Is surgery really necessary?

bradfordvero

Is surgery really necessary?

bradfordvero

I am 46 and found a breast lump a few weeks ago.  I had a mammogram, magnified mammogram and an ultrasound, all the same day.  The mass was listed as a category 4 on the pathology report which was sent to my surgeon.  Upon examination, my surgeon could NOT make a determination if this is a cancerous lump or not.  Because the lump was hard to see on the mammogram but clearly seen on the ultrasound, my surgeon feels the lump cannot be properly "watched" over time.  He also said that even if I have the core biopsy done, I most likely would also need to have the entire lump removed.  So he recommends that I have the entire 3cm lump removed at an outpatient surgery center.  Does this sound logical?  It sounds to me I would be better off "watching" the lump by ultrasound for a while.  I have very few risk factors (my age, I smoke, and I stopped having my periods almost 2 years ago-no hormone replacement).  I have no family history, I breast fed my children, I started my period at 13, my first child was born at age 19.  I have no idea how long the lump has been here.  I have ignored my breast health for the past 4 years while I concentrated on other health issues.  I became blind and adrenal insufficient during the last 4 years due to a case a spinal meningitis.  Now that I know the lump is there, I feel it over 50 times a day, just checking to see if it is going away.  I am not super worried that it is cancer but of course there is a little bit of me that is worried since I just don't know what this lump is.  Any words of wisdom are welcomed! 

Anonymous

If you have a lump, no matter what a mammogram or ultrasound reveals (or doesn't reveal), it should definitely be biopsied. The radiological tests sometimes show obvious malignancy (as in my case), but often are questionable or show nothing. The lump is the reality and it's not normal to have it, so you need to know what it is....and the only way to know for sure is through biopsy, getting a piece of the tissue and having it examined by a pathologist. As for having it totally removed, many doctors do recommend an excisional biopsy, while others go for a 2-step approach involving either fine needle aspiration or core needle biopsy and then the removal via lumpectomy. If you're uncomfortable having the lumpectomy, perhaps you can consult another breast specialist who will go for a core needle biopsy. Whatever you decide, please get a piece of it and have it examined. I don't mean to be overly dramatic, but it really could save your life.

~Marin

Beesie

I understand why your doctor is recommending that the lump be entirely removed, and personally I agree with that approach. 

First, it's not unusual that your doctor can't identify whether your lump is cancerous or not from the way it looks on the ultrasound.  It is not possible for any doctor or radiologist to identify a cancerous mass just from a film, whether it's an ultrasound, a mammogram or an MRI.  Sometimes a doctor may have a pretty good idea that a mass appears cancerous, but the only way to know for sure is through a biopsy. 

There are two categories of biopsies - needle biopsies and surgical biopsies.  More often, a needle biopsy is done first, because it's non-invasive.  In this case, if the mass is benign and the mass can be left in the breast, then no further action is required.   Sometimes, though, a doctor will recommend that the mass be fully removed via a surgical biopsy  - what's called an excisional biopsy - as the first step.  This is what your doctor is doing.  This is done is cases where the doctor feels strongly that regardless of the result, the mass should be removed from the breast.  This is often because of a concern that if a mass is relatively large (as yours is), it can block the view of the breast tissue when you have future tests.  So even if the mass is benign, in the future if you had problems, they might be hidden on a mammogram or ultrasound by this mass. 

If you are uncomfortable with the doctor's suggestion to have the excisional biopsy, then ask to have a needle biopsy first.   Then you will know what you are dealing with.  But at your age, I completely understand why the doctor would want to remove the entire mass so that you have clear breast tissue for any future testing.

msannie57

I agree with the above ladies and want to add a little information.  Your doctor didn't get a pathology report; he got a mammography report.  So no one has seen this tissue under a microscope to see what it is.  BIRAD Category 4 means possibly malignant.

You mention your risk factors.  The number one risk for being diagnosed with breast cancer is being a woman.  The second is aging.  The other factors you mention, especially breastfeeding, age at conception, time you started your period--those only work for estrogen receptor positive tumors and even then are not the main risk factors.  And the vast majority of women who are diagnosed with breast cancer have no known family history.  I want to be sure that you understand risk factors so that you can make an informed decision.  It's fine not to have it biopsied if you really can't bring yourself to do it but please realize that you are not necessarily at low risk of being diagnosed.

Mizsissy

You should get the lump out, the sooner the better, because you don't know what it is and you won't know until it's out.

I had a lumpectomy as an outpatient with tranquilizer and it went very nicely. Very little pain and it healed very quickly.  In fact, I can't even see the scar any more (this was a year ago).

Keep in mind that once any cancer cells has leaked beyond the breast there is little that anyone can do to keep it from spreading.  The best cure for BC is early detection and surgery.

Good luck! 

CaliforniaKate

My tumor showed up as a tiny spot on the mammogram, but couldn't be felt, and didn't show at all on my untra sound. I had the entire lump removed, which turned out to be my lumpectomy, with clear margins. They didn't know if it was cancer for sure, so they left my lymph nodes alone.  In my case, it was early stage cancer, and they went back and took some lymph nodes a few weeks later. Mine was also a day surgery, and I was only gone from the house for about 4 hours. They explained to me that because my lump was so hard to find, they didn't want to try to just do a biopsy. Instead they went for the whole lump, with the help of a wire inserted mammogram.  Sounds like you have been thru a lot. Wishing you benign results. Sounds to me like you are getting great advice.    Kate

JoelKM

If the lump is in a place where needle biopsy is not a reasonable option, then you have to have an excisional biopsy.  It sounds like his approach is reasonable. You are going to have to get this thing looked at one way or another.  You might want to pursue a second opinion to make sure that a surgeon cannot do an ultrasound-guided needle biopsy. If it came back malignant, then you could hit it with neoadjuvent chemotherapy.There is a 30% chance that you might not need surgery at all after that.