Biopsy vs 6 Month FU

MandySanAntonio

I'm 43 and started having mammograms at 39 because I get lumpy due to what has always ended up looking clearly like a cyst. I've always been called back for more imaging and US but after that they always tell me it is benign and to go back to my regular screening schedule. In late December I had my annual mammo and paid the extra $75 for Tomosynthesis. I went on a cruise in January and came back to a letter stating there was an area of concern and to come in on the 16th for another mammogram and an US. During that visit the nurse showed me the white star type shape on my mammogram they were looking at. In the ultrasound I noticed that this particular area did not look like the other areas where I have what is pretty clearly a cysts (Clear center). This one was a lot more white and looked very different to me, which obviously got me a bit upset. The radiologist said he would send my report to my dr and to follow up in 6 months. I got the letter today that said again, my ultrasound/mammogram showed an area of concern and to come back in 6 month. I'm really used to seeing them say "benign" and this really is causing anxiety. I'm confused about the difference between a 6 month fu vs a fine needle aspiration? Why wait? My husband deploys in 4 months and I'd rather know what's going on before he deploys rather than wait until he leaves. If it ended up being something serious I would want him with me. Also, my dad has brain cancer and my grandma is about to pass away. I can't take another unknown in my life right now. If it's breast cancer I'll tackle it but I don't want to have anxiety for 6 months.

Is it weird for me to ask my doctor to approve a biopsy now instead of waiting 6 months? Seems like the only benefit to waiting is for the insurance company to save money.

momto3sons

What a thing to come home to after a cruise!

Have you had a follow-up appointment with your doctor? It might not hurt to voice your concerns, especially with your husband deploying soon.

Lula73

yes you can definitely request the biopsy or even an excision. Back in my early 30s I had a fibroadenoma (benign lump). Mammo & ultrasound supported the diagnosis and surgeon concurred after exam. I told her I’d prefer to have it removed and they scheduled it. Quick outpatient surgery on a Friday and back in action at work on Monday

teachermomfl

What did the mammo and ultrasound report show specifically?

MandySanAntonio

I just got back from the doctor and was a little surprised by what she said. The area they called me back for ended up being what they think is something called "nonspecific parenchyma" with no evidence of mass or architectural distortion. I'm not sure what that means but the doctor said it was unchanged from my mammogram and sonogram 12/22/2016. So I guess that's good?

However, during the sonogram they say that in the 12-1 o'clock position 3cm from nipple there is a 6mm grouping of cysts and in 5-6 o'clock 8mm grouping of cysts. No sonographic evidence of a solid mass and no left axillary nodal enlargement.

BIRADS III is what my report says. This sounds to me like it's a fancy way of saying they don't know what it is and they wanna keep an eye on it.

My doctor said that if the cysts are still there in 6 months or if I notice any changes she would order a biopsy. She seemed to think going the route of surgical biopsy would be better for me if either of those two things occurred. She told me I would need to have follow up mammograms and ultrasounds every 6 months for at least 2 years.

That's all I know. I just got home so I have not had time to fully process everything. I can't decide if this is good or not so good news. Either way, after my doctor explained her position on how to handle this I feel better with waiting 6 months now. I know she is taking it seriously because she told me if I notice any change whatsoever to call and we would biopsy it.

teachermomfl

Birads 3 is rated as probably benign. They have to put the "probably" part in, so please don't get stuck on that. Cysts are benign. I have multiple cysts and am always given Birad 3 due to the cysts and my dense breasts.

LisaAlissa

It sounds like you have a very good (and careful) med team. If they were worried about "it" (whatever it is) they wouldn't have rated it a BiRADs 3...they would have used a "4" or "5," which call for an immediate biopsy.

But since they're careful, they want to confirm that their assessment (that it's benign) is correct. So they want to take a look at it periodically (every six month) for a while (two years), to see if it changes or starts to look different to them. Once they've confirmed that it hasn't started showing concerning changes, they can return to standard (annual) screening, knowing that "it" isn't something that needs to be worried about between screenings--and that when they see it in the annual screenings that it is a "known" something that doesn't require biopsy/short-interval screening (unless of course there are changes...).

Try not to be anxious about this. It's just another part of well-woman care. Think of this more like having a pap smear. Sometimes they want a short-interval smear. It doesn't mean that there's a problem, just that they want to make sure they haven't spotted something that's a very, very, very early indicator of a problem. Here, you have a good/careful medical team that's giving you what sounds like excellent care. If you have concerns about the quality of your medical team or their judgement, you could ask for a second opinion on the imaging, but otherwise, I'd suggest just waiting it out. You can find more information on the BiRADs system on this site as well. (I'm not writing from home, so can't easily locate the link I'd usually add to a good description of the BiRADs system here--but you can find it if you search my posts for BiRADs system.)

You may also want to check out the "Anxiety" thread here, as there are a number of good ideas about how to deal with anxiety if it's affecting your life.

HTH,

LisaAlissa

Georgia1

Mandy, just chiming in to say that sounds like good news. Cysts are liquid filled and squishy, while breast cancer is a solid mass. So while I'm not a doctor I think you can rest easy. All best wishes to you and your family, and thanks for the sacrifices you and your husband are making for us.