Mammo questions

Usergreen

Awaiting L breast biopsy results. I was looking for some mammogram help. I got one Dec 2019 at age 34, Birads 0 and one June 2020, Birads 0. Both were diagnostic. Is it normal to have two Birads 0 in a row? Would there ever be reason to discontinue mammo short term follow up with Birads 0? My L breast ultrasounds were continued every 6 months. Would that take place of mammograms?

SpecialK

usergreen - Birads 0 does not mean a clear test result, it means an incomplete result that requires further investigation. Are your ultrasounds immediately following the mammograms? Are those being triggered due to the mammogram result, or routinely in addition to them?

Usergreen

I have a terrible memory but here is how I remember it and I've checked the appointment dates on my portal. I complained to family NP December 2019 of L breast pain and was ordered Bilateral Diagnostic mammo by her and referred to the breast center. The breast center ordered L breast ultrasound. So here's my testing:

Dec 2019 bilat mammo diagnostic Birads 0

Dec 2019 L breast US Birads 3

Jun 2020 bilat mammo diagnostic Birads 0

Jun 2020 L breast US Birads 3

Dec 2020 L breast US Birads 3

Jul 2021 L breast US Birads 4

I am confused by the results of the mammo too. They don't seem to "match" which I know we're changing but, in my non clinical opinion, something seems off. Kudos to me to wait until it's biopsied and I haven't slept in days to notice and start asking questions. Just

Thoughts coming from any other person than myself are appreciated. Tired of my non stop thinking!

ctmbsikia

As mentioned Birads 0 means additional imaging is needed. The Birads 3 is the result of those images. That's a probably benign finding, see ya in 6 months. Good luck on your biopsy results. Hopefully if benign you could either be guided to check again in 6 months, or possibly back to annual.

Usergreen

I know it’s common to look for something “missed” but my baseline mammo says

On the CC spot view the right breast, there is dispersion the small asymmetric density in the lateral subareolar region

my follow up mammo says

Stable upper left breast asymmetry, which is actually slightly less prominent than prior study

I’m confused about breast asymmetry. So I admittedly have a comprehension problem with reading but I thought it wasn’t an interchangeable laterality thing. I get that it compares one breast to another but if it’s calling out a specific site on a specific breast that’s that. Right? Follow up should call out that site too.
The initial mammo mentions a nodule on left breast and the follow up does not. Just not understanding everything and feeling a bit stupid for it. thanks so much for the help.

SpecialK

usergreen - my take is that the initial mammo was diagnostic because you had a complaint of pain, this was not a routine screening based on age. Because of the Birad 0, meaning incomplete, the US was done shortly thereafter. Looks the same with the following mammo/US six months later. I would also hazard a guess that you were then switched to US based exam because the mammos were not an effective tool? That would likely based on breast density and your young age. This is not uncommon, I had very dense breast tissue and mammograms were essentially useless for me, and almost always followed by US as I had many palpable lumps for the 20 years I had annual mammography. Depending on the results of your biopsy your screening might include MRI in the future, maybe alternating with US and/or mammo. Asymmetry means that things look different in comparison to the other, and could be due to a variety of different causes - sometimes benign, sometimes not - but it should be investigated further which is why you had the US. Reasons for asymmetry can range, but are generally linked to density and can be affected by where you are in your menstrual cycle or whether you are on any birth control, as well as how compression is done in the mammo as normal breast tissue can be superimposed and look like asymmetry that really isn't there if the breast isn't being compressed. I have read that roughly 80% of this type of asymmetry noted is due to this. Wishing you the best, and certainly hoping your biopsy reveals a non-cancer result.

Usergreen

Thank you. I think you're right about my age and the ultrasounds being more helpful as my left breast has many cysts visible on ultrasound. The thing that I don't understand is that baseline mammo calls out the right breast for asymmetry but the follow up says stable for left. Can they diagnose either side that way since it is in comparison to one another? That's what I'm struggling with. Just like I could say my left side of my face is asymmetrical to my right or I could also say my right side of my face is asymmetrical to my left. Does it work like that?

Or, what you’re saying is, since the reason for asymmetry on mammograms can vary so much (like compression)so maybe that’s why my sides varied?

I have never had any ultrasound or anything else done to my right breast besides the 2 bilateral mammograms, which may be standard based on results (I know the results aren’t super alarming.) I just feel Birads 0 that calls something out in right side was really never followed up on. I could be totally off base. We tend to get weird when things are personal results and we’re waiting to see if we need to go into fighting mode for our health.

SpecialK

usergreen - kind of a combination of both - the sides were not like each other - thus the term "asymmetry", but they are looked at individually in the follow up because the cause of the asymmetry can be for so many different reasons. When you receive your biopsy results can you request US on the right, if it concerns you? It may be that what was seen on the mammo for the right was not concerning enough to warrant looking any further, but it is also common to have cysts bi-laterally - that was definitely always the case for me. Are both sides symptomatic, or only one? Or neither? Has there been any discussion about surveillance going forward from here, or are thy waiting for the biopsy results before formulating a plan? I had my first cysts investigated at 25, and at the time of bi-lateral mastectomy, at 55, I had half a dozen in each side - always palpable and painful.

Usergreen

The left was the only symptomatic. It had a painful (burning) area around 11:00. I do plan to ask about ultrasound of the right because it’s sort of a mystery in there right now, but so far no plan mentioned. There hasn’t been discussion about moving forward yet. My follow up is Tuesday. Nothing ever palpable in either side besides “that could be it” kind of feel in the left sometimes. Her last exam note said non palpable too

What happened with my biopsy is the Birads 4 US of L breast found 10 cysts and one area changed enough that they (radiologist and doctor) recommended an aspiration (5:00.) The radiologist also called out that there were other changing probable complex cysts that could also be aspirated vs 6 month follow up. I asked about the painful 11:00 spot since it was complex and growing and the doctor added it to the order. They aspirated 5:00 with no issue calling fluid milky. But 11:00 was solid so I had a vacuum assisted needle core biopsy.

I am just going over past results during my anxious wait for biopsy results which I will guess is pretty normal. But I’m feeling angry that I didn’t do this sooner, before Birads 4.