Wondering about something

Martha Anne · Posted: Sun Nov 28, 2004 5:50 pm Post subject: Wondering about something

I was thinking about mammograms and you know how they really press down hard on the breast making them as flat as possible? It is painful and it is a lot of pressure. And sometimes they have to do it mulitple times.
Well, I was thinking, if you had a DCIS that was still safely IN SITU could a mammogram's pressure push it so it breaks through the duct?
My path was a DCIS AND IDC. So I always assumed that had I caught it early I would have a better prognosis. But if a woman has just a plain contained DCIS that is forced out of its containment just from the mammo could that be why some women do much better than others? Meaning that they didn't have as aggressive a cancer as assumed- it was just made to look that way.
What do you think Dr. Leo?

Minnlady13 · Posted: Sun Nov 28, 2004 6:54 pm Post subject: Re: Wondering about something

Hi Martha Anne, I'm sure Dr. Leo will respond to your questions, but I've never heard of a mammogram procedure causing cells to rupture. I know that they squish you really hard and flat, but I would really be surprised if something happened that was not supposed to. If you are really concerned, talk to your doctor about an ultrasound. Neither proceedure is foolproof, but are better than not having any diagnosistic tests done. Just my 2 cents. Lauri

AlaskaAngel · Posted: Sun Nov 28, 2004 9:51 pm Post subject: DCIS... mammogram... -> IDC...

It is nice to know I am not the only one to suppose this is possible.

Mammograms have been around a lot longer than much knowledge about DCIS, what it is, what it does, and what it doesn't. And mammograms are so well established that it is pretty hard to get anyone to consider change even if it IS in everybody's best interest.

(Consider how long it took science to get a better idea about the danger of estrogen replacement therapy.)

I don't think anyone has ever collected the statistics to find out whether mammos cause DCIS to be squished out of the ducts or lobules, and if it does, whether it then sends out signals to stimulate angiogenesis and the subsequent development of IDC or lobular cancer. (Not to mention the cumulative effects of annual rads from the mammograms.)

Studies are already demonstrating that MRI and not mammograms should be used for women at high risk with dense breasts. MRI's are more expensive in the short run, but early detection for such woman with MRI is cheaper in the long run (not to mention more humane).

AlaskaAngel

leo · Site Admin Joined: 23 Sep 2004 Posts: 1574

Hello

There are theoretical risks of causing the malignant cells to migrate when you push the tissue surrounding it. But it is a matter of risk/benefit ratio, meaning that there is so much information that can be gained from a mammogram, and there is little if any evidence out there about the risk of cells migrating when you squeeze the breasts. Sure, MRI is an alternative, but if we just stop doing mammograms and start doing MRIs on everyone we will have to sell our houses to pay the insurance bills.

regards,
Leo
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AlaskaAngel · Posted: Mon Nov 29, 2004 1:12 am Post subject: Re: Wondering about something

As noted, the studies that support the use of MRI are in regard to those women at high risk, with dense breasts. This is not the entire population of women receiving mammograms, just those most likely to present the highest risk. Early detection is of significant economic value; the larger a cancer is, the greater the $ expense of treatment.

Again, current science seems uncertain whether or how DCIS progresses to IDC or lobular carcinoma. Unless someone does a study of breast tissue to find out if squishing it and radiating causes DCIS to break through the duct walls or lobule walls and then lead to IDC or lobular cancer I wouldn't be the one to pooh-pooh the notion out of hand. If we aren't willing to consider the possibilities we are more likely to see the 1 in 8 women who get breast cancer become 1 in 7 and then 1 in 6....

And that truly would raise the cost of our insurance.

A.A.

Muttsmom · Posted: Mon Nov 29, 2004 2:55 am Post subject: Re: Wondering about something

The last report I saw said that it is down to 1 out of every 7 women will get BC in their life time. When I was dx in 2/02, it was one out of 9, so every year it is becoming more and more likely that more and more women will get this disease. I wonder how much lower it will go, I mean the odds against women.
Nancy

penelopez · Senior User Joined: 11 Oct 2004 Posts: 165

Hi,

But then we're still left with the problem of the biopsies. Who knows if when they stick the needle in it stirs everything up to the extent of spreading cancer cells? Or maybe the surgeon just isn't careful enough about the procedure?

Margie

Muttsmom · Posted: Mon Nov 29, 2004 10:11 am Post subject: Re: Wondering about something

Leo may need to correct me on this 1st part, but I'm almost positive I'm right on it. A needle biopsy can still miss cancer cells unless several area of the tumor/mass are taken and get right where there are cancer cells.
I asked my surgeon and my onco about always hearing that once they open you up, like for an incisional biopsy, that when air hit it, it spread. They both told me that "urban legand), for lack of a better word has been told for years and years and there in absolutely no truth to it.
Take care
Nancy
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Nancy
2/14/02 ILC 43 - 5.5 cm 9+/16 nodes
Stage IIIA er/pr+ Her2-
2/02 MRM
FECx6 radsx33
Tamoxifen - Arimidex (chemo induced menopause)
4/03 SM w/bilat. recon.
9/03 expanders removed
5/04 repair reconst. disaster
10/04 Actonel for bone/joint pain from Arimidex
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In memory of Kim 12/1/04

penelopez · Senior User Joined: 11 Oct 2004 Posts: 165

Yes, I had the fine needle biopsy and it came back negative for cancer. But my surgeon INSISTED that we go in anyway and do the excisional. And to think I almost cancelled the excisional. I almost cancelled it because back then I knew absolutely NOTHING about BC and I thought if the fine needle says negative, then I must be fine and why not live with a benign tumor? That was back in my days of total ignorance. Scary.

Hugs,

Margie

AlaskaAngel · Posted: Mon Nov 29, 2004 12:26 pm Post subject: Challenges

Unfortunately breast cancer is a complicated disease, and the vast majority of those of us with bc do not know enough about it at the time of diagnosis. I didn't.

Medical specialization is contributing to the problem. Most practitioners we see have little ability to coordinate overall treatment for a disease that directly affects primarily females. How many oncologists or radiologists have had breast cancer? They expect the GP, the internist, or the OB-GYN to handle the problems with the rest of the body that result from chemo or rads. But the GP, the internist, and the OB-GYN who acknowledge that these things affect the endocrine system stand back and do nothing about the endocrine problems that are a direct result of chemotherapy or rads.

IF estrogen and and and an increasingly estrogenic environment coupled with heredity are major reasons for the development of breast cancer, then isn't it an endocrine disease? We usually see a GP, internist, or OB-GYN for monitoring the breast, who refers us to the radiologist (who often never sees us in person) and we are then referred to a surgeon. If the surgeon finds breast cancer we have surgery and are referred to the oncologist, who doesn't deal with endocrine problems, psychological issues such as sexuality and reproduction, or much of anything other than chemotherapy and radiation and sometimes death. Very rarely do any of us see an endocrinologist, and by the time we do it is only after more damage has been done to the endocrine system and the immune system. How often are we referred to an immunologist to help us figure out what we have left to work with after chemotherapy and rads?

The chain of command used to deal with breast cancer just might not make a lot of sense.

Martha Anne · Posted: Mon Nov 29, 2004 10:45 pm Post subject: Re: Wondering about something

I hope this posts! I have been trying to respond to my own post since last night! LOL!

First, THANK YOU for all your responses.

I must say I think I think the most like AA here. But I want to clarify I wasn't asking the question to avoid a mammogram but rather to think out of the box a bit. Why is it some women do wonderfully well and others with the same pathology do not?

In thinking about my own case I had (in the same tumor) both DCIS and IDC. Couldn't it be possible that the extreme pressure of the mammogram plates repeatedly pressing on me have pushed my DCIS out of its duct so that by the time I was biopsied it appeared as DCIS AND IDC? You might say I am trying to do a little wishful thinking here too because that would indeed mean a much better prognosis for me.

For those who may remember- I am the one awaiting the MRI on my pelvis that the CAT scan picked up the the Sclerotic Foci. I finally have my date! December 2nd and I am trying to think as many positive things as possible because I am worried to death it is mets.

As for the needle biopsy I have always fretted that as they are pulling the needle out they are seeding the entire breast with loose cancer cells! That is if they can find the cells to begin with!

I think the answer to the question here would be if there was a study done on women who have been diagnosed with DCIS and who want a mastectomy. If, after they remove the breast, before they send it to pathology they could somehow recreate the pressure caused by a mammogram and see if indeed the DCIS can break through the ducts.

I don't think anybody will be signing up for that experiment too soon but I think it would be worth it!

And yes! We are now 1 in 7- isn't that awful!!!!

Blessings to you all,

Martha Anne

leo · Site Admin Joined: 23 Sep 2004 Posts: 1574

Wonderful thread. Lots of thoughts.

It is true that a needle biopsy (fine needle and core biopsy) can miss a malignant nodule. Each of these procedures have sampling errors associated with it. It is something that physicians are aware, and it is useful when it is positve since it then can dictate the treatment. When it is negative it can not rule out disease, and therefore often it has to be repeated OR an excisional biopsy has to be done.

About the other comment on the rising prevalence of breast cancer. There are many confounding factors that may be causing that increased frequency. For example, our methods of detection are better nowadays, so we end up detecting more breast cancer. Another important fact is that people are living longer, so the lifelong risk of a 90 yo developing breast cancer is much higher than the lifelong risk of a 60 yo. Also, people are having children later in life, which has also been cited as a risk factor. But the increased prevalence is a combination of multiple factors.

regards,
Leo
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Disclaimer: this information is for informational purposes only. It is not medical advice.

lbenham1@netscape.net · New User Joined: 29 Nov 2004 Posts: 2

I am new to this site. I am glad to see that I am not alone in my fears of DCIS somehow escaping and becoming invasive. I tend not to talk about my DCIS because it somehow doesn't seem as dramatic as IDC -- I'm going for my six month check and mammogram next month and I fear that they did not get all of the DCIS out or that some had migrated to other places. I didn't have radiation. How does everyone feel about DCIS without radiation? I keep hearing different thoughts on this.
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Partial Mastectomny 6/04
Tamoxifen

AlaskaAngel · Posted: Tue Nov 30, 2004 2:44 pm Post subject: Re: Wondering about something

Thank you for thinking outside of the box too--

I started out with a surgeon who waited through 3 separate recommendations for biopsy before she would do one... and I am miles from any alternative surgical clinic where I live in Alaska....

At any rate, I question if she compounded things when she actually attempted to biopsy from the opposite side of the breast.... this would mean she potentially would drag any cells across the breast as she withdrew the needle... along with attempting the direct entry.

I switched surgeons with the help of a very good internist here... and the surgeon I had was wonderful.

But I still wonder....

A.A.

Donnabell · New User Joined: 28 Nov 2004 Posts: 3

I personally believe or should say "know" that the compressions from mammograms can cause the ducts to rupture and spill the dcis into the breast tissue. Although it did happen to me, I still believe that it is rare. I did find an article on this with bcaction.org (Newsletter #3 Cool

. You could do a search on the "dangers of mammograms" for alittle more information also.
I remember telling my husband after going through the torture of all those mammos that I would never go through that again. I really didn't intend to lose both breast to avoid future mammograms!!
I hope the information is helpful and I don't mean to scare anyone from having their routine mammograms. I wished I had known more before all of this happened to me.

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