Sad, scared and confused, update on appt with bs

OldOakTree

I posted a week or two ago about my appt for a spot compression after having calcifications show up on my mammo (9.5 years after having dcis on other side).  What I wrote was

I went back and had 2 more films taken . . .  she took them up to the radiologist, came back and said the radiologist says they appear to be benign and she would recommend waiting 6 months and then having more pics taken . . . she asked me if I would like the radiologist to come talk with me.  The radiologist couldn't have been nicer.  She said they have been watching these since 2008 (I had no idea!!) and they were stable until now.  There are a few calcifications in one area, not clustered though, and with this reading there are 2 additional ones, thus the callback. All appear to be round and she doesn't see anything alarming.  With my history though, there may be reason to do a biopsy.  She said she could could understand that and wouldn't be against it.

Okay, so her recommendation was a 6 month follow up and said no biopsy is needed at this time unless I want one.  She assured me they were not clustered and were round and she saw nothing to suggest cancer. This is good news as compared to what I could have heard and I could have left it at that but I still wanted to follow up with my bs to get her opinion and I saw her yesterday.

The doctor talked me out of a biopsy unless I want one now and concurred with the radiologist that a 6 month follow up is sufficient and if there is further change at that time a biopsy can be done or if I'd like she'll do a a biopsy now but there really isn't a need for that.  And like the radiologist she gave no indication that these are thought to be cancerous.

Now the confusion - I ask her for a copy of the mammo report.  I wish I had read it in her office but instead waited until I got home.  With both of them telling me to wait 6 months and saying they do not look at all cancerous I assumed it would be a bi-rads 3 but no it is a "bi-rads 4 - suspicious finding - biopsy should be considered . . .  recommendations: wire localized excisional biopsy of calcifications in the right upper-outer breast."  So why are they both telling me not to have a biopsy at this time???  I don't understand.

I google to find everything I can about round microcalcifications and while they are usually benign there are some characteristics that separate the good from the bad

 size - the bigger the better, mine are "punctate," which is what they call the tiny round ones, therefore not good

 number - more than 3-5 is not good, I have about a dozen

 clustered or not - if they are well spread out it is better than if they are contained within an area less than 2 cubic centimeters.  Mine are in an area 2 x 4 mm.  And she told me they are not clustered??  Plus the report mentioned another area of "loosely clustered" puncate calcifications nearby.

Today I get my letter from the bc center in the mail, following up on my mammogram and it says " . . . shows an abnomality for which biopsy is recommended."

I'm so confused as to why they are both telling me to do nothing at this time yet everything written tells me to get a biopsy now, no waiting around.  I don't know what to do.  I feel like I am fighting this alone.

Beesie

It is confusing that both the radiologist and your BS used words that suggest a BIRADs 3 but then you see that it's a BIRADs 4.  My guess is that if they'd used a breakdown of BIRADs 4 into a, b, and c, as is sometimes done these days, probably yours resembles a BIRADs 4a.  

The thing that you have to consider is that most of the calcs you have have been stable since 2008.  That means that these original calcs are not very likely to be a sign of breast cancer.  And now some more calcs have shown up, in around the same area. These new calcs might not even be related to the old ones.  Calcs develop all the times; 50% of women get calcs.  And about 95% of calcs are benign.  So your first calcs that have been sitting there doing nothing for all this time might still be sitting there doing nothing. And maybe just a few new calcs have developed.  It would be much more concerning if new calcs showed up, and then 6 months or a year later, there were many more.  The fact that your original calcs have been stable for so long suggests that they probably are nothing.  And if that's the case, then what needs to be assessed is the number and pattern of the new calcs.  And it doesn't sound as though those are high risk.

In my one remaining breast, I have calcs that have been biospied and found to be benign.  If I ever get any new calcs in the same area, what the radiologist will have to do is assess the amount and pattern of just these new calcs - not considering the old ones that we already know to be benign.  You situation might be similar.

Having said all that, if this is making you nervous, then get the biopsy.  A stereotactic biopsy is no big deal, and hopefully it will be benign and give you peace of mind. 

OldOakTree

Bessie - thank you for your response and your own calc story.

I get so frustrated dealing with doctors both for this and a couple other unrelated problems I'm dealing with.  The BS I am seeing is supposed to be one of the best in the area but she has left me feeling very confused and unsure as to what direction to go in.  It makes no sense to me how two of them can clearly say wait 6 months and have another mammogram yet both the mammo report and letter they sent to me say " . . . abnormality for which biopsy is recommended."  Nothing about a 6 month follow up.

If I could just drive myself to the center and get it done and drive myself home it would be so much easier.  But of course I have to have someone take me, the person who would do that will not drive in the snow, at all, not even a flake, it's almost an hour away, I am petrified of being put to sleep, even consious sedation,  I don't want to have to explain to people at work why I need a couple days off, and I don't know how I will cope if it is cancer.  Sorry, I know I'm whining, I can't help it.  I wish I could change things.

Jelson

might it be that the radiologist wanted to make sure there would be no problem in getting your biopsy approved by insurance/the hospital, by assigning you BiRads 4, he/she leaves the door open for the biopsy if you choose to have one now. It sounds like this surprise finding has really thrown you for a loop and you need to take some time - maybe not the full 6 months, what is magical about 6 months? how about 4 months - not that long but- there probably wont be snow on the ground - get another mammo, more info with which to decide whether a biopsy is necessary.

proudtospin

after passing my mamo with flying colors in June 2011 and released for a year, the mamo in June 2012 had new calcifications.  And cysts, needless to say I was very upset.  The radiation center said do biopsies on about 3 locations.

The BS chose 1 spot to biopsy, it came back fine with no problem.  I have a habit of turning to my onco for a second opinion as I questioned why the BS only did one location.  She agreed with the BS and said that many woman have new calcifications (or what she called fat necrosis) after the 3 to 4 year marker, and that is me.

it is what we live with.  My BS & MO are actually at 2 dif hospitals but do work well with each other so I bounce things off of them all the time.

course, the key to if it was the right choice will be on this Wed when I have my 6 month mamo......need to stay positive on the choices

LindaLS

I had similiar but different situation in 2007, prevously did not have DCIS but had a regular mammo annual appointment at age 42. Asked to come back for spot comprehesion. Was shown calcificatons on mamo, they were very round and not clustered but close to each other. I was told by radiologist that they are most likely benign based off of their characteristics. Was told to come back in 6 months for follow up but at the very end of comment she indicated I could go ahead and get a steriotactic biopsy if I was concerned. These calcifications were apparently new as they had not shown up on the previous 2 years of mammos. It scared me that is could possibly be cancerous so I made the personal choice to do a biopsy. Much to their and my surprise it came back as DCIS with necrosis grade 3. I will never know but often wonder if I had waited 6 months would it have turned into invasive cancer. My personal opinion is that if there is the smallest of chance that it could be cancer,I feel I have to take immediate action otherwise I would worry and stress over it and I can't live life in perpetual waiting. This is just one story and I'm sure most are probably benign but there is another side be at very small chance. I did learn that radiologists are human and generally go off of text book information and sometimes that is not always the case. Good Luck in whatever decision you make and the best of health to you.           

OldOakTree

Linda - thank you for your response, it was very helpful and gave me the push I needed to call the surgeon's office and make an appt for the biopsy.  I asked them if I needed to see the doctor again and was told only if I want to, otherwise I can go ahead and make the sugical appt.  So I said let me check with the person who will be taking me to see what days are good.  When I called back two days later the girl told me I now DO have to see the doctor because I will be having conscious sedation.  She is out of town so it will be another week and a half before I can even see her.  I just want to get this over with. 

But in retrospect it is probably good, because I can ask her why she is telling me I can wait 6 months with a birads4.  Also, my mammo report talks of another nearby area of calcifications, benign appearing, loosly clustered, unchanged, punctate.  I want those checked out also but I fear I will get nowhere when I ask the doctor to do that.  She will tell me there is no need, they are unchanged and it will remove too much of my already small breasts.

What I really need is a doctor close to me, this one is almost an hour away and in a very inconvenient spot.  I know the person who willl be taking me isn't real happy about doing this and I feel so bad, she hasn't said anything but I know how she dislikes city driving and it is even longer for her.  Ever since my oncologist and then her replacement retired I have felt so lost in this. Before I could talk it over with one of them, ask what they think I should do, who they think is a good doctor.  Now I feel like I am fighting the battle alone.

LindaLS

I know there seems to be a lot of obstacles but I would not be discouraged. Persistance and patience pays. Just remember it is your body and your choice. I have had the same problem as what you think you may encounter with the Dr who will likely tell you no need on the 2nd area you want checked that is unchanged. Good that it is unchanged, but if it bothers you, you should be persistent to your doctor to have it checked. My Dr and I disagreed about a number of things. Although I think he is the best in the city I live in.  I had a fibroadenoma that was approx 1.5 cm. My Dr. wanted me to just leave it alone and I was insistent that I wanted it removed surgically given there could have been a very small chance that there may have been some dcis surronding it. He finally agreed to do the surgery and luckily nothing was found but I had peace of mind after that. I also have to insist on getting MRI's every year as he thinks after 5 years there is really no need. I had to insist that I did need one in return since the radiologists are telling me my breast tissue is extremely dense so my mammos are of little value in finding anything that may be there. So next month I will be getting my 6th MRI, one for every year upon diagnosis of DCIS. I got him to understand my point of view.

Yes it seems to be a struggle sometimes to work with some Drs. and it does get frustrating, even mine who I have the highest regard for and who is considered a premier oncologist. If upon explaining to them why you want something checked and you have educated yourself on it, if the Dr still tells you no need to do it first let them know that you think there is a need and remember they work for you. If they ultimatly will not do it then find a Dr that will. By the way, I have small breasts and was told the same thing but four years later I physically can't tell the difference. As far as a sterotactic biopsy, it usually does not change the shape or appearance of the brest once it is healed. Please don't feel lost and if you do just keeping pushing forward then you will feel like you are more in control. Also, you are never fighting the battle alone. All the women on this board support each other so we are all in this together. I hope to hear back from you anytime you feel the need to talk or just to update us. Thank you for sharing your struggles. Things will work out. Take care, Linda

OldOakTree

Linda - thank you again!  I can relate to so much of what you are saying. Yeah, about those MRI's.  I was getting one every year also.  My oncologist ordered it for me.  Back when I first saw her I wanted a bilateral mastectomy but she talked me out of it, assured me there was no immediate need and said I could get an MRI every year to help ease my mind (I am a big hypochondriac).  Now that she is retired and her replacement is retired there is no one to order this for me.  I usually get it in June and this will be my first year without.  I asked the surgeon about getting one and she said at 10 years there is no need.  And then she added, "you don't want to be exposed to all that radiation."  "Since when is there radiation in an MRI?" I wanted to cry to her.  It's like a losing battle sometimes. 

I will not be having a sterotactic biospy, it will be en excisional biopsy.  Both the surgeon and doctor who read the mammogram said I don't have enough breast tissue for one.  So that's why I say if she takes two separate areas with big margins (at my insistence) there won't be much left.