Varying pathology reports on these dense breasts

Hi!

I have extremely dense breasts, and it’s driving us all a little crazy… I was originally diagnosed with DCIS in the left breast, and I visited 3 docs for opinions … two docs thought it was microinvasive, one didnt (this is where I had surgery). Post-op pathology now says it was actually IDC 1a (though I still need my lymphs out for testing! oy.). These are all top-notch NYC hospitals, and I’m a little amazed at how differently they’ve all approached my case.

Now I’m paranoid about all these varying ideas around my right breast. I had a MRI assisted biopsy on that side that 2 hospitals thought were atypical ductal hyperplasia and flat epithelial atypia—that would be surgery. They also thought I needed more biopsies for different spots on both left and right. My current hospital isn’t so concerned, and thinks that the right is a mix of the below (that is, no surgery):
Breast Parenchyma:
Benign breast parenchyma
Apocrine metaplasia
Columnar cell change
Pseudoangiomatous stromal hyperplasia (PASH)
Usual ductal hyperplasia (UDH)
Benign skin

Obviously, there’s a lot going on in the right breast. Other docs think there’s also “suspicious” spot directly behind my nipple - I understand that can be very dangerous. I’m worried my current pathologists are too … dismissive?.. with my imaging. I know that a lot of different pathologists will look at the same report, but I’m alarmed that other pathologists find my imaging concerning enough to warrant more biopsies. And god I hate MRI biopsies - they give me zanax to deal with it haha - so it’s difficult leaving that decision up to me.

I really love my doctor, but her pathologists are freaking me out. I’m only 38, and I’m happy with her work on my left (you can barely see the scar). But I’m also feeling quite sure something is stewing on my right, maybe even my left! , and wondering if I should just get a mastectomy. I don’t want this to get out of hand and obviously want to preserve my nipples, and if that means doing the mastectomy before it’s too late - I will.

This is partly to vent a bit, but I’d also love your professional and experienced opinions about this. My breasts just feel like two ticking time bombs, but I also do not want to go through traumatic surgery if I don’t have to. I wish I could have a pathologist and radiologist sit down in front of me and explain everything, because I’m tremendously confused!

Many thanks in advance,
S

Hi fuwafuwa24

Thank you for posting.

The information we offer is specific to what is currently available in the UK

Because treatments and healthcare services vary so much in different countries, it is difficult for us to answer queries from outside of the UK

It sounds like this has been a difficult time for you having recently been diagnosed with breast cancer and it’s understandable that you are feeling confused. Having mixed pathology from biopsies can make decisions more difficult. It’s not clear whether you have been offered any genetic testing to assess your risk.

We know that having dense breasts increases the risk of breast cancer. However, young women often have denser breast tissue.

It’s not possible for us to say what needs to happen next. You mention that following your diagnosis of invasive ductal cancer (IDC) you are still awaiting lymph node surgery. Do talk to your treatment team about your concerns.

Everyone copes with a diagnosis of breast cancer in different ways and you’re likely to experience a range of emotions. It’s not clear what support you have had up until now. You may want to discuss with your treatment team or your GP about a referral for talking therapies.

We are a national organisation providing information and support to anyone living in the UK. If you now live in the UK we offer a range of free supportive services that you might be interested in.

If you are still in the USA you may find The National Cancer Institute and Breastcancer.org helpful. The American Cancer Society has a national helpline.

Best wishes

Grete

Breast Care Nurse

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