Expert: Claes-Gustaf Nordquist, M.D. - 8/1/2007

Question
QUESTION: I am 43 years old and was just recently diagnosed with DCIS, I underwent an open excisional biopsy, which came back with clean margins, but showed atypical hyperplasia.  I was also told that my MRI showed something in my other breast.  My Dr, (surgeon) says he is unsure how to proceed, and has me on hold for now.  He said he is not sure if he will do radiation or not, I am a little confused on why he is acting like this isn't a big deal, could you please tell me what I should be having done?  And should I have someone looking at my MRI results to see what is going on with the opposing breast?
Please tell me what the proper treatment should be, and if I should be seeing a specialist?

ANSWER: First of all it has to be determined what you have in your other breast! That should be possible using a stereotactic needle biopsy. If nothing malignant there you should go ahead with radiation therapy of your operated breast. If the biopsy is unclear or there are signs of malignancy an operation of that breast should be done. Further action there should be determined by what is found. Also your first breast (the one operated now) should be checked with MRI! Even if your other breast needs an operation I still think your first breast should be irradiated. ANY tumor should also be checked for hormonal receptors to determine if you should have (anti) hormonal therapy. If only cancer in situ is found I would not recommend chemo therapy. Ok?


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

QUESTION: I want to know if my pathology or MRI report changes things.
The first path reports states:
1. Single focus of intermediate grade ductal carcinoma in situ, 0.2 cm size.
2.  Multifocal atypical duct hyperplasia, (three foci).
3.  Proliferative type fibrocystic change with florid duct epithelial hyperplasia.
4.  Pseudoangioma stromal hyperlasia.

The MRI post op states:

Focal area of probably benign enhancement measuring 6 mm in the medial aspect of the left breast at 8 o clock.

A 6 mm slightly irregular area of enhancement in the medial aspect of the right breast close to the chest wall just underneath the skin surface at 4 o clock.  I think it represents a small fibroadenoma.  

The path finding on my open excision/partial mastectomy reads:
1.  Single focous of atpyical lobular hyperplasia
2.  Fibrocystic change, proliferative type with florid duct epithelial hyperplasia without atypia
3.  Single focus of slerosing adnosis
4.  previous biopsy site changes
5.  Negative for residual DCIS

OK, there is much more, but can you still recommend to me what should be done from these findings?  My dr seems to think since he removed so much from the left breast, he should do no further preventive measures, and has yet to mention the other breast.

Thank you!

Answer
No I see nothing that changes anything. I still think that a biopsy of your right breast should be done to be on the safe side and irradiation of the operated breast when a cancer of any kind has been operated in a lumpectomy is standard procedure, though I understand how your dr. is reasoning and it is not unreasonable. I however would still suggest irradiation.