Lump, calcifications, family history- do I need a biopsy?

Mamainsmalltownusa

Hi. I would love some guidance from more experienced people here. I come from a very small town, and I'm just not sure I should seek out care at a larger place, get a second opinion. I am 42 years old. I have a history of breast and ovarian cancer in my family. A sister with breast cancer, a great grandmother and great aunt that both died of ovarian cancer, and a current aunt that is battling breast cancer. All on my father side. This past year I noticed changes to my nipples. They became irritated and inverted. Then, I felt a small lump in my right breast. It's probably only a couple millimeters large. Soft and moveable, feels round. I had a mammogram(my first). I had both the 2-D and 3-D mammogram. I also had a sonogram only for that right breast. The radiologist assumes the lump is a fibroadenoma. They also found a fat necrosis in that breast. However, they found numerous scattered calcifications in my left breast. I also learned that both breasts are extremely dense. This worried me. They advised me that they consider all of these things benign based on their radiology images. They would like to just follow up with a 2-D mammogram in six months. I did a little bit of research online, and I'm just not sure how I feel about it. Should I go to a larger center? I sort of wanna biopsy everything. I want to biopsy the calcifications. I want to biopsy the lump. Can they biopsy calcifications that are numerous and scattered? Has anyone done that before? I spoke to the radiologist again with my concerns, and they told me that they would biopsy the lump, but they didn't think that they would be able to biopsy numerous tiny small calcifications. I am not sure if this is a universal truth or if they just don’t have better technology to do it. Like, if I went somewhere bigger would they be able to biopsy the calc? They also noted that my risk for any of this being cancer was put out at about 17%. I don't know how they come up with these percentages, but I feel like that is high. Has anybody ever had numerous small calcifications biopsied? Should I request biopsies based on the density and my family history? Anyone ever deal with something similar? Any recc for a place in the southeast that is larger and well regarded?

Rrobin0200

I had my calcifications biopsied, and as you can see from my signature line, my diagnosis was DCIS. However, my calcifications were pleomorphic. I would say, to be on the safe side, get a second opinion. Best of luck to you.

Mamainsmalltownusa

thanks rrobin0200!

mebmarj

given your family history- I would pursue a second opinion from a breast specialist.

Radiologists are good reading films. The reason they would recheck in 6 months is to see if there are any changes in the number and shape of calcifications, which is a recommendation many of us have heard before.

Something to think about also is breast MRI. They are helpful with viewing dense breasts for abnormalities and pinpointing areas to follow up with ultrasound.

A specialist may advise an MRIgiven your family history as well as inquiring if any of your family has had genetic testing.

Many times our concerns are benign, but trust your gut and get yourself some peace by inquiring further. Best wishes to you.

Mamainsmalltownusa

thanks!

Palesa2018

Hi. With your very strong family history I would suggest getting a second opinion at a larger facility.

I had scattered calcifications that turned out to be DCIS and with surgery a small IDC was also found. Oddly enough my first ultrasound revealed nothing and radiologist said to return in 6 months. I insisted on more scans and that's how it was caught early.

I'm so sorry. I know how nerve wrecking this is. The sooner you know for sure either way the better.

Mamainsmalltownusa

thanks! I appreciate all the info and feedback. I have a consult at Emory end of the month so hopefully we can do additional tests or biopsy. Thanks!

djmammo

Mamainsmalltownusa

Scattered calcifications are easily biopsied with a stereotactic biopsy unit, ask if they have one. Not all scattered calcifications need a biopsy.

If the lump is clearly a fibroadenoma by imaging criteria it can be followed at 6 months. If the other finding is clearly fat necrosis (a post traumatic phenomenon), that can be ignored. Have you had prior surgery or injury to that breast?

High risk starts at 20% lifetime risk. It is calculated using a formula and a number of items from your history. There are several different formulas. Here is an example of one tool.

At 20% many ins companies will pay for screening MRI exams yearly. 17% is pretty close plus you have had breast related symptoms so you might give them a call.

Emory has a nice breast center.

Mamainsmalltownusa

Thanks Djmammo. To answer your question, I have had no surgery or injury to that breast.

Mamainsmalltownusa

Hi everyone! I wanted to give an update as this may help someone like me that was searching these forums a while ago. I did go to emory, and they agreed that checking in 6 months is ok. So for now, we will not biopsy. They told me that there is only a 1-3% chance that my lump or calcifications are not benign. We all tend to worry we are that minority, but they assured me that even if it is cancer, it is not likely the kind to spread fast so waiting 6 months is ok. I have a breast MRI scheduled in 3 months and then a follow up mammogram in 6 months. We may do biopsy then, but most likely not. I am glad I had this experience though because it forced me to look into my family history, which is pretty significant. With the updated info, my lifetime risk is now at 20%, so I will get to have a breast MRI from on, and I am going to have genetic counseling to see if our family has a gene. Hopefully I will not be back here with bad updates! I appreciate everyone's kind words and info!