1. In the recently publicized Breast Cancer Prevention Trial, the use of Tamoxifen reduced the incidence of invasive cancer for women considered at high risk of developing it. Women with lobular carcinoma in situ were eligible for the study, but women with ductal carcinoma in situ were not. Do you know why?
2. I was treated for DCIS with surgery and radiation. Is this a cancer? Do I check “yes” on forms when asked “Have you had breast cancer?” I tried to donate blood. I was told that I had to wait until 5 years after treatment even though my cancer was in situ. Why?
3. What is intraductal papilloma cancer? What are the treatments?
4. My sister (50 years old, white, generally good health) suffers from fibrocystic disease in her breasts. Her condition (which runs in our family) has been getting worse over the last 2-4 years. Her physician is now talking about a double mastectomy. Just what are her options? If she does not have the surgery, is there any danger of the tumors causing other health problems?
5. How often is fibrocystic change malignant?
6. What is Paget’s Disease and how does it form?

Carcinoma in Situ

In the recently publicized Breast Cancer Prevention Trial, the use of Tamoxifen reduced the incidence of invasive cancer for women considered at high risk of developing it. Women with lobular carcinoma in situ were eligible for the study, but women with ductal carcinoma in situ were not. Do you know why?

Lobular Cancer in Situ (LCIS) are small round cells inside the lobules of the breast and the lobules usually don’t have any cells inside them. LCIS does not grow into cancer but is only a sign that cancer is a possibility. Some experts believe LCIS isn’t even a precancerous condition. Having LCIS is a risk for breast cancer, similar to having a mother or other first degree relative who has had breast cancer. That is why these women are in the Tamoxifen study, along with other high risk conditions for breast cancer, but do not have breast cancer. As data continues to be analyzed with this study, it will become clearer whether Tamoxifen is a good choice for women with LCIS.

Ductal Carcinoma in situ (DCIS) is a lesion that can become invasive cancer or there are ductal cancer cells that have not grown outside of their site origin. This is the difference between the two types. Women with DCIS were not candidates for the study because they may already have cancer cells or the cells can become cancer, whereas, LCIS cells do not become cancer.

I was treated for DCIS with surgery and radiation. Is this a cancer? Do I check “yes” on forms when asked “Have you had breast cancer?” I tried to donate blood. I was told that I had to wait until 5 years after treatment even though my cancer was in situ. Why?

DCIS or ductal carcinoma in situ, is one form of breast cancer. Yes, you are a survivor of breast cancer. Giving blood on your part would cause a temporary anemia from the blood loss. Another reason may be that your blood may have antibodies that should not be transmitted to another. Call the blood bank in your community for additional information.

What is intraductal papilloma cancer? What are the treatments?

You are using some mixed terminology . . . Intraductal papilloma is a small wart-like growth on the lining of a duct in the breast. This is a non cancerous or benign condition. Intraductal papillomatosis is the same condition but there are many small warts. Intraductal papillary cancer is cancer within the ducts or one duct of the breast which has cells that have fingerlike projections. Intraductal carcinoma is most often called ductal carcinoma in situ (DCIS) or even sometimes called noninvasive or precancer. The papilloma part is describing the visual appearance of the cells under the microscope which I have already described as fingerlike projections.

The treatment may depend upon the pattern of the ductal cancer cells. One pattern is called micropapillary which looks like a finger sticking out into the center of the duct. Another pattern is cribriform which looks like punched out holes within the duct. The third pattern is comedo which is like a whitehead pimple that fills the duct. Some cases of DCIS have both the comedo and non-comedo patterns. Mastectomy was the treatment of choice since a cancerous duct may run through and intertwine a large area of the breast. More recently, the surgeon tries to remove the entire duct using a wide excision which also includes a rim of normal breast tissue. Some experts say that when DCIS is present, it is likely that more ducts are precancerous and believe a mastectomy should be the treatment. Studies show that mastectomy treatment gives a lower recurrence rate of cancer. Radiation used along with wide excision proved to have a lower recurrence than those treated with wide excision only. There seems to be a growing belief in using radiation with wide excision for certain cases of DCIS. Other cases need a mastectomy. The patient needs to know and understand the pathology report and discuss these options with the surgeon according to individual history and the extent of DCIS.

Fibrocystic Breasts

My sister (50 years old, white, generally good health) suffers from fibrocystic disease in her breasts. Her condition (which runs in our family) has been getting worse over the last 2-4 years. Her physician is now talking about a double mastectomy. Just what are her options? If she does not have the surgery, is there any danger of the tumors causing other health problems?

“Fibrocystic breasts” is a name given to conditions of the breast that are not cancer. The breasts may swell and become painful, especially at menstrual periods. Often the breasts develop a lumpy texture which sometimes becomes permanent. This lumpy condition is caused by normal changes within the glandular tissue and the milk ducts. It is common in women from age 20 to menopause when female hormones are at a high level. It is believed to be related to the response of the breast to hormones. Therefore, after menopause the fibrocystic activity lessens with reduced hormones in one’s body. The symptoms of lumpiness and breast pain vary in intensity and can be constant, so I understand your sister’s anxiety about her condition. The fibrocystic condition and changes are not precancerous as they were once believed to be, even though they may be noticeable lumps that can be confused with cancer. In some severe cases, certain drugs have been used to control the pain and swelling, such as Danazol or Tamoxifen. These drugs are rarely indicated because of side effects of the drugs and simply do not work for everyone. If your sister does want to proceed with surgery to relieve her symptoms, she must have all the information she needs about risks, dangers, and alternative options.

How often is fibrocystic change malignant?

Fibrocystic disease of the breast is a term that is very often misused and misunderstood. Fibrocystic changes in the breast are any changes in the breast that are not cancer. These problems could be lumpy breasts, painful or tender breasts and even swelling. These signs and symptoms have no relation to cancer. Late in the l980’s, the American College of Pathologists stated that fibrocystic disease does NOT increase the risk of cancer.

There is one breast condition that does suggest increased cancer risk called atypical hyperplasia that has been wrongly termed fibrocystic disease. Atypical hyperplasia are cells in the breast that are abnormal and increased in number. Women with atypical hyperplasia have an increased relative risk of 3.5 for breast cancer. If they have a family history of breast cancer the risk increases to 8-9. A woman who has been told she has atypical hyperplasia should be very committed to close follow-up. This means a yearly mammogram and a physical exam of the breasts every 6 months by a doctor or a certified health worker.

Paget’s Disease

What is Paget’s Disease and how does it form?

Paget’s disease is a form of breast cancer that first affects the nipple, then progresses to the areola, but rarely involves the surrounding skin of the breast. The disease presents itself as an itchy scaly skin on the nipple that looks like eczema. It never clears up and comes back like eczema but is persistent and is rarely found in both nipples. Itching, burning and hypersensitivity are frequently the first symptoms. A serous or partially bloody discharge is sometimes present.

Paget’s Disease is diagnosed with a biopsy of the skin. A mammogram must be done to see if the cancer is in the breast as it is sometimes associated with ductal carcinoma. Treatment depends upon the extent of the disease. If the cancer cells are only of the nipple, only the nipple and areola need to be surgically removed. This type is usually slow growing and has not invaded the lymph nodes. Sometimes a wide excision of the area and radiation is done without a mastectomy. If the cancer is invasive and present deeper in the ducts, a mastectomy of the breast is the treatment. The diagnosis of cancer is frightening but Paget’s Disease is very treatable.

There are two theories as to the origin of the disease. One is associated with invasive cancer inside the breast. The malignant cells originate in the parenchyma of the breast and migrate along the duct to the nipple epithelium. The other main theory is that the malignancy originates in the epithelium or the cells covering the nipple. The malignant cells arise in the epidermis from multipotent cells (cells that have the ability to become any of several mature cell types) in the basal layer that suggest a transformation of normal epidermal cells into Paget cells.

When any of the above symptoms occur, a mammogram is necessary to the see if cancer is in the breast itself. The skin on the nipple should be biopsied. Under the microscope cancer cells can be seen growing up into the skin of the nipple, which causes the itching, scaling skin. Sometimes Paget’s is associated with cancer inside the breast and sometimes it is only on the nipple and areola. Treatment is according to the origin of the disease.

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Go to the Breast Cancer health topic.