Mom newly diagnosed with IDC, how soon should she get surgery?

Decker

Mom got diagnosed with 2.1cm IDC, with an adjacent 0.8cm tumor, and grade 3, does not appear to be lymph involvement. We're seeing the breast cancer specialist next week, as this was just our family doctor giving us biopsy results. How soon should we schedule surgery? We're in Canada, so there may be a wait time, and if so, we'll probably seek surgery in the US.

I'm really disappointed in the healthcare system, the doctor saw the mass over a year ago when it was at 1.3cm and wasn't growing at the time, and didn't ask my mom to get a biopsy because it was below 2cm, and now it basically grew from 1.3cm to 2.1cm in about six months.

Beesie

As much as breast cancer feels like a medical emergency, except in rare cases (inflammatory breast cancer, for example), it's not. Whether in Canada or the U.S., a wait time of several weeks before surgery - up to 4-6 weeks - is the norm.

You are assuming that you will not get good treatment in Canada, but it sounds as though it was your mother's doctor who dropped the ball - and there are crappy doctors everywhere. That has nothing to do with the healthcare system. That said, your mother also should get copies of all the imaging reports from the past few years, and a copy of the new biopsy report, to find out what's really happened. I'm in Canada and I've had breast issues since I was a teenager. I've had lots of biopsies over the years, and even more call backs. I've also been on this site for 14 years. In my experience and from my reading here, I have never heard of a doctor saying that a biopsy isn't necessary because a mass is less than 2cm. The reason for no biopsy sooner more likely was because the appearance of the mass looked much more likely to be benign - a BIRADs 3 assessment of the appearance, which indicates less than a 2% chance of cancer and a recommendation for 6 month follow-up imaging. Any imaging assessed as a BIRADs4, which means a 2% or greater risk of cancer, is sent for biopsy. As far as I know, the BIRADs system is used everywhere in Canada as well as in the U.S..

Healthcare is provincial in Canada so there are slightly different guidelines in each province. Where are you located?

Decker

Hi, we're in Alberta and the radiologist just said the mass was “stable" and told us to get it checked again in 6 months

Beesie

Decker, based on that explanation, it sounds as though the mass had a benign appearance plus stability, which is a valid reason for a BIRADs3 and a 6 month follow-up. It's what most Radiologists, in Canada or the U.S., would recommend in that situation. The size of the mass isn't what drove the decision to initially not recommend a biopsy - that decision would have been based on the appearance and stability of the mass. In more than 98% of cases where this path is taken, the mass/area of concern remains stable and is benign. Unfortunately your mother fell into the unlucky <2% who have BIRADs 3 imaging and then 6 or 12 months later, the mass exhibits changes, a biopsy is done and breast cancer is diagnosed. I completely understand your disappointment and I'm so sorry your mother fell on the wrong side of the odds.

Has your mother seen the surgeon yet, or is an appointment set up? Does she have a surgery date or other testing scheduled?

Decker

Regardless, the radiologist made a mistake. They didn’t mention anything about the appearance in the report. You could argue it was chance, or you could argue it was a poorly-trained radiologist, or you could argue it was the system’s fault. We’ll never know.

Yeah we are in the process of setting up appointment with the oncologist and then schedule surgery, hopefully surgery will be done in the next few weeks.

wrenn

I found my lump June 15th and surgery was August 16th. My tumour was aggressive but stayed the same in that time frame.

I am very grateful for our health care system even though I have had one or two doctors I didn’t like over the years. What age is your mother? Is she able to make decisions on her own?

I hope she has trust in her care givers. It will make a difference in how she does with this. I would try tobuild her confidence if she is worried.

As Beesie said above. What happened in her case is protocol.

Decker

So why did they tell you to get a biopsy if it was stable. Also how did you get from finding the lump to surgery so quickly? Scheduling the biopsy here in Alberta took a month, and after biops, 2 more weeks to see the specialist.

wrenn

Did she follow up in the 6 months? Often we are given the option of waiting 6 months or getting a biopsy. Do you know whether she was given that option and chose to wait?

No matter what happened cancer is scary for everyone involved but it can be made so much worse if you don't trust your team. You are free to pay in the US but they aren't 100% there and you may end up not pleased with the outcome. If it is one radiologist you have a problem with in Canada it may hurt your mother in the long run to judge the entire system on one event. Again I can't stress enough how important it is for your mother's mental health to make it as smooth an experience as you can. Maybe being close to home for any treatment will be a comfort to her.

Decker

No she wasn’t given the option of a biopsy, told by the radiologist they don’t do biopsies if mass is under 2cm, which is why I find this healthcare system so bad. It’s a 20 minute procedure... and scheduling the biopsy took a month even AFTER they found growth in the mass.

Decker

But how did you get from finding the lump to surgery in 2 months? didn’t you have to wait to get the biopsy, get the results, meet with oncologist, and get scheduled for surgery, how was all this done in 2 months?

Beesie

What goes into each BIRADs category is well defined and where this classification system is used, the breast Radiologists would be well educated on it.

This explains BIRADs3: https://radiopaedia.org/articles/breast-imaging-reporting-and-data-system-bi-rads-assessment-category-3

And this explains all the BIRADs categories, including descriptions of the characteristics of abnormalities that assign a mass or area of concern to one category versus another, and the appropriate action plan by category: https://radiologyassistant.nl/breast/bi-rads-for-mammography-and-ultrasound-2013

wrenn

Yes, all of that was done in the 2 months. You keep calling that one radiologist "the system" is what I struggle with and your angst is going to affect your mother.

Decker

Could you let me know the individual steps in your situation that led to surgery in 2 months? How long did the biopsy phase take? How long from getting biopsy results to the surgery? How come there was so little wait time in your situation?

MinusTwo

Decker - I think what Beesie & Wrenn are both trying to say is that every one of us is different. Our cancers are different. The symptoms are different. The treatment is different. Docs are different. Hospitals are different. As Wrenn has said again, your concerns are no doubt affecting your Mother. You need to be calm and strong for her. Most important for everyone, you have to trust the team or go elsewhere, not second guess all their recommendations.