Concerns About A1 Stage Breast Cancer Follow-Up Findings

Annual examination for Stage A1 ductal carcinoma in situ (DCIS) reveals issues?

Hello, doctor.
My wife was diagnosed with Stage A1 tubular carcinoma in April 2023, with a size of 1.8 cm, ER/PR both at 90%, FISH negative, no lymph node involvement, and a Ki-67 of 8.
The malignancy index is 1.
After undergoing a lumpectomy and radiation therapy, she received hormone therapy and underwent a follow-up mammogram one year post-surgery.
The doctor informed us that the breast ultrasound, abdominal, and chest scans showed no abnormalities, but the mammogram revealed suspicious calcifications.
The doctor mentioned that these calcifications were present at the time of her initial diagnosis (a mammogram was performed before the surgery last year) but were classified as requiring only monitoring.
This year, the mammogram indicated a possible increase in the calcifications, raising concerns about residual cancer cells that may require further surgery.
If malignant, a total mastectomy would be necessary.

We understand the need to confirm whether the calcifications are benign or malignant, but we have some questions:
1.
We have been taking our medications on schedule and completed radiation therapy (20 sessions).
Why would the original calcifications show changes? Does this indicate that the treatment was ineffective?
2.
If the calcifications are indeed multiple, would this change the stage and type of the tumor? Would the treatment approach also change?
3.
Does this indicate a recurrence or metastasis? Has her condition worsened?
Thank you for your guidance, doctors.
This situation has been quite distressing, making it hard to eat or sleep.
We thought that Stage A1 tubular carcinoma would not lead to recurrence so quickly.
We sincerely request your explanations.
Thank you very much.

Nìmíng, 40~49 year old female. Ask Date: 2024/04/11

Dr. Yuan Tianmin reply Breast and Thyroid

The primary physician of your wife is the one who understands her condition best, so it would be more beneficial to discuss these questions with him for accurate answers.
If you wish to have another consultation, it may be necessary to bring your wife's complete medical records to receive appropriate responses.

Reply Date: 2024/04/11

More Info

Dear Patient,
I understand that you are facing a challenging situation regarding your wife's recent follow-up findings after her diagnosis of Stage A1 lobular carcinoma. It’s completely normal to feel anxious and concerned about any changes in her condition, especially after undergoing treatment. Let’s address your questions and concerns one by one.

1. Why are there changes in the calcifications despite treatment?
Calcifications in the breast can be benign or malignant, and they can change over time. The presence of calcifications does not necessarily indicate that the treatment was ineffective. In some cases, calcifications may remain stable or even increase in number due to benign processes, such as fibrocystic changes or other non-cancerous conditions. However, it is also possible for calcifications to represent residual cancerous cells, particularly if there has been a change in their appearance. It’s important to remember that treatment, including surgery and radiation, aims to eliminate cancer cells, but it does not guarantee that all cells are eradicated. Regular monitoring through imaging is crucial to assess any changes.

2. If multiple calcifications are found, will the cancer stage or type change?
If the calcifications are determined to be malignant upon further investigation, it could potentially change the staging and treatment plan. The presence of multiple calcifications may suggest a more extensive disease process, which could lead to a reassessment of the initial diagnosis. However, it is essential to conduct a biopsy or further imaging studies to determine the nature of these calcifications. The treatment approach may also change depending on the findings. For instance, if it is confirmed that there is residual cancer, your wife's oncologist may recommend additional surgery, chemotherapy, or targeted therapies.

3. Does this indicate a recurrence or metastasis?
The appearance of new or changing calcifications does not automatically indicate a recurrence or metastasis. Recurrence refers to the return of cancer after treatment, while metastasis involves the spread of cancer to other parts of the body. The calcifications could be a sign of residual disease or a new primary lesion, but definitive conclusions can only be drawn after further diagnostic procedures. It is crucial to follow up with your healthcare team for additional imaging or biopsies to clarify the situation.

In summary, while the presence of new calcifications can be concerning, it is essential to approach this with a comprehensive evaluation. Your wife’s healthcare team will likely recommend further imaging, such as a targeted ultrasound or a biopsy, to determine the nature of the calcifications. It’s important to maintain open communication with her oncologist and to express your concerns during follow-up appointments.

I understand that this is a stressful time for both you and your wife. It’s important to take care of your mental health as well. Seeking support from friends, family, or support groups can be beneficial. Remember, early detection and intervention are key in managing breast cancer effectively.

Please do not hesitate to reach out to your healthcare provider with any further questions or concerns. They are there to support you and provide the best care possible.

Best wishes for your wife’s health and recovery.

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