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Breast Cancer

Possible high risk, should I get a biopsy?

03/06/2008

Question:

Hi. I understand that there is a link between ovarian cancer, melanoma, and breast cancer. My sister died six years ago at the age of 42 from ovarian cancer. My aunt died in her late 40`s/early 50`s of ovarian cancer also. I just had a biopsy on foot for a possible melanoma - came back with atypical cells. I`m 41 - my first mammogram was 4.5 months ago - followed by an ultrasound due to dense breast - they found a hypoechoic nodule close to chest wall( they think probably benign). I`m due for my follow up sonogram, and I trying to decide about getting a biopsy of the breast nodule - even if there are no changes just because of my family history and the fact that atypical cells were found in what they thought was a melanoma. If atypical cells were found there, do I have a higher chance of them being found elsewhere in body? So, in your opinion, would a biopsy be advisable and if so, what type?

Answer:

Ovarian cancer is a rare tumor, and to see 2 cases diagnosed at early ages is certainly suspicious for Hereditary Breast and Ovarian Cancer Syndrome, and there is an even higher risk of this syndrome in certain groups (Ashkenazi Jewish individuals, for example).  As you point out, this syndrome is associated with an increased risk of breast and ovarian cancer and melanoma can also be seen at increased frequency.  I certainly think that a genetic counseling session is in order.  It is always preferable to start genetic testing in someone affected with cancer who is still living, but not always possible.  You can find a counselor in your area at the following website:  www.nsgc.org.  In terms of the biopsy question, probably benign lesions are often followed with serial exams (mammograms or ultrasounds), so I think that if the lesion is not changed, it may not require biopsy.  Having said that, you may very well be at increased risk for breast cancer, and it may give you peace of mind to have the biopsy. 

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Response by:

Doreen M Agnese, MD Doreen M Agnese, MD
Clinical Associate Professor of Surgery and Internal Medicine
College of Medicine
The Ohio State University