New here; suspicious mammo results, ack!!!!!!!! [edited]

bluephoenixx · New User Joined: 10 Jul 2007 Posts: 9

Hello, everyone.

I'm 45 (female). I recently had my second mammogram last month. First one was in '99 (unilateral) after finding a "lump" which turned out to be what I was told was a simple fluid cyst on my right upper breast, confirmed with ultrasound. At the time, they told me there was nothing to worry about and to just go home, everything was fine. The reasons for the eight-year lapse are multiple; no insurance for a long time, not wanting to experience that kind of fear again nor expose myself to excessive radiation, assurances that 90% of any lumpiness is always benign, I was too young to worry about cancer yet, etc.

This time, they did several digital x-rays, since my newer doctor noted a "mass" in the same area I had the cyst years ago. On palpation and self-exam, the area didn't change much except it feels like the cyst was smaller. Here are the radiologists' reports from the mammo and ultrasound:

Digital mammography bilat w/CAD.
Assessment code: suspicious mammo-ca++
Follow-up code: biopsy

Comment: bilateral digital mammography is performed in the craniocaudal and mediolateral oblique projections. Additional spot compression views of the right upper outer breast were obtained in the region of a palpable abnormality.

The breast tissue is heterogeneously dense. This may lower the sensitivity of mammography.

There is a grouping of pleomorphic and suspicious microcalcifications in the upper outer right breast corresponding to the palpable site. Biopsy is recommended. In addition, ultrasound may be useful to determine whether there is an associated mass as dense breast tissue may obscure a lesion.

R2 computer-aided detection (CAD) analysis was performed and used in the interpretation of this mammography examination.

Conclusion: MICROCALCIFICATIONS IN THE UPPER OUTER RIGHT BREAST CONCERNING FOR MALIGNANCY (BIRADS-4). BIOPSY IS INDICATED.
~~~~~~~~
Ultrasound (unilateral), Conclusion:

1. The palpable abnormality is a simple cyst.

2. There remains a group of pleomorphic calcifications in the right breast and magnified views are recommended. [Actually, I just called the breast center to get some answers, and they're going to set up an appointment for these additional views.]
*******************************************

My confusion on it is thus: First, don't these radiologists talk to each other?! One reads the mammo; one reads the sonogram. Second, why would my doctor jump the gun and immediately recommend a biopsy instead of considering extra views first?

My questions: Can a sonogram pick up calcifications very clearly? Can you have calcifications inside a cyst, and what can that mean? Should I go ahead and schedule a biopsy AND do the additional views, or wait and see what the next reports say?

Other notes: my mother died this January of metastatic ovarian cancer. Only close female relatives with breast cancer are my paternal grandmother. ***EDIT (new info today): My grandmother was 77; my aunt was 40, and it was found on her very first mammogram--a 2 cm invasive lobular carcinoma w/out lymph node involvement; she had a mastectomy due to the size of it (back in 1994) and then developed atypia in the other breast eventually and opted for a mastectomy on that side, too.*** Both relatives were smokers for many years. I am childfree and have never smoked. Thyroid disease is quite strong on my mother's side; I've had Hashimotos for years. I'm not that much overweight (maybe 15 pounds), and live in the northern California Bay Area--supposedly one of the 'dangerous' areas in the U.S. for a higher percentage of breast cancer cases.

Naturally, I'm scared nearly out of my wits. I have Susan Love's breast book, Bosom Buddies, and several other general women's health books, and of course there's always the 'net ( Shocked

) -- which can be frightening at times, I admit. I'm glad we have these forums, however! Any advice or helpful comments would be greatly appreciated, and TIA.

brainman

Ok, starting from the beginning: I am glad you have already had a mammogram and that you obviously asked for a copy of the test results!! So few people do that and therefore do not have some of the vital information they need for an informed decision.

Q: "don't these radiologists talk to each other?"
A: Usually, yes. They at least read each other's reports.

Q: "why would my doctor jump the gun and immediately recommend a biopsy instead of considering extra views first?"
A: The simple answer is: Better safe than sorry. They want to find out if it is cancer as soon as possible. The more complex answer is scheduling all the scans and the biopsy. It may be that they WILL have the results from the additional scans before the biopsy.

Q: "Can a sonogram pick up calcifications very clearly?"
A: I do not know how well a sonogram can detect calcifications but I do think that a sonogram can detect them. My answer is not that I doubt that a sonogram can detect them it is that I do not know how small of a calcification it can detect.

Q: "Can you have calcifications inside a cyst, and what can that mean?"
A: The simple answer is that I do not know the answer Smile

. However, as I interpret the test results, the microcalcifications are not in the cyst but in the same area. I think the doctors are rather certain that the lump you feel is a "simple cyst". However, the microcalcifications might be signs of cancer and therefore a biopsy is warranted.

Q: "Should I go ahead and schedule a biopsy AND do the additional views, or wait and see what the next reports say?"
A: ABSOLUTELY!!! You do not know how long it will be before the doctors can actually do the biopsy nor how long it will take to get the additional tests. So do at least start the scheduling process as soon as possible!

I am sorry to hear that your mother died of ovarian cancer! I am sure that fact increases your anxiety about your prospect of having cancer as well. However, the good news is that breast cancer when found early is a lot easier to cure than most other cancers.

I am sure that Nancy and other women will also respond to your posts with better information. I just hate to see anyone not receive a prompt reply. I will keep you in my thoughts and my prayers. Keep us informed.
_________________
Jim
Site Administrator and long-term cancer survivor
1992 Astrocytoma grade 2, left motor strip
2005 Recurrence this time said to be an Oligodendoglioma grade 3, same location.
My Story Part 1: http://cancerforums.net/viewtopic.php?p=7350
My Story Part 2: http://cancerforums.net/viewtopic.php?t=8029
Blog http://jimhawkinsport.blogspot.com/

Muttsmom

Hi,

I'm sure my brain won't remember everything, but I'll try Smile

1st - NO test can tell if it's cancer or not, just if there is something "abnormal" and depending on what they see, a good radiologist can have increased cause for concern. The only way to know if a lump is cancerous or not, or if microcalificaitons are cancerous or not is by removing the lump/cluster and have it sent to pathology. The one that's recommending a biopsy is ABSOLUTELY right.

Age, family hx, plays a roll, but a very small one. I was 43, no hx of any kind of cancer in my family. I was dx Stage III (bio at bottom). This is not to say that you have cancer, but I was told to come back in a year, I was fine, it was "just a cyst". Well, the "cyst" ended up being a 5.5 cm tumor. I didn't have a year to wait and thank God I called a surgeon myself, but the radiologist that read your mammogram is telling you to have a biopsy.

Someone gave you some bad info 8 years ago. There is no such thing as too young. I've met ladies that were in the 20's, 30s and 40s and they weren't the exception, there are many of us unfortunately. Did they do a needle biopsy and get fluid out of the lump and the lump completely disappeared? They can't tell by a US or mammogram if it's a fluid filled cyst. I know that 1st hand. Also, I don't know what the latest stats are, but about 10 years ago, it was said that 80% of lumps were B9, but I'm sure now since the odds of being dx with BC, the number is probably more like 75%. Those are still good odds, but when it comes to our lives, it's not time to play the odds.

I too am very sorry to hear about your mom. I have no doubt that she would want you to be pro-active and do what needs to be done to know for sure if it's cancer or not. If it's not, celebrate. If it is, we'll be here to help you through.

Please let us know what you biopsy shows and as long as it's been going on, I'd get it ASAP.
_________________
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
NED - 5 years
3/07 Diabetes
In memory of Kim 12/1/04

bluephoenixx · New User Joined: 10 Jul 2007 Posts: 9

(How the heck do you reply to an individual's comment in here??)

Muttsmom:

[quote]1st - NO test can tell if it's cancer or not, just if there is something "abnormal" and depending on what they see, a good radiologist can have increased cause for concern. The only way to know if a lump is cancerous or not, or if microcalifications are cancerous or not is by removing the lump/cluster and have it sent to pathology. The one that's recommending a biopsy is ABSOLUTELY right. [/quote]

That's what I'm learning, so I will get the biopsy.

[quote]Age, family hx, plays a roll, but a very small one. I was 43, no hx of any kind of cancer in my family. I was dx Stage III (bio at bottom). This is not to say that you have cancer, but I was told to come back in a year, I was fine, it was "just a cyst". Well, the "cyst" ended up being a 5.5 cm tumor. I didn't have a year to wait and thank God I called a surgeon myself, but the radiologist that read your mammogram is telling you to have a biopsy. [/quote]

Hmmm. So having "just a cyst" after an ultrasound is no guarantee that there was no cancer at the time?! :\

[quote]Someone gave you some bad info 8 years ago. There is no such thing as too young. I've met ladies that were in the 20's, 30s and 40s and they weren't the exception, there are many of us unfortunately. Did they do a needle biopsy and get fluid out of the lump and the lump completely disappeared? They can't tell by a US or mammogram if it's a fluid filled cyst. I know that 1st hand. Also, I don't know what the latest stats are, but about 10 years ago, it was said that 80% of lumps were B9, but I'm sure now since the odds of being dx with BC, the number is probably more like 75%. Those are still good odds, but when it comes to our lives, it's not time to play the odds. [/quote]

No one else told me I was too young; I just figured I probably was. I was 37 at the time, and thought my risk was probably not that high, all things considered. No biopsy or FNA was done back in '99; it was not recommended or mentioned at all. The latest stats I've heard is that it's still 80% of lumps are benign.

[quote]I too am very sorry to hear about your mom. I have no doubt that she would want you to be pro-active and do what needs to be done to know for sure if it's cancer or not. If it's not, celebrate. If it is, we'll be here to help you through. Please let us know what your biopsy shows and as long as it's been going on, I'd get it ASAP[/quote]

Thank you. I certainly HOPE it's not cancer! I won't delay in getting a biopsy, but the surgeon who was so highly recommended appears to be out this week; maybe on vacation. I might very well be gone tomorrow 'til Sunday and will have to wait 'til Monday to make calls in absence of cell phone service where I'm going (Medicine Lake, CA). I assume a few days isn't going to make or break anything, and I did already call for the magnification view mammos earlier today--getting that done this coming Tuesday.

I will keep everyone informed, and thanks again!

Muttsmom

So having "just a cyst" after an ultrasound is no guarantee that there was no cancer at the time?! :\

I was told that mine was a "B9 cyst" based on the reading of the ultra sound. That wasn't the case. I had a 5.5 cm tumor and 9 cancerous lymph nodes. Unless they did a needle biopsy and got clear fluid and the lump disappeared, they couldn't tell by a test if it was a "just a cyst". If they give you an option of a needle biopsy or having the lump removed, I would have it removed for 2 reasons. 1st, a needle biopsy is painful and it's not always accurate. With them removing the lump, they send the whole thing to pathology, so it's all looked at, and then they will know for sure if it is or isn't cancer.

Waiting until Monday won't be a problem. Unless the whole office is gone, you could call and make an appt. for next week and if the whole office is gone, if you called Monday, hopefully they could see you next week.

Will be praying for B9 results. Let us know when you will be having it done.
_________________
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
NED - 5 years
3/07 Diabetes
In memory of Kim 12/1/04

brainman

It is called a "false negatives." Although ultrasounds and mammograms have greatly improved the early detection of breast cancers, they do have a relatively high incidence of false negatives and inconclusive results. I have a friend who is a pathologist and he always says "The issue is the tissue", meaning that the only way to know with absolute certainty is to do a biopsy. He uses that phrase for any type of cancer. Unfortunately, what my friend rarely says is that biopsies also can result in false negatives or inconclusive results.
_________________
Jim
Site Administrator and long-term cancer survivor
1992 Astrocytoma grade 2, left motor strip
2005 Recurrence this time said to be an Oligodendoglioma grade 3, same location.
My Story Part 1: http://cancerforums.net/viewtopic.php?p=7350
My Story Part 2: http://cancerforums.net/viewtopic.php?t=8029
Blog http://jimhawkinsport.blogspot.com/

Muttsmom

Hi Jim,
I know that needle biopsies can give false negatives because they only remove tiny bits of the tumor/lump/mass, but I've never heard of an excisional biopsy having a false negative since all of the area is examined. Have you heard of excisional biposies having false negatives or were you talking about the needle biopsy?
_________________
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
NED - 5 years
3/07 Diabetes
In memory of Kim 12/1/04

brainman

Hi Nancy, I cannot remember a specific instance of a breast biopsy giving a false negative, but I know of many other biopsies that have. Men with extremely hi PSA level having total resections of what looked like a cancerous growth that did eventually turn out to be cancer but that were initially said to be non-cancerous jumps to mind. But I was thinking of a needle biopsy that often does not get a core that has any cancer cells in it.
_________________
Jim
Site Administrator and long-term cancer survivor
1992 Astrocytoma grade 2, left motor strip
2005 Recurrence this time said to be an Oligodendoglioma grade 3, same location.
My Story Part 1: http://cancerforums.net/viewtopic.php?p=7350
My Story Part 2: http://cancerforums.net/viewtopic.php?t=8029
Blog http://jimhawkinsport.blogspot.com/

bluephoenixx · New User Joined: 10 Jul 2007 Posts: 9

Jim: do you have information as to what type(s) of biopsy more consistently yield "false negatives"? I'm not sure yet what type of biopsy I'll get. I think I would prefer a more 'accurate' biopsy even if it means taking out more tissue, but want to hear what the surgeon thinks after going over everything before making that decision.

BTW, I did get ahold of them today and the appointment is scheduled for July 25th. Meanwhile, I'm having magnified view mammos done next Tuesday.

brainman

In general, the smaller the sample, the more likely a false negative can occur. That is why a needle biopsy can be less accurate than a lumpectomy.

I am glad that you have an appointment scheduled!!

By the way, have a good time at the lake.
_________________
Jim
Site Administrator and long-term cancer survivor
1992 Astrocytoma grade 2, left motor strip
2005 Recurrence this time said to be an Oligodendoglioma grade 3, same location.
My Story Part 1: http://cancerforums.net/viewtopic.php?p=7350
My Story Part 2: http://cancerforums.net/viewtopic.php?t=8029
Blog http://jimhawkinsport.blogspot.com/

Muttsmom

Thanks Jim. That's why I'm not a fan of needle biopsies!! I wasn't sure if you were talking about different kinds of BC biopsies or in general. I had both and if I had to do it over again (and I pray that never becomes the case), I would say no to a needle biopsy. The surgeon that did my mastectomies was a different surgeon that did my biopsy, and I doubt this one would have messed with a needle biopsy. I guess the 1st one thought it could be a cyst, based on the Ultra Sound report, and that's why he did the needle biopsy, but needless to say, it wasn't a fluid filled cyst.
_________________
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
NED - 5 years
3/07 Diabetes
In memory of Kim 12/1/04

bluephoenixx · New User Joined: 10 Jul 2007 Posts: 9

Hi, everybody.

Sorry I've taken so long to get back. I went to the lake for several days, and it's been pretty busy here since then. Also, I've been reading and researching all this stuff quite a bit, so it's taking a lot of my time!

I had magnified views done on July 17th. Discussed it all with my local GP. He concurred that "you do need a biopsy." However, one change: the magnified views had a final analysis of the microcalcifications being INDETERMINATE. They still recommend a biopsy, of course, but I think that has as much to do with the breast density as it does with the microcals being there.

So, I was supposed to get an appt with a surgeon here in town. The one two doctors recommended is not taking any new breast patients. However, he has a new associate who is, so I'm scheduled to see him this Monday. ::yikes::

Also, when I had a good long conversation with the director of the breast center, she said, "90% of the biopsies we do here come back benign." When I asked her, "even for these types of calcifications?" She said, "oh, yes." So I hope she knows what she's talking about!

Oh, and get this: I also consulted with my physician assistant (whom I've been a patient working with for 10 years). She said she met someone at a party awhile back who used to work at the hospital I had the mammos done, although it was about eight years ago. This person did NOT like working there, said the equipment was old and the radiologists were really arrogant. I think some things must be different now since they utilize digital equipment for mammos, but I don't know if the same doctors are still there. Interesting, no? I get the feeling I'll be doing my future mammograms elsewhere.

I also have the name of a "top of his field" pathologist who does second opinion consultations for mammograms and biopsy slides, so if it comes down to it, I'll use him!

That's all for now. More after my appt(s) this week with the surgeon and whatever type of biopsy I end up getting.

Thanks, all! Smile

brainman

Good to hear that at least you are getting some attention to your case Smile

. I do hope it turns out to be benign and not cancerous. We are here for you in either case. I keep you in my prayers and thoughts during the week in front of you.
_________________
Jim
Site Administrator and long-term cancer survivor
1992 Astrocytoma grade 2, left motor strip
2005 Recurrence this time said to be an Oligodendoglioma grade 3, same location.
My Story Part 1: http://cancerforums.net/viewtopic.php?p=7350
My Story Part 2: http://cancerforums.net/viewtopic.php?t=8029
Blog http://jimhawkinsport.blogspot.com/

bluephoenixx · New User Joined: 10 Jul 2007 Posts: 9

Thank you, Jim! Smile

bluephoenixx · New User Joined: 10 Jul 2007 Posts: 9

Hi, everybody.

My biopsy is scheduled for this coming Tuesday (in two days). I'm a little nervous, but I've been driving the hubby absolutely nuts lately with all my worrying, so it's starting to stress out both of us. Although I'm not looking forward to it, I suppose I should get it resolved, one way or another!

I had the appt with the surgeon last Monday. He didn't feel anything odd at all in the manual exam, and also did an ultrasound on the right side where he saw the dominant cyst (and many other small cysts). He clarified for me that they did NOT in fact actually see the microcalcifications on the ultrasound. That was just the confusing wording on the report; the doctor was referring to the mammogram report. Also, they aren't in the exact area of the dominant cyst; just "in the same quadrant." The ultrasound report stated the palpable mass being a "simple cyst" which, IIRC, is not anything to worry about since it's only fluid-filled. That's what the surgeon said anyway. We're going to aspirate it at the next appointment, however, since it's somewhat large and close to the chest wall. About time. Hopefully, it won't come back, either.

Also, the head of the breast center and the surgeon both said that AT LEAST 80% of these things come back benign. Now, just whether they were referring to all abnormalities and lumps or just calcifications, I wasn't sure, so I asked again. They said, yes, even for this sort of finding, about 80% of the time the diagnosis after biopsy is benign. Apparently, there are all sorts of things that can account for even small calcium deposits--only one of them being cancer. The surgeon was a little surprised and dismayed that my original doctor was being such an alarmist about it, but then she was mistaken about the microcalcs actually showing on the ultrasound; they didn't.

The magnified views resulted in a revised final report of being "indeterminate" rather than "suspicious." Hopefully, that's a good sign! (And I did get to see the mammo and ultrasound films.) Tuesday I'll ask a few more questions since I will be able to speak with a radiologist before the biopsy procedure. The whole appt is 90 minutes, only about 30 of which is comprised of the stereotactic tissue removal.

Another thing, I am learning, both through experience and self-education, is that mammographers and many doctors in general are so paranoid these days, particular of cancer and/or missing a cancer diagnosis, that the hypervigilance and increased number of biopsies is in part due to our overlitigatious society (and cancer-phobic patients). Mammographic radiologists are sued more often than other doctors due to missing things that later turn out malignant, and they are dropping out of the field and becoming more scarce. In a very interesting exchange with my husband's doctor: at HIS appointment on the same day I got the magnified views (I went with him), he brought up my recent mammogram and the recommendation to have a biopsy. The doctor gave me a questioning look so I explained to him the exact wording on the mammo report. He shook his head and said, "god, they're so paranoid" and went on to complain that if we could just get rid of most of the lawyers, it would save people a lot of worry and money. Also that since they don't have a recent mammo to compare this one with, they're just being more careful. Now, admittedly, people who ARE diagnosed with cancer probably have more reason to be somewhat grateful if it's found early, but for the other 80% who have to undergo expensive biopsies for abnormalities simply because our current screening techniques are not as good as they could be, it's a real problem.

Part of me wants to just skip this biopsy, wait another month and repeat the mammogram (at a different facility!). And get a second opinion, on both of them if need be, BEFORE any invasive procedure... if I could actually find someone who'll give me the straight dope on it without worrying about a malpractice suit. I'm so tired of the fear-mongering!!!!!!!!!!!

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