Worried about callback

Pandawnb1987

Just had a 3D mammogram. I have to go back and have another 2D, 3D, and sonogram. The report shows all kinds of descriptions that are scaring me. Apparently I have very dense tissue, and the report is showing a mass here and mass there. When I look up the terminology it's just totally worrying me

MelissaDallas

A callback just means they need a better and closer look at things they were unsure about on your initial imaging. It does not mean they think you have cancer at this point. About 10% of women get callbacks, so very common, especially after first mammogramswhen there are no old films to compare to. If you want to post the language from your report, folks here may be able to help you interpret.

Pandawnb1987

Are we allowed to post the report? There’s no pictures of course

MelissaDallas

I should add, does the “1987 mean you are 33? If so, what prompted the mammogram?

Pandawnb1987

No, that’s my daughter’s birth year. I’m 60. Ug

MelissaDallas

Did the facility have your old films for comparison purposes?

Pandawnb1987

No, I hate to admit but it’s been a while since my last mammogram. I’ve hada solid lump for over 33 years, and it’s been biopsied twice. Both times benign.

Beesie

Yes, you can post the report. It would be helpful.

Sounds like the lump you've had for years is probably a fibroadenoma. Those are benign and harmless and usually develop in younger women.

Pandawnb1987

I copied directly from the report.

Comments from the Doctor's Office

Helen,

The mammogram showed dense breast tissue, making it difficult to do a full/complete evaluation and further imaging is recommended. The radiology office will be calling to set this up.

Study Result

Impression

There are multiple bilateral macrolobulated masses present in both breasts as described above. In addition there is a cluster of pleomorphic microcalcifications in the upper central aspect of the left breast. These findings are of questionable clinical significance.

Final Assessment: BIRADS 0: Incomplete: Need additional imaging evaluation.

Recommendations: Bilateral diagnostic 2D and 3D mammogram with ultrasound as needed.

Notes:
--We will attempt to contact your patient to schedule a return appointment for a diagnostic mammogram and/or breast ultrasound. If we are unable to do so, or your patient does not return, we will contact you. As soon as the required followup is completed, we will provide you with a report.
--Letter sent to patient.

Narrative

Exam: BILATERAL SCREENING 3-D MAMMOGRAM WITH CAD

History: Screening.

Technique: Bilateral digital screening 2-D and 3-D mammogram with CAD (Computer-Aided Detection).

Comparison: Priors unavailable

Breast Density: c - The breast parenchyma is heterogeneously dense, which may obscure small masses

Findings: There is a macro lobulated nodule present in the outer central aspect of the right breast. No suspicious cluster of microcalcifications are demonstrated in the right breast. In the left breast, there is a cluster of pleomorphic microcalcifications in the upper central posterior aspect of the left breast. In addition there is a macro lobulated well-circumscribed mass present in the lower central aspect of the left breast middle depth and a second well-circumscribed nodule is seen in the upper outer aspect of the left breast middle depth.

Beesie

Okay, so here's the good news, and there is quite a lot of it.

First off, you do not have very dense breast tissue. That would be Category D, which is >75% dense. Your breast tissue is Category C, which is 50%-75% density. That's actually pretty normal for your age (it's the yellow category on this graph):

Now, more importantly, the language used to describe the masses seen on your mammogram is good. The masses/nodules are described as being "well-circumscribed" and "macro lobulated". These descriptions are more likely to indicate a benign mass than a malignant one. Additionally, the presence of several similar masses is also more suggestive of these being benign than malignant. It's not uncommon to have several cysts or several fibroadenomas but it would be quite unusual to have several breast cancers in different places in both breasts, and for all to show up with the same appearance on imaging.

Read here: Masses in mammography: What are the underlying anatomopathological lesions? https://www.sciencedirect.com/science/article/pii/S2211568413003872

"Probably benign masses: BI-RADS 3

In mammography, they are well-circumscribed, round, oval or lobulated masses and are not calcified or liquid in sonography. The vast majority of these masses correspond to benign lesions such as a fibroadenoma or cyst with thick contents."

And here: Are Irregular Hypoechoic Breast Masses on Ultrasound Always Malignancies? https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4644748/

"On mammography, fibroadenoma shows well-defined round, oval, or lobulated masses with some calcifications ranging from small peripheral dots to popcorn-shaped features."

"The mammographic finding of apocrine metaplasia is a micro- or macro-lobulated mass with equal to low density relative to breast parenchyma owing to its prominent cystic composition"

To my (admittedly amateur) reading, the most concerning finding is probably the cluster of pleomorphic microcalcifications. If anything is going to require a biopsy, this is probably it. According to the following site, fine pleomorphic calcifications have a 25%-40% chance of malignancy. Most often, if malignant, the finding will be DCIS, which is non-invasive and Stage 0.

Read here: Differential of Breast Calcifications (scroll about 2/3 down the article to find pleomorphic calcifications) https://radiologyassistant.nl/breast/calcification...

And this site explains that a single grouping of this type of calcification is moderately suspicious: Suspicious breast calcifications https://radiopaedia.org/articles/suspicious-breast-calcifications?lang=us

The follow-up diagnostic mammogram will take a closer look at the calcifications, to determine if a biopsy is necessary. The ultrasound will be targeted at the macro lobulated masses, to see if they can be identified as complex cysts or fibroadenomas. If I had to guess, I'd say you probably will be sent for a biopsy - but that's because anything assessed to have a risk of 2% or greater is biopsied. But based on these descriptions, I'd say that nothing is loudly shouting "breast cancer".

Has your follow-up imaging been scheduled?

Pandawnb1987

<,}Thank you so very much for taking the time to explain my report! My mind is more at ease now! I have a follow up appointment this Wednesday!