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January 30, 2011

LCIS & CANCER ~ Part 2 of 5

Health Disclaimer
All material on this blog is provided for information purposes only and may not be construed as medical advice or instruction. No action or inaction should be taken based solely on the contents of this information; instead, Readers should consult appropriate health professionals on any matter relating to their health and well-being.  The medical information and opinions expressed here are believed to be accurate, based on the best judgement available to the author, and readers who fail to consult with appropriate health authorities assume their own risk of injuries & consequence. This content is intended for entertainment purposes only.  LRBF,  January 30, 2011

“LCIS - Lobular Cancer in Situ”  
(Precancerous Conditions, page 194)  
Reference:  Dr. Susan Loves’ Breast Book by Dr. Susan Love (1992 printing)
“Under the microscope, LCIS is seen as very small, round cells stuffing the lobules, which normally don’t have any cells inside them.  If there are only a few cells and they’re not too odd looking, you have lobular hyperplasia, while if they fill the whole lobule and do look very atypical (odd), you have LCIS.  Such collections of cells are usually what we call ‘multi-centric” - you can find them scattered through both breasts.”
(page 196)  “What can you do if you have lobular carcinoma in situ?  Removing the LCIS isn't’ enough, since the LCIS isn’t what grows into cancer.  Basically, there are two options:  bilateral mastectomy or no treatment and close follow-up.  The more drastic, and the more foolproof, is bilateral mastectomy.  If you have no breasts, you won’t get breast cancer.”
Dr. Susan Love's Breast Book 5th Edition: Chapters/Indigo:

Biopsy No. 2
Here We Go Again
I had just had my first 6 month follow-up mammogram after the first biopsy that had determined my left breast held LCIS (Lobule Carcinoma In-situ).  The radiologist had found something on this mammogram that she thought needed to be explored with surgery and I was waiting for my appointment with the surgeon to discuss the prognosis.  I characterized my first wide-excision biopsy as a ‘breeze.’  No complications, no pain.  I felt good and healed fast, so I was able to face the next one with a positive attitude.
Terry came with me this time and together, we listened to the surgeon explain that there were more sinister looking calcifications clustering inside a lobule.  The same breast, but in a different location.  This site wasn’t as evident as the first, but they were alarmed that it had appeared so quickly (LCIS is considered to be a high-risk marker for developing breast cancer at anytime, in either breast).  This one hadn't been seen on the previous mammogram, so it would need to be addressed, regardless.
Several weeks later, we went through the same process.  Our first stop was the imaging centre where I would endure another ‘squish’ (via mammogram) to pinpoint the offending area.  They inserted a guide wire into the breast, via a fine needle, allowing the surgeon to cut without guesswork.  Once the wire was in place, we drove to the hospital where I was prepped for the OR.  I was assigned a gurney where I would wait for the surgeons call.
They were behind schedule, but unlike the first time, the surgeon never called to order a sedative for the purpose of relaxing me while I waited.  The nurses seemed harried and distracted, so inattentiveness was added to the mounting tension.  The room was chilly but there were no heated, flannel sheets to cover me this time.  These things all served to compound the growing feeling that I wasn’t being looked after.  I really believe these things go a long way to make a distinct difference in ones recovery and healing. 
By the time I was being wheeled into the OR, I was quite anxious. I hadn't been reassured or comforted before disappearing under the effects of the anesthesia.  Then, instead of waking to a smiling, attentive nurse in a private room again, I woke up in a room alongside other recovering, day-surgery patients.  The attending nurse told me to leave when I felt up to it and to make an appointment to have the sutures removed in a week.  "Whatever happened to dissolving sutures?"  I wondered, out loud.  She just shrugged.
What Now?
Although the following week was uneventful, I felt inexplicably ‘blue.’  It wasn’t anything I could put my finger on exactly, but the prospect of having to face this every 6 months was starting to weigh heavily.  LCIS shone a light on the fact that I could develop breast cancer at any time in my life and in either breast - not something one can dismiss easily.  I went to the internet again to do more research as there were always new studies on the subject of breast cancer.  I explored  dozens of sites, including the Mayo Clinic and the American & Canadian Breast Cancer organizations.  I found nothing new on the subject of LCIS.
Hitting The Books
I decided to re-visit Dr. Susan Love’s Breast Book (1992 printing) and poured over the pages once more.  This time I found myself focused on the section where she describes how some of her patients opt for a bi-lateral mastectomy (removal of both breasts) after enduring several biopsies, because the stress levels of this constant ‘unknown factor’ proved too stressful.   
(page 197)  “When a patient of mine is undecided. I usually suggest that she take the follow-up route, and see how she feels about it after six months or a year.  If she’s comfortable living with it, then she can continue the follow-up course for the rest of her life, or until a cancer occurs.  If she finds herself living in a constant state of anxiety, waking up every morning thinking, “this is it-this is the day I’ll find the lump,” then maybe a bilateral mastectomy is what she needs.  If you’re uncertain, it makes more sense to try out the follow-up course.  You can always decide on mastectomy later, but you can't undo a double mastectomy.?
Some women who aren't ready to have one or both breasts removed, make the decision to reduce their odds by opting for a breast reduction;  
(page 196) "the subcutaneous mastectomy, which leaves the nipple and outer breast skin intact.  It's a little better cosmetically." says Dr. Love, "But self-defeating, since it still leaves some breast tissue, which is as vulnerable to cancer as the tissue that's been taken away.  So it has much of the disfigurement of a whole mastectomy, without the guarantee that you won't get breast cancer, which is the sole justification for the operation." 
I concluded that the thinking is this; reducing the breast tissue, reduces the risk.  It sounds feasible, but Dr. Love disagrees with this conclusion because it leaves behind vulnerable breast tissue.  This makes sense, but at this point both reduction and mastectomy were not options I was ready to seriously entertain. However, I was beginning to understand the reasoning for those  decisions.  I continued reading and researching LCIS but close monitoring remained the only recommendation and option that I was comfortable with for now.
Importance of  Communication
The oncologist and I would discuss my situation at each visit.  He’d check my breasts for change and then we’d sit and chat.  I'd tell him what I'd learned from my research and he'd expound on these points, adding important information and subjective conclusions to clarify what I wasn't clear on.  He really listened to me.   I felt heard.  Between the oncologist and GP, I was doing everything I knew to do.  The time for my next follow-up quickly approached.
To be continued in part 3 of 5.....

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