Family Breast Cancer: Key Questions and Insights

Q: Family Breast Cancer: Key Questions and Insights

The pathology report from your biopsy is quite rare for me, so it may be necessary to discuss the results in conjunction with the final postoperative pathology report with your physician and the pathologist. <br>I also have limited experience with tumors of this type, so I cannot

Family history of breast cancer?

Dear Doctor,
Family's medical condition description: My mother had a mammogram and fine needle aspiration at a clinic last year, where the doctor noted an abnormal area (Tumor 1).
At that time, there was suspicion of ductal carcinoma in situ, but later we went to Hospital A for a core needle biopsy, and the doctor reported it as benign, indicating inflammation only.
In May of this year, my mother returned to Hospital A for a routine check-up, and the doctor found another abnormal area in the left breast (Tumor 2), which was small and recommended observation.
She returned for a follow-up at the end of August, where the doctor suggested proceeding with a core needle biopsy.
The biopsy results indicated a malignant tumor with neuroendocrine differentiation (the core needle biopsy report will be attached below).
However, the doctor mentioned that such tumors typically do not occur in the breast, so he recommended a full-body examination to rule out the possibility of metastasis from another site.
If no issues were found elsewhere, it would be considered a primary neuroendocrine tumor of the breast.
We later chose to go to Hospital B for additional opinions.
The physician at Hospital B recommended immediate surgical removal (to excise all visible tissue, regardless of its condition) and sentinel lymph node biopsy.
The results confirmed that the lymph nodes were clear, and all tumors were less than 0.5 cm.
The doctor confirmed left-sided breast cancer, but due to the presence of neuroendocrine cells, there was a discussion with an internal medicine physician, who stated that this was unrelated to the neuroendocrine system.
The doctor only mentioned that this is very early-stage cancer, without specifying the stage or type of breast cancer, and advised that, although chemotherapy is not necessary, radiation therapy is still required.
I would like to ask:
1.
Does this count as stage 0 breast cancer?
2.
Based on the core needle biopsy report from Hospital A, is this considered triple-negative?
3.
Why is an abdominal ultrasound and CT scan needed before radiation therapy?
4.
In this situation, is it advisable to perform a total mastectomy to prevent recurrence?
—Below are the core needle biopsy results from Hospital A—
DIAGNOSIS: MALIGNANT INVASIVE TUMOR WITH NEUROENDOCRINE DIFFERENTIATION, see Note, breast, left, echo-guided core needle biopsy
(1) Combined histological grade: II (nuclear grade: 2)
(2) ER: (-) & PR: (-) & HER 2/neu: negative (0)
GROSS DESCRIPTION: The specimen is composed of three fragments of tissue measuring 1 x 0.4 x 0.1 cm in aggregate.
They are tanish brown.
All are submitted in one cassette.
MICROSCOPIC DESCRIPTION: Section shows a picture of invasive epithelial tumor in the breast composed of tumor cells in papillary, cords, or trabecular structure (combined histological grade II; tubule formation: score 3, nuclear pleomorphism: score 2, mitotic rate: score 1).
Tumor cells have salt-and-pepper nuclei.
No ductal carcinoma in situ is present in the specimen.
No evidence of tumor emboli in vascular or lymphatic spaces is found.
Immunohistochemical study shows the tumor is diffusely positive for synaptophysin and negative for TIF-1.
TRPS1, GCDFP-15, and GATA3 show equivocally focal staining.
Note: A primary breast neuroendocrine tumor is possible.
However, metastasis from other origins cannot be ruled out.
Clinical survey is recommended.
IMMUNOHISTOCHEMICAL STUDY
1.
ER (Estrogen receptor): Negative (<1%) (Internal control: positive) (Antibody: Ventana, clone SP1)
2.
PR (Progesterone receptor): Negative (<1%) (Internal control: positive) (Antibody: Ventana, clone 1E2)
3.
HER-2/Ncu: Negative (0) (scored by 2018 CAP guideline) (Antibody: Ventana, clone 4B5)
4.
Ki67: 15-20% nuclear staining in invasive tumor cells (Antibody: Genemed, Ventana, clone 30-9)
5.
P63: Negative around invasive tumor cells.
6.
SMMHC: Negative around invasive tumor cells.
I sincerely apologize! Since we have not seen the pathology report after the tumor removal at Hospital B (it is possible my mother did not actively request to see it), we can only provide the core needle results from Hospital A.
Thank you for taking the time to review this, and I appreciate your answers.
Thank you (this is the first time encountering such a situation, and without a medical background, I may have many questions; I truly apologize).

Jess, 20~29 year old female. Ask Date: 2023/10/15

Dr. Yuan Tianmin reply Breast and Thyroid

The pathology report from your biopsy is quite rare for me, so it may be necessary to discuss the results in conjunction with the final postoperative pathology report with your physician and the pathologist.
I also have limited experience with tumors of this type, so I cannot provide you with a complete answer.

Reply Date: 2023/10/15

More Info

Understanding family history and its implications for breast cancer risk is crucial, especially when there are multiple instances of cancer within a family. Your mother's recent diagnosis and the complexity of her condition raise several important questions regarding breast cancer, its treatment, and the potential risks for family members.

1. Is this considered stage 0 breast cancer?
The term "stage 0" typically refers to ductal carcinoma in situ (DCIS), which is a non-invasive condition. However, based on the information provided, your mother's diagnosis includes an invasive tumor with neuroendocrine differentiation. This suggests that the cancer has invaded surrounding tissues, which would classify it as at least stage I or higher, depending on the size and extent of the invasion. The specific staging would depend on additional details such as tumor size, lymph node involvement, and metastasis.

2. Is this triple-negative breast cancer?
Triple-negative breast cancer is characterized by the absence of estrogen receptors (ER), progesterone receptors (PR), and HER2 protein overexpression. According to the report from hospital A, your mother's tumor is negative for ER, PR, and HER2, which classifies it as triple-negative. This type of breast cancer tends to be more aggressive and has fewer treatment options compared to other types, making it essential to discuss targeted therapies and treatment plans with her oncologist.

3. Why are abdominal ultrasounds and CT scans needed before radiation therapy?
Pre-radiation imaging studies, such as abdominal ultrasounds and CT scans, are often performed to ensure there is no metastasis to other organs, particularly the liver and lungs. These scans help in staging the cancer accurately and determining the appropriate treatment plan. They also provide a baseline for monitoring any changes in the future.

4. Should a total mastectomy be considered to prevent recurrence?
The decision to undergo a total mastectomy versus a lumpectomy (breast-conserving surgery) often depends on several factors, including the size and location of the tumor, the patient's personal preferences, and the oncologist's recommendations. Given your mother's diagnosis of an invasive tumor, a total mastectomy may be considered to reduce the risk of recurrence, especially since she has a family history of breast cancer. However, this decision should be made collaboratively with her healthcare team, considering the potential benefits and risks of each surgical option.

In addition to these specific questions, it is essential to consider the broader implications of family history on breast cancer risk. Individuals with a family history of breast cancer, particularly first-degree relatives (such as mothers and sisters), may have an increased risk of developing the disease themselves. Genetic counseling and testing for BRCA1 and BRCA2 mutations may be advisable, as these mutations significantly elevate the risk of breast and ovarian cancers.

Regular screenings, including mammograms and clinical breast exams, are crucial for early detection, especially for individuals with a family history of breast cancer. The American Cancer Society recommends that women with a family history of breast cancer begin annual mammograms at an earlier age than the general population, often around 10 years before the age at which their relative was diagnosed.

In conclusion, navigating a breast cancer diagnosis within a family context can be overwhelming. It is vital to maintain open communication with healthcare providers, seek second opinions when necessary, and consider genetic counseling to better understand personal risk factors. Regular screenings and proactive health management are key components in addressing breast cancer risk for both your mother and family members.

Similar Q&A

Understanding Breast Cancer Risk: Genetics vs. Lifestyle Factors

Hello Doctor, my father is 82 years old. Last August, he discovered a lump near his chest close to the armpit, but he did not pay much attention to it at the time. It wasn't until early January this year that he went for a biopsy, which revealed breast cancer. The doctor did...

Dr. Yuan Tianmin reply Breast and Thyroid
Your father is elderly and has pre-existing lung issues, so the doctor may not recommend a more standard treatment approach. However, I personally suggest that the tumor should at least be removed, as it could potentially bleed and lead to ulceration of the wound, making care mor...

Understanding Breast Cancer Diagnosis and Family Risk Factors

Hello, about a month ago I was diagnosed with breast cancer. Two weeks ago, I underwent a left modified radical mastectomy at Chang Gung Memorial Hospital. I have now received a pathology report, and when I asked my doctor, he didn't say much, only mentioning that it is stag...

Dr. Zhou Jiazhen reply Breast and Thyroid
Dear Ms. Chien: 1. For Stage III C, which is classified as locally advanced breast cancer, there is a high likelihood of metastasis. Chemotherapy is necessary, and the tumor size ranges from 2 to 5 cm, with lymph node involvement exceeding 10 nodes. However, I have not seen any ...

Understanding Breast Cancer Risk and Evening Primrose Oil: What You Need to Know

Hello, my mother had a liver tumor (which has been surgically removed) and later was diagnosed with breast cancer (which was not metastatic and has also been surgically removed). Does this indicate a potential hereditary risk for breast cancer? I read online that individuals with...

Dr. Cai Yonglong reply Obstetrics and Gynecology
Dear Mia, The term hereditary breast cancer is currently understood in the medical field as being associated with the presence of BRCA1 or BRCA2 genes. However, these genes are generally not used as screening tools since they account for a relatively small proportion of breast c...

Understanding Family History of Lung Cancer: Key Definitions and Guidelines

Hello, doctor. Thank you for your response to my previous question; I will return for my report. I would like to inquire about the definition of a family history of lung cancer. I am 41 years old, do not smoke or drink, and would like to understand the definition of family histor...

Dr. Zhou Ziguang reply Pulmonology
Hello: Question 1: The Ministry of Health and Welfare defines a family history of lung cancer as having a parent, child, or sibling diagnosed with lung cancer. Can I use this standard to assess whether I have a family history of lung cancer? Answer: 1. According to the National H...