Referred to Breast Specialist after Ultrasound

Loueffie

Hi. I am 41 & went for a mammogram after having developing pain & finding a lump in my left breast. The results came back showing a "mass in my left breast that they wanted a closer look at with an ultrasound." I had that last Thursday, and when the tech was finished, she showed my results to the radiologist, told me that it appeared to be 2 cysts, and that I would need a repeat mammo & ultrasound in 6 months. She also said I could have the larger cyst aspirated if I wanted since it is causing so much pain. I left the imaging center feeling relieved.

Fast forward to around 6:30 that night when my PCP calls me. That conversation goes like this:

Her: Did the radiologist tell you anything about your scans today?
Me: Yeah. Just that I have 2 cysts, that one is fairly large & I can have it aspirated since it's causing me so much pain.
Her: Yeah, I see that here. I also see they recommend a follow up ultrasound and scan in 6 months on that left breast.
Me: Yes, they told me that as well.
Her: (Sigh) Yeah, I'm not okay with this. Looking at these scans, I don't feel comfortable letting you sit on this for 6 months. What they are calling "a cyst" in your left breast that is the largest, is over 4cm & is at the 3 o'clock position, which we don't usually like to see b/c it's close to the lymph nodes. And, she didn't scan up into your arm pit at all to check those.
Me: Ooookay.
Her: Plus, they classified your scans as a BIRAD 3. It's basically on a scale, 0 means it's definitely not cancer, 5 means it definitely is. 3 means it PROBABLY is benign. With all the other indicators I'm seeing here, it being so large, in the position that it is, and her finding an extra cyst that the mammogram did not pick up, I just don't feel comfortable recommending you sit on this. If it were my breast, I would NOT wait 6 months to follow up on this. I am referring you to a breast specialist and I would very much like for you to get a 2nd opinion.

So, that is where I am at now. I can't get in to see the specialist until 7/9 because she is supposedly the best in my city and on vacation all next week. Just wondering if anyone has had anything similar happen? I was intent to write this off as a cyst, but now my PCP has me concerned.

Moderators

Loueffie,

Welcome to Breastcancer.org, and thanks for posting. We're so sorry you're here and worrying, but we're glad you've found us.

It's great that your PCP is so vigilant and wanting to make sure to put all concerns at ease, rather than wait. BI-RADS 3 is good news and it sounds like her concerns are just to confirm that the news really is good.

Please keep us posted with what you find out -- we're all sending good thoughts for benign results!

--The Mods

Beesie

Radiologists are experts on breast imaging. PCPs are not.

Your PCP is right about one thing however, which is that BIRADs 3 means "Probably Benign". What he perhaps doesn't understand is that the "probably" means that the Radiologist has assessed from the images that there is no more than a 2% chance that this is cancer. Anything more than 2% would be classified as a BIRADs 4, and a biopsy would be recommended.

"BI-RADS 3 is an intermediate category in the breast imaging reporting and data system. A finding placed in this category is considered probably benign, with a risk of malignancy between 0% and 2%" https://radiopaedia.org/articles/bi-rads-3-1

You are 41, which means you are probably entering perimenopause. These are the prime years to develop cysts. I had many cysts in my 40s, often had more than one at a time, and often had cysts that was huge. There was never any concern on the part of the Radiologist, my Breast Specialist (I'd been seeing a breast specialist for years because of other issues) or my PCP.

Do you have a copy of the radiology report? If not, get one. You can post the information here - a retired Breast Radiologist, who goes by the name djmammo, is a member here who might see your post and respond. The description of the cysts will be very telling as to whether or not you should have any concern. There is no harm in seeing the Breast Specialist to get a second opinion - and you can ask the BS to aspirate the larger cyst, since it is causing pain (aspiration is painless, takes 2 minutes and can be done in the office), but there is no urgency to this. From what you were told by the Radiologist, which was confirmed by your PCP in his reading of the report, it does not appear that there is any reason to be worried.

Loueffie

Thanks for that info. I do not have a copy of the report, but will ask for one. I am not however, going through perimenopause, I don't believe, because I'm currently on my cycle (started last night) and am very regular. Last month, I had to go to the ER for severe stomach pain and they did a vaginal ultrasound to rule out any ovarian cysts and could actually see eggs in my fallopian tubes b/c I was ovulating. Is is still common to start developing cysts at this age even if I'm not entering perimenopause?

Thanks for your response and I will try and get my hands on that radiology report.

Beesie

Breast cysts are most common in women aged 35 to 50, so that includes the pre-menopause years, when cycles remain normal and there are no noticeable signs of menopause, but the hormonal changes are starting to develop in the body. I believe it's the fluctuations in the hormones that cause the cysts to develop.

Ovulation does continue through peri-menopause, although it becomes irregular in the later years until it stops at menopause. If your pain last month was related to your cycle (pre-menstrual syndrome), that could be a sign of peri-menopause, since pre-menstrual syndrome can worsen.

While 35-50 are the most common ages for cysts, younger women do develop them and older women do too. I had lots of cysts in my 50s.

footballmomma

I have been in the process for about 6 weeks. I can tell you the waiting is the worst. I don't think getting a second opinion would hurt anything. I've had the second mammo and u/s and had a stereo biopsy yesterday. I have an architectural distortion. It's the vaguest thing ever. It can be seen on the mammo, but not on the 2 u/s I have had. I have a strong family history which will definitely play into my decisions.