete masses or nodules identified.  The specimen is submitted entirely in cassettes 2A-2B.

Answer
Thank you! Your breast biopsy result shows some hyperplasia but without any dysplasia and also shows some sclerosing adenosis. While this may show some increased breast cancer risk that risk can most probably not be described as big. Evista treatment has some increased risk of blood clots but again not a big risk. I can not say that I consider Evista treatment in your case as essential but nor do I consider it as very risky. So I can not exclude it due to any risks but again I can not say that I regard it as absolutely necessary. It will probably decrease any breast cancer risk that you may have though that risk is probably in spite of your biopsy result not very big. So is also the blood clot riosk of any Evista treatment. I do suggest that you have a straight discussion with your doctor about the need of this treatment and try to reach a decision together. Good luck!


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Breast Cancer

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Claes-Gustaf Nordquist, M.D.

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I`m a doctor of medicine and a specialist in radiation therapy and medical oncology. I have long experience in diagnostics and treatment of breast tumours.

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I'm a Doctor of Medicine and specialist in Medical Oncology and Radiation Therapy educated & trained in Sweden. Now retired. Background in Radiation Therapy, Medical Oncology, Radiation Protection, Nuclear Medicine, Diagnostic Radiology, Gynecological Oncology, Clinical Pathology, Clinical Cytology,Hematology and Internal Medicine. M.D. from the faculty of medicine, Royal Karolinska Institute, Stockholm, Sweden. Have also been an exchange student at the Hebrew University, Hadassah Medical School, Jerusalem Israel. Former medical consultant, Swedish National Board of Radiation Protection. Former Police Surgeon and Medical Examiner, Stockholm Police Department. Former Chief Medical Officer, The Royal Guards, The Royal Horse Guards and the Royal Household Brigade, Royal Swedish Army Medical Corps.You can also reach me on: http://www.lifestylerescue.com/expert/health-fitness-advice/dr-claes-gustaf/128 I have no restrictions on the number of questions there.

I also answer questions about Oncology (General Cancer), General History, Military History, Brain Tumors, Colon Cancer

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I'm a medical doctor and specialist in medical oncology and radiation therapy.

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