My diagnostic testing revealed micro-calcifications & atypical hyperplasia. What exactly are these conditions? I was diagnosed with DCIS.

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ZevaHermanMD (Physician - Radiology (Verified) ) - 12 / 04 / 2011

Microcalcifications on a mammogram are a very common finding. They appear as tiny white specks or granules, composed of the element calcium. Most calcifications on a mammogram are perfectly normal and we just include them in the catchall diagnosis of "fibrocystic changes". They are not related to your dietary intake of calcium and you may continue with any dietary calcium you take.

Because cancer can lay down calcium, as well, it is the job of the radiologist to differentiate between the normal, innocuous calcium and the worrisome calcium. When calcifications are punctate and "round and regular" they can be dismissed. Calcifications within cysts are also normal. Calcifications which are potentially of concern are clustered, and their morphology is pleomorphic, appearing brached or irregular in shape, size and density. Clustered calcifications which are not definitively benign will either be watched at 6 month intervals, or biopsied. The best mode of biopsy for mammographic calcifications is a Stereotactic guided vacuum-assisted core needle biopsy. This is a minimally invasive needle procedure performed by the radiologist, or in some instances by a surgeon, that takes 20-40 minutes.

Results of this evaluation commonly are: normal (I won't go into all of those pathologic entities), ADH (atypical ductal hyperplasia), DCIS (duct carcinoma in situ), or invasive ductal carcinoma (IDC). Other important entities such as papilloma and radial scar will not be discussed here.

ADH is atypical cells. That means the pathologist visualizes abnormal cells, but they do not fulfill the criteria of cancer. ADH is significant because women with this diagnosis have an increased risk of breast carcinoma compared with the general population (about 4 times normal). If ADH is identified on needle biopsy, an excisional (surgical) biopsy is required to further evaluate this area. The tissue in this area is removed in order to see if there is any additional disease which was not removed by the needle sampling, such as DCIS or IDC, and to remove the remaining ADH. Statistically most women with ADH will never develop an invasive cancer, but they must be watched carefully because of the increased risk. Tamoxifen, an anti-estrogen drug, may sometimes be an option to reduce risk of breast cancer in these patients.

DCIS (duct carinoma in situ) is an early caner, stage 0. It is not a pre-cancer, it is an early cancer. It refers to cancer cells which are confined within the [basement membrane of the] duct. If cancer cells break through the basement membrane, it is refered to as IDC, invasive duct carcinoma. If DCIS is identifed on needle biopsy is must be surgically removed. The patient's prognosis is excellent. There are different subcategories of DCIS, some more aggressive than others. A women diagnosed with DCIS has an increased risk of developing a second DCIS later, or an invasive carcinoma. Because DCIS is confined to the ducts it should never metastisize or spread to other organs (but we never say never in medicine). Newer studies are characterizing DCIS by protein markers or genetics to identify the more aggressive ones, which have higher risk of the patient developing an invasive cancer in the future. Medical treatments such as Tamoxifen can be considered. Mastectomy is indicated in a small number of cases including depending on the size of the DCIS and the family history. Your diagnosis of DCIS supercedes your diagnosis of ADH, so there is no reason to mention the ADH. Your diagnosis is DCIS.

Good luck, I am confident you will do fine!
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