Indent, something is not right

Arienne1222

UPDATE: I had my mamogram and US today. Radiologist said from what he sees they both look normal however I am BIRADs Density Catagory C. He said he would not be able to see smaller abnormalities because of this. I also got my generic testing back and I was negative for 32 mutation but tested positive for a variation (not yet a mutation as it is still being researched) my risk score came back as 24.3%. Radiologist advised talking with my surgeon on Monday as risk scores above 15% with a Cat C Density should have an MRI. Anyone with Lobular have a clean mamo and US and found it on an MRI?

Hi ladies, I need some advice. Trying to decide if I should push for an mri or not.

A little history. I just turned 40, am in premature menopause. In 2010 I had a partial hysterectomy due to cervical cancer cells. In 2012 I started having mamograms due to my dense lumpy bumpy breasts. In 2020 my regular breast surgeon recommended genetic testing due to my father's side families cancer history. At the time the counselor told me to invest in life insurance before continuing. Well of course I agreed and well, life got in the way and I never did it.

In 2021 my GP found a swollen lymph in my left armpit. I went for a mamogram and US and followed up with a breast surgeon (not my normal surgeon). He stated he did not feel the lymph and the mamo and US were clear. I left feeling fine about it.

Fast forward to this Christmas. Right after the holiday I was getting out of the shower and noticed a horizontal indent on the side of my left breast. Now I am very diligent about checking my body and skin for changed as my dad had melanoma and I have had 3 severe dysplasic moles removed on the last year so monthly checking is diligent. This indent of new, goes from my armpit towards my nipple. When I raise my arms is is not visible. So I want about 5 weeks to see if it changes. Meanwhile I have shoulder blade pain. The pain is beyond the muscle and doesn't change. This brings me to the Gyno for a regular visit to monitor my enlarged ovaries and discuss my HRT progress. I show her the indent. She doesn't like the look of it but doesn't feel a lump and sends me to my normal breast surgeon. He is booked for months so I go back to the breast surgeon that I saw last year. He sees me and says it doesn't look worrisome then says "it's probably always been there" when I tell him definitely not he brushes me off and says he will do a US in the office to put my mind at easy. He does it and says "don't see anything there, do you feel better?" I was so in shock by his earlier comment I just nodded. He said I still want to check it in 3 months.

I tell my Gyno all this and she says I need to get a diagnostic mamo just to see if there are changes from last year and I need to follow up with genetic testing as well as my regular surgeon. So I have scheduled my mamo for the 23rd and had my genetic testing done this past Monday.

Long story, I'm sorry but my question is in your experience if you have changes that you know are different should I push for further testing? When I read my mamo from last year I read I they suggested a biopsy of my lymph on the left in question if symptoms presisted (of course no one mentioned this). If my mamo and US comeback negative in a few weeks do I request an MRI or am I over reacting?

NOTE: my 35 year old cousin had 3 negative mamos before they found her lobular cancer doing a mri for something different.

Thank you!

ctmbsikia

Hi. I would start with the diagnostic mammogram first. If something is out of comparison from your last one, it will show. What was the birads score on lasts years mammo? It doesn't seem right they would suggest a biopsy and not follow through. It could just be a note though from the radiologist. Good luck.

Arienne1222

Thanks for responding. My Birad on last year's mamo was 3. The biopsy recommendation was from the radiologist. I honestly feel like the "back up surgeon" thinks it's nothing because the mamo was negative and the ultrasound stated the lymph was swollen due to suspected fat infiltration. Just strange to me that now there in an indent in that same area. Plus the only reason I'm getting the mamo is because the gyno didn't think "its probably always been there" was an acceptable explanation.

ShetlandPony

Dense breasts. Hormone replacement therapy.* Family history of lobular breast cancer. Indent on breast. My opinion is get the breast MRI.

Be aware that it could lead to a biopsy that turns out benign, because breast MRIs see a lot without being able to show exactly what it is. But you would not want to miss a possible cancer.

*HRT may increase risk of lobular breast cancer in particular. ILC is very hormone-driven.

Arienne1222

Shetland,

Thank you for the response. That's exactly how I have been thinking. I started second guessing myself though because of how passive the one surgeon was.

My cousin ILC was missed on multiple mamograms so that is making me very anxious.

Can I ask how yours was diagnosed?

Moderators

Dear Arienne1222,

Welcome. We are glad that you posted your situation here. You have received some good suggestions. Keep us all posted and let us know if we can offer additional help.

The Mods

ShetlandPony

I felt a hard stony lump while showering, then noticed an indent. Mammogram saw the tumor, but as you may know ILC sometimes does not show well on imaging, and MRI is the most sensitive for detecting it. I don't want to alarm you, and I have no way of knowing what your indent means. But I encourage you to follow through and not let a doctor dismiss you, given your particular situation.

Please let us know.

Rah2464

Arienne I am sorry you had the experience with a physician who dismissed your observation about your body. You do note that the backup surgeon wanted to see you again in 3 months so it does sound as though he wants to keep an eye on things so there was some level of recognition about your concern. I agree with Shetland that given your status - dense breasts and HRT along with a visible change - that warrants more investigation and monitoring. Wishing you the best for some clean imaging.

Stboo607

Hi Arieene,

Thank you for sharing your story and am sorry that the doctor was very passive with you. I recently had a similar experience. I have an indent on my breast along with discoloration in the same area. It’s all very slight and seems to be visible only in certain positions. Both my mammo and ultrasound came back negative but because I have extremely dense breast and a significant family history that lead to a high risk assessment, my general who ordered the tests had referred me to a breast specialist to take a closer look. The first specialist I saw spent about 15 minutes with me and was also very passive. He didn’t want any further imaging like an MRI because he was concerned about a false-positive and a biopsy that I wouldn’t need. He didn’t even suggest a follow up or early screening schedule (I’m only 34 and won’t start annual mammos until 40). I felt unsettled and that my questions weren’t answered. I posted my concerns on this site and got lots of support and advice from women to get a second opinion.

The second breast specialist I saw was much more thorough. This specialist ran a breast center, whereas the first was just a general surgeon who was also qualified to do breast surgery. He did a new ultrasound and suggested I do genetic testing to help customize an early screening schedule for me. He also gave me a plan for follow up and suggested some tips to better track changes to help my follow ups be more thorough. Although he still didn’t see anything, he offered other potential reasons for the change. I also felt much more confident with the follow up plans he set up with me. Just being heard and having a plan to continue to assess my concerns was what I needed to feel more confident moving forward

Long story short, if you feel he was being passive with you and you don’t feel like you have the answers you need to feel confident moving forward, then asking for a second opinion might be a good option for you. Ease of mind and having clear answers to you questions is important regardless of the results. If you do decide to go for another opinion, I found it helpful to find someone who is solely dedicated only to breast cancer rather than someone who is general but also qualified to address breast issues.

Sending you positive thoughts and wishing you all the best. Please keep us posted.

trinigirl50

I was on HRT, dense breasts, had an ident, felt a lump myself - clear US scans, clear diagnostic mammograms, nothing palpable according to Drs. My gynecologist was the one who actually rang my breast surgeon (specialist) to request he see me again despite clear scans. She also told me to stop the HRT immediately. The BS offered to do a biopsy because of my worries and because I wouldn't accept anything else.

ILC hides. Mine was not seen. Look at my stats. Also personally I would consider stopping the HRT until you are certain there is no cancer. The HRT was absolutely a factor in the speed of the cancer growth with my diagnosis.

Hopefully it's nothing to do with cancer, I can only give you my experience. I would ask for an MRI if necessary.

Arienne1222

Trinigirl50,

Thank you for sharing your experience. My cousins ILC was very similar. 3 negative mamograms until finally an mri for something else and they found it. I will definitely be asking for a baseline mri even if the mamo is negative. Thankfully my geneic counselor is amazing and let me know today that no matter what my genetic testing comes back as my risk score is high enough that she will recommend it to the surgeon.

I'm praying for a clear on everything and appreciate everyone's support in here 😊

LillyIsHere

Arienne122, I would definitely insist on MRI. My case is similar and different. I had extremely dense breasts and I was told not to bother with mammograms however, I decided to have a mammogram because I changed PCP. Luckily, I had a very well-experienced radiologist who saw my mammogram, and even though ILC can't be seen in a mamo, her theory was that some tinny new calcifications may be suspicious because cancer cells grow and shed fast. I was advised for a follow-up mammogram in 6 months or a biopsy. In my case, the biopsy showed ILC. I have never been in hormone therapy. I have no family history of breast cancer. I am in the younger group especially for ILC (old ladies' cancer) and my genetic testing didn't show cancer in 84 genes that were checked. I had no visual signs of the breast cancer.

Good luck and keep us posted.

Arienne1222

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