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Forum Name: Breast Cancer

Question: 35 y.o. female lump in rt breast post LAVH & starting HRT


 DKaylin - Tue Sep 02, 2008 2:06 pm

I had a total hysterectomy (LAVH/BSO) in 2002? due to endometriosis. I began HRT with p.o. hormones and later switched to transdermal hormone replacement. Soon after beginning transdermal hormones I noticed a lump in my right breast. I immediately stopped all forms of HRT and haven't taken any since then (approx. 4 years now). The lump has persisted and the margins are not well defined, however it is palpable and is best felt using a pinching method with the finger tips. It is thick and painful, especially if touched. I have had a mammogram and ultrasound that were both inconclusive. I am a R.N. in the operating room and one of the general surgeons I work with has suggested a needle biopsy while his partner suggests that I skip the needle biopsy, since the margins are so irregular, and have a lumpectomy. I realize that "most" forms of breast cancer are not painful, which is probably the reason I haven't been more proactive in seeking treatment thus far (which I acknowledge is not a very wise choice). Should I have the needle biopsy or go ahead with a lumpectomy?

Thanks in advance for your time
 Dr. Safaa Mahmoud - Tue Oct 14, 2008 7:08 pm

User avatar Hello,

Any woman presenting with a breast mass must be investigated properly considering breast cancer in the differential diagnosis.

There are 4 main factors when considering a history of risk factor. Those are age, prior history of breast cancer, history of benign breast disease, and family history of breast cancer.

Studies about hormone replacement therapy have been so conflicting. Studies have shown that cumulative (over years) absolute risk of breast cancer for women aged 40-79 falls with increasing age. Those who are on estrogen only hormone replacement or short term (less than five years) use of combined therapy aged 50 years or more, are not exposed to significant elevation in their cumulative absolute risk for breast cancer.

So, recent publications concluded that the cumulative absolute risk of developing breast cancer for women on hormone replacement therapy is not as high as previously assumed. The risk may also declines with discontinuation of therapy.

However, it is not correct to underestimate the additional cancer risk on those who continued to take hormone replacement therapy for long periods (more than 5 years and those received the combined form). So, the risk of any mass to be a cancer in these women can not be excluded unless all investigations are done. Investigations include, Mammography, US and FNA biopsy.

If a mammogram is abnormal, comparison with previous films is essential and ultrasound is recommended to further characterize the lesion.
In premenopausal women, if the mass is not likely to be malignant follow up is an acceptable approach by many physicians. If the mass persists after 3 months surgical consultation is mandatory. In postmenopausal women follow up strategy is not generally accepted and biopsy (FNA) is essential.

Any suspicious criteria by Mammography, US, or FNA, an open biopsy is recommended.

Considering also your positive family history for cancer, it is mandatory to exclude that this mass represents breast cancer.

I advise you to follow up with your doctor and to do mammographic and US comparison with previous studies. Surgical consultation is essential to evaluate the mass and a surgeon is the physician who will recommend FNA or lumpectomy. In general FNA biopsy is done and if not conclusive lumpectomy is recommended.

Hope you find this information useful.
Please keep us updated.
Best regards.
 DKaylin - Tue Oct 14, 2008 11:21 pm

Dr. Mahmoud, thank you so much for taking the time to respond to my post. I had another digital mammogram and ultrasound on Oct. 9th. The radiologist that reviewed my results told me that while the lump isn't suspicious for cancer it has in fact changed somewhat. First of all, it is larger and on one of the views "there is actually a distinct lump". On the previous mammogram the area was simply defined as an area of dense tissue. I'm not sure if the fact that the most recent mammogram was digital, and the first was not, has anything to do with these new changes; nonetheless I have decided to go ahead with a lumpectomy (scheduled for Oct. 24th) and I will keep you updated with the results.

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