Newbie - Feeling rushed - typical timeline?

NewAndNervous

New friends-

I'm feeling desperate and overwhelmed with all of the tests and new BC language that I am learning. I do not officially have a diagnosis, but hoping for thoughts on my journey thus far.

Here is my story:

In just 4 weeks I've had a mamo, 2^nd mamo after a call back, a stereo biopsy to LB, a meeting with breast surgeon, followed by MRI yesterday – and today I just got a call back to schedule an MRI biopsy – but now for bi lateral.

First biopsy shows ADH, ADL and cell change associated with microcalcifications, high risk and concordant – which led to the MRI. MRI shows lots of calcifications in LB , but non-mass enhancement. MRI also shows area of small concern in my right breast (this is new to me). They are recommending a bilateral MRI.

Here are my questions:

• Does this order of testing seem typical? Moving from 2 mammos, to biopsy, to MRI, now to a MRI bilateral biopsy?
• Does this timeline sound typical? All of these tests in less than a month? I'm feeling pressured to schedule the next test right away; really before I have had a chance to even process all the new information coming at me. Both the breast nurse and the surgeon's NP have called me today to schedule the MRI bilateral biopsy.
• Has anyone had a MRI biopsy after a stereo biopsy (as a next step before a surgical excision)? I did ask how the MRI biopsy would be different from a stereo, they would be checking another area of the breast, plus looking at the RB that was not seen on mamo, (only evident from the MRI).

One part of me says to trust this aggressive timeline and my Dr.'s opinion. The other side of me says to take some time to process all of this information and make informed decisions. I can't help but be skeptical at the speed of this process. Is it wrong to say that MRIs and other large pieces of medical equipment have sat idle for 3 months (due to Covid) and now there is a big rush to "Put patients in the machines to regain lost profits"? I'm not sure that this timeline is as it should be or too quick?

Thank you for reading this far – and I welcome your thoughts. TIA!

FindingOptimism

Your experience mirrors mine. I had the original screening mammography that identified an area of concern, followed by a diagnostic mammo and ultrasound to confirm, then biopsy of that area. Upon confirmation of diagnosis they then did the MRI to make sure there were no additional areas that needed to be considered in the treatment plan. I had one additional area of concern that had to be biopsied because if it was problematic I would have required a mastectomy. My testing extended over a month and a half, but I wished it could have been quicker. Overall, this is all for your benefit so you have all the necessary information prior to analyzing treatment options.

MelissaDallas

The MRI biopsies are needed because the areas of concern were not seen on the other imaging, thus they are not amenable to stereotactic or ultrasound guided biopsy. You are very fortunate that this is not getting dragged out over two or three months. If you want to wait a couple of weeks and need a breather, ask the breast surgeon if that would be okay. You can’t make any informed decisions without the other biopsies. The surgeon doesn’t want to do any surgery without complete info. They are not using you to profit from the MRI having had idle time.

Beesie

NewandNervous, I don't think the timeline is rushed - most people want the diagnostic process to move quickly - but even if you end up diagnosed with breast cancer, it rarely is urgent so if you want more time, tell the doctor that and ask for a 2-3 week delay before the next biopsies.

What is a bit unusual is that you weren't scheduled for an excisional (surgical) biopsy after the stereotactic biopsy found ADH and ALH. Because DCIS and/or invasive cancer sometimes accompany ADH and ALH, usually a surgical biopsy is done to remove the entire suspicious area just to confirm that nothing more concerning is hiding in there. About 20% of the time, a needle biopsy diagnosis of ADH or ALH will be upgraded to either DCIS or invasive cancer based on the pathology from the excisional biopsy.

It seems you were sent for an MRI instead of the surgery, and that is somewhat unusual. But it's not a bad thing (it's actually just really thorough), since the MRI has now found two additional areas of concern. Since these are in different locations of the breast than the previous finding of ADH and ALH, it makes sense to have the MRI biopsies so that the surgeon has a more complete picture before doing the excisional biopsy, in case more than one area of the breast needs to be surgically removed for a pathology assessment.

FindingOptimism, what was different in your case is that it appears that your first biopsy found cancer, and in that case, an MRI as a next step is quite common, to help determine if the appropriate surgery should be a lumpectomy or a mastectomy. In NewandNervous's case, her biopsy found a high risk condition so usually a more extensive biopsy (i.e. surgical removal of the suspicious area) is done as the next step to finalize the diagnosis. If the diagnosis is cancer, then often an MRI will be done, prior to the cancer surgery.

New, let us know when your MRI biopsies are scheduled and how it goes. And after the MRI biopsies, I assume you will be sent for the excisional biopsy on the left breast, and anything else that might arose from the MRI biopsies. If the excisional biopsy isn't scheduled for the ADH and ALH, that raises concerns.

Good luck!

NewAndNervous

Thank you all for sharing insights! This is all new territory to navigate. It's reassuring to know that the recommended approach and timeline seem solid. It's on to the next step and see where it goes. Thank you.

AliceBastable

I see a lot of people on this site complaining about how long it all takes and how they hate waiting - and many of them are on the same timeline as you.

MelissaDallas

Newandnervous, my surgeon sent me for an MRI before she did my excisional biopsy too. Luckily nothing not already seen showed up on it, but if it had I know I would have had MRI guided biopsies before my surgical biopsy.

Greeneggs

A rapid succession of testing is pretty common. I had a stereotactic mammo bx, MRI with contrast, second MRI with contrast and biopsy, bone scan and CT/PET, all within a month.

Getting a lot of information about a serious health condition in a short time frame is stressful. You should take the time you need to make decisions and your care providers should respect that. As others have said, usually people feel waiting is intolerable and complain that it takes too long.

IMO it is unlikely that profits are driving your providers time line. COVID has produced delays in cancer care. In my case, my surgery was initially put on "indefinite" hold based on an institutional decision following the American College of Surgeons March recommendation that all non-emergent surgeries be placed on hold. I was lucky to wrangle a timely OR spot, but it took some pressuring. (The ACS hold recommendation was revamped within a month so it is not a current recommendation).

In later discussions with my MO (at a different cancer center), she stated that the cancer centers have serious backlogs in appointments, procecures and surgery because of COVID-related holds/partial shut downs/and necessary appointment limits due to space requirements for social distancing. Her institution was "hoping to get cancer care caught up" before either a new surge of COVID or the mix of COVID plus infuenza caused another system wide challenge. She was not confident the catch up would happen, and it clearly was worrying her.

So, my guess is your cancer providers are feeling more pressure than usual to deliver timely care. Irrespecitve, you should feel you have some time to make appropriate decisions.

Best wishes to you during this challenging time.

NewAndNervous

Thank you so much, Greeneggs. Your reply - and the others above - have given me confidence in this timeline. I did have my MRI bilateral biop this week. It went smoothly, though not an experience that I hope to repeat anytime soon. The bruising, swelling and soreness are no picnic lol

Now I wait for results and to see where the next step in this journey may be. I wish the best for all of you!