Question: Question: I am currently 43. In July 2011 I was diagnosed with multifocal (7 focuses – largest 2mm – well differentiated – Grade 1 IDC and Tubular) with Extensive Intermediate DCIS and LCIS with Comedo Necrosis). My Oncotype score was 8 on the 2mm focus. I had a bilateral mastectomy with deep clean margins free of tumor per pathology, no positive nodes and a total hysterectomy. I now take Arimidex. Since my hysterectomy my ALP Phosphate level has run high first 85 then for the past year 105-115 consistently. My calcium is around 9.7-10.2. Prior to my surgeries my ALP was in the 60-70s and my calcium 9.2-9.7. My Oncologist explains this is due to high bone turnover from the hysterectomy and Arimidex. I also have Gilbert’s Syndrome. My current concern is for 3 months I have had pain on and off in pubic bone area. It is a dull pain…like a sore muscle. It does not hurt at night but sore when I wear tight pants or mostly after long walks/running or sit ups and squats. I have been working out with a trainer which was new as of 5 months ago. I saw a pelvic floor specialist who said internally it felt like a tight muscle possible due to estrogen depletion. I am concerned of course, that it is bone mets. I do not like to run for scans as they cause me anxiety and radiation. The pain may be present after a workout and then go away for 2 weeks. Do you feel this pain combined with my blood levels is cause for alarm. I have young children and do not want to be ignorant to symptoms. Please let me know. Thank you!

Thank you Doctor for your reply. Another point regarding multifocal breast cancer. When in the same quadrant, is it realistic to assume that each focus and DCIS & LCIS all are the same receptors? My 2mm was the largest any only one tested for receptor status. All pathology describes samples as “well differentiated without LVI”, but I have never really understood if that guaranteed same receptor status. DCIS was extensive, 4-5 cm with 20% DCIS and 10% LCIS of tissue, the focuses of invasive cancer were 2mm, 1.3mm, 1 mm, 1 mm and 0.8 mm. Considering all of my treatment was focused on the estrogen status I still worry that the other focuses were different more aggressive receptors. Thoughts?