Bi-Rad 3

hi,

My two cents- do whatever you need to, to feel safe. If you re ok waiting six months, then do. If you re not, then ask for a consult with a breast surgeon.

Whatever décision you make, you need to be At peace with it :-)

Alicki

Dear Tracy:

I would follow up in 6 months with a 3D diagnostic mammogram and a sonogram.  If your doctor thought that what was seen on your mammogram was more suspicious, the doctor would have ordered a biopsy now, rather than having you wait.  Most of the time (80%) , the area of concern is benign.  That being said, if you are going to worry for 6 months then, if it were me, I would ask for a biopsy now or I would go for a 2nd opinion.  Worrying, waiting, and anxiety suck.  There is no reason why you cannot go to a 2nd doctor and ask for more tests and/or a biopsy now so that you can have peace of mind.

Good luck and I wish you a benign finding and no stress.

Dear Ms. Pharoah:

I did not know that a risk factor for bc was benign biopsies.  I have had 6 excisional biopsies/lumpectomies, 6 core needle biopsies, and 1 cyst aspiration.  I am also in a 6 month wait and watch situation for a 1.8cm linear non-mass enhancement with rapid washin washout kinetics that could not be biopsied.  (The area changed from Bi-Rads 4B to Bi-Rads 3 because it was not well visualized on my MRI when I was supposed to have the biopsy.)  I will know more in November 2015 when I have my follow up MRI.

Thanks for the information.

Hi - I too have read that a biopsy increases risk. Does anyone know if all biopsies increase risk, or do the findings of certain biopsies increase risk and other biopsy findings not so much- meaning biopsy findings that show proliferative findings vs non-proliferative findings?

Hi Tracy:

By "doctor", do you mean a primary care physician? If so, then I would follow the recommendations of the radiologist. It seems to me that the question falls squarely within the expertise of the radiologist, who classified his findings as BIRADs 3.

What is the basis for the "doctor's" departure from the recommendation of the radiologist? Because a "BIRADs 3" rating means a short follow-up is recommended, per the American Cancer Society:

http://www.cancer.org/treatment/understandingyourd...

"Category 3: Probably benign finding – Follow-up in a short time frame is suggested

The findings in this category have a very high chance (greater than 98%) of being benign (not cancer). The findings are not expected to change over time. But since it's not proven benign, it's helpful to see if the area in question does change over time.

Follow-up with repeat imaging is usually done in 6 months and regularly after that until the finding is known to be stable (usually at least 2 years). This approach helps avoid unnecessary biopsies, but if the area does change over time, it still allows for early diagnosis."

If you have not done so already, please obtain a copy of the radiologist's report for yourself (this is distinct from a "letter"), so you can see for yourself the description of findings and the actual recommendations of the radiologist.

You can also look to see if you have any issues with density ("heterogeneously dense" or "extremely dense"), as this may obscure possible findings on a mammogram, and would further support the use of an additional imaging modality (ultrasound). Density can also increase risk.

BarredOwl

Hi Djabi53:

I am not sure, but I think that the frequency after the first 6 month follow-up examination may vary depending on individual imaging results, the application of certain technical criteria (the algorithm mentioned below), and the judgement of the radiologist. Institutional practices might also play in.

Please ask your radiologist to be sure about what is recommended in your particular case, and immediately make your appointment to ensure timely follow-up.

The American College of Radiologists (ACR) has a document which discusses BI-RADs scoring for density and for mammographic findings here. To access the document, click on "2. Reporting System" under "BI-RADS Mammography 2013":

https://www.acr.org/~/media/ACR/Documents/PDF/QualitySafety/Resources/BIRADS/01%20Mammography/02%20%20BIRADS%20Mammography%20Reporting.pdf

Regarding BI-RADs 3 follow-up, the free content has this information:

"A probably benign finding is not expected to change over the suggested period of imaging surveillance, but the interpreting physician prefers to establish stability of the finding before recommending management limited to routine mammography screening. . .

. . .Refer to Figure 155 (see page 152) [NOT INCLUDED in free content] at the end of the Guidance chapter for an illustration of the recommended algorithm for follow-up examinations during the entire mammographic surveillance period. While the vast majority of probably benign findings are managed with an initial short-interval follow-up (6 months) examination followed by additional examinations until long-term (2- or 3-year) stability is demonstrated, there may be occasions in which a biopsy is done instead (patient preference or overriding clinical concern)."

By the way, it also indicates that the category 3 assessment should be based on a "diagnostic" mammogram, and not a "screening" mammogram:

"All the previously cited studies emphasize the need to conduct a complete diagnostic imaging evaluation before making a probably benign (category 3) assessment; hence, it is recommended not to render such an assessment in interpreting a screening mammography examination."

BarredOwl

[Edited to make link operational.]

Hi Mkkjd60:

This is what the National Cancer Institute says about the differences between screening vs. diagnostic mammograms:

"Mammograms can be used to check for breast cancer in women who have no signs or symptoms of the disease. This type of mammogram is called a screening mammogram. Screening mammograms usually involve two x-ray pictures, or images, of each breast. The x-ray images make it possible to detect tumors that cannot be felt. Screening mammograms can also find microcalcifications (tiny deposits of calcium) that sometimes indicate the presence of breast cancer.

Mammograms can also be used to check for breast cancer after a lump or other sign or symptom of the disease has been found. This type of mammogram is called a diagnostic mammogram. . . .A diagnostic mammogram can also be used to evaluate changes found during a screening mammogram or to view breast tissue when it is difficult to obtain a screening mammogram because of special circumstances. . .

. . . Diagnostic mammography takes longer than screening mammography because more x-rays are needed to obtain views of the breast from several angles. The technician may magnify a suspicious area to produce a detailed picture that can help the doctor make an accurate diagnosis."

Here is some information from BC.org regarding screening vs. diagnostic mammograms:

http://www.breastcancer.org/symptoms/testing/ask_e...

And from the American Cancer Society:

http://www.cancer.org/treatment/understandingyourd...

Thus, the context differs, with diagnostic mammograms performed because of some symptom(s) or a suspicious screening mammogram. The diagnostic mammogram typically includes additional views and may include magnification of a suspicious area.

BarredOwl

Ballet12 thank you for the clarification and the correlation does not equal causation explanation. I admit I was a bit perplexed when I read here that biopsies increase risk. I had never heard that biopsies themselves cause anything, and also read that for example, fibrocystic tissue is very common as in, over half of women get that, but that such tissue does not increase risk of BC.


Not directly anyway. It COULD obscure findings on a mammogram or sonogram though. That can be problematic.

I also considered that any breasts prone to changes of any kind, may be "busy" as MsPharoah suggested, and as such, MIGHT have an increased risk of triggering the wrong kinds of mutations?

But that's so hard to ultimately predict.

I've known so many women who had biopsies that came out B9 and are well into their later years and have not ever been diagnosed with BC so far. Thank goodness many of us do well!

Hi Tracy, I would definitely follow up in 6 months. I have 2 suspicious masses in my right breast that were classified as BI-RADS 3 in February. My doctors (radiologist and breast surgeon) want me to have diagnostic mammograms and ultrasounds every 6 months for 2 years. If they see continued stability, they will feel comfortable forgoing a biopsy. If they see changes, I'll probably need a biopsy.

There is no way I would wait a year between tests after my experience with the other breast. I had DCIS in 2 different quadrants of that breast. Because both areas of DCIS were small (well under 1 cm), I was able to have lumpectomies. If DCIS had grown larger, lumpectomy might not have been an option for me. Mastectomy might have been my only choice, and that would have meant a tougher surgery with a longer recovery time and hard choices about reconstruction.