Should I biopsy?

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jliznelson
jliznelson Member Posts: 8
edited November 2017 in Benign Breast Conditions

Hello everyone,

About a week ago I found a marble sized lump in my right breast. It moves between my fingers and felt soft. For a couple of days it felt hard and maybe bigger. Then softer again. My primary doc felt it on Tuesday and said it felt like a cyst but scheduled a mammo and ultrasound.

Yesterday (Thurs) I got the ultrasound. No mammo due to my age (24 in a couple weeks). The tech said "you can leave, see you in 3 months" I was like uh???? That's all I get?? And started asking questions, then the radiologist stopped in to talk to me. He said it looks like benign tumors called fibroadenoma. He said there are actually two. He was very adamant about how he usually says to come back in 6 months, but I need to come back in 3. He said that is because 3 months won't change anything if it is cancer. He would say I don't need to worry, but then talk about how it's so important that I come back in 3 months and we need to monitor it for a year every 3 months and that "we will monitor this very closely." I am diagnosed with anxiety so I read into everything yall. Lol but anyway...I also have cancer in my family. Grandma and aunt on my dad's side are breast cancer survivors. Oh. And radiologist said he doesn't recommend biopsy because scar tissue looks like cancer and it can also make it look/feel bigger. I am wondering if I should still biopsy though.

I also read on the cancer association website that fibroadenoma also increases chances of getting breast cancer. I know odds are still in my favor it's just hard to digest. I went in thinking it would be a cyst and it's not which is a hard pill to swallow.

I go back to my primary doc whom I trust very much on Wednesday. I will ask him what I should do. I hope my husband is home early enough to come with me. I feel silly because I know it's most likely nothing. But my mom and dad are worried and they're the ones who are supposed to say everything will be ok, you know? Anyway, any advice or shared feelings would be helpful. Thank you for hearing me out.

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  • leaf
    leaf Member Posts: 8,188
    edited October 2017

    I know you are worried. Its natural to be worried when you have something that potentially life threatening.

    This may be what you saw

    Women with simple fibroadenomas have a slightly increased risk of breast cancer – about 1½ times the risk of women with no breast changes. Complex fibroadenomas seem to increase the risk slightly more than simple fibroadenomas. https://www.cancer.org/cancer/breast-cancer/non-ca...

    According to this paper, in the USA in 2004, the average risk of breast cancer for a woman 25 years old was about 1 in 8654 (Table 1, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC28940...) so, if these numbers were accurate, a fibroadenoma would increase this risk to about 1 in 4300. I'm sure these numbers are approximate since the risk is so low.

    How old were your grandmother and paternal aunt when they got breast cancer? If they were postmenopausal, or over about 50 years old, then its more likely their breast cancer was due to age/chance and not family history. Remember, roughly 5-10% of breast cancers are thought to be from single inherited gene changes. Younger women who DO get breast cancer are more likely to have an inherited gene change. But remember, you have NOT been diagnosed with breast cancer.

    This does NOT mean your chances of breast cancer are zero, of course. But your chances of it being breast cancer are low.

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  • jliznelson
    jliznelson Member Posts: 8
    edited October 2017

    Thanks for your response. I feel so dumb for being worried about something that is likely to be common benign tumors. I'm not really scared anymore, after the 2nd day back from the radiologist I chilled out. I just want to know and even though I'm not scared I'm anxious as hell. And I know statistics don't really "matter" because you can't change if you're gonna get it or not get it.

    Gma and aunt were early 40s I believe.

    Do you think it's better to wait 3 months or get a biopsy? My question is if they're not worried then why do I have to come back in 3 instead of 6? And why every 3 months for a year? Honestly I am very uneducated about cancer and tumors in general, I wasn't alive when my gma and aunt had it and I don't know anyone close to me that has had cancer. Does it matter that my gpa and great gpa died of lung cancer and my uncle had thyroid cancer? Or are cancers "isolated" by their type? If that makes sense..

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  • PauletteK
    PauletteK Member Posts: 2,205
    edited October 2017

    it is always good to monitor so make sure your lump is not getting bigger. Maybe you can ask your doc to check gene test on breast cancer

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  • jliznelson
    jliznelson Member Posts: 8
    edited October 2017

    What is a gene test? I mean I know it tests genes but how do you do that? What will it tell me?

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  • leaf
    leaf Member Posts: 8,188
    edited October 2017

    The gene test is just a blood draw. It takes roughly weeks-about 2 months to run the gene tests. You do need to consent to it. We don't know what legal ramifications this may have in the future. If a person tests positive, its possible for legal rules to change and be discriminated against by insurance companies. They normally try to test the first person who has the condition: in this case your grandmother or paternal aunt (if they are still alive.) Are your grandmother and paternal aunt on the same side of the family? If not, then your chances are lower that you have a gene change.

    The most common single gene change that affects breast cancer risk are BRCA1 and BRCA2. If a woman has one of these deleterious gene changes, then some of them can have a 45-65% chance of having breast cancer by age 70, and in the BRCA1 gene up to a 39% chance of ovarian cancer by age 70. In the general population, about 1 in 300 or 500 women have these mutations. https://www.uspreventiveservicestaskforce.org/Page...

    There are other mutations that can increase a person's risk of breast cancer, but normally they don't confer this high of a risk of breast and/or ovarian cancer.

    If you have insurance, do check with them beforehand if they will pay for the testing. I was tested about 2 years ago for a panel of breast cancer genes, and at that time, it would have cost about $20K for the testing (out of pocket) if I didn't have insurance. I don't know if different gene companies differ in their cost.

    IF you did test positive for a BRCA mutation, and IF you would NOT do anything different than what you do now (in other words, you wouldn't have your ovaries or breast removed at some point in your life, or wouldn't undergo any more intensive testing (such as yearly MRIs)) then there isn't a real point in doing the test.

    If you do consider running the test, I would HIGHLY recommend seeing a certified genetic counselor before you do: he or she can explain to you the risks and benefits BEFORE you consent to the test.

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  • bew66
    bew66 Member Posts: 81
    edited October 2017

    I'm just going to throw this out there. Will your insurance pay for a biopsy if the radiologist's recommendation is to follow it every 3 months? I'm not sure, but doesn't it need to be a certain BI-RADS rating for insurance to cover a biopsy?

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  • jliznelson
    jliznelson Member Posts: 8
    edited October 2017

    Grandma and aunt are both on my dad's side. I talked to my mom and to clarify, grandma got cancer in her early 40s, around 41-42, aunt got it in her 50s. Grandpa, great grandpa, and uncle who have had different types of cancer are on mom's side. But I am still wondering if that matters. Does anybody know? Like...does it ONLY make a difference for getting breast cancer if the family member had breast cancer in particular, or can any type of cancer increase the probability?

    Thanks for the info about gene testing. I don't think I would benefit from the testing because it would severely increase my anxiety and obsessiveness if I got results I didn't hope to get. I will continue getting my yearly pap smear and breast exam and maybe I will start getting yearly ultrasounds if my doc says that's a good idea (after my 3 month routine is up) until I'm old enough for mammograms.

    That is a good question, bew66. I was wondering the same thing. I need to find out what category a biopsy falls under with insurance. This is what I found for my insurance plan: Diagnostic X-ray Covered 100% (other than Complex Imaging Services) If performed as a part of a physician office visit and billed by the physician, expenses are covered subject to the applicable physician's office visit member cost sharing. Diagnostic Laboratory Covered 100% If performed as a part of a physician office visit and billed by the physician, expenses are covered subject to the applicable physician's office visit member cost sharing. Diagnostic Outpatient Complex Imaging $500 copay

    The ultrasound was covered 100%. I am thinking a biopsy is diagnostic laboratory. What do you think?

    Also, I wasn't told the BIRAD rating but I will ask my primary doc, I think it's because they didn't have the official results (radiologist took about 60 seconds to look at my ultrasound). I was wondering if BIRAD is only on mammograms or if it is on ultrasounds, too?

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  • muska
    muska Member Posts: 1,195
    edited October 2017

    Jlisznelson, I think you should follow the recommendation of the radiologist, i.e. come back in three months for another ultrasound - unless your PCP advises otherwise.

    Best

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  • bew66
    bew66 Member Posts: 81
    edited October 2017

    I think you are right. BI-RADS are only given on mammograms. I would suggest you talk to your primary....you trust her, and she knows you and your history of anxiety. Maybe she can advise you and give you some peace of mind. Good luck!

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  • jliznelson
    jliznelson Member Posts: 8
    edited October 2017

    Thanks yall. I'll let you know how Wednesday goes.

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  • leaf
    leaf Member Posts: 8,188
    edited October 2017

    BIRADS scores can be given for breast mammograms, ultrasounds and MRIs. https://www.acr.org/~/media/ACR/Documents/PDF/QualitySafety/Resources/BIRADS/Posters/BIRADS-Reference-Card_web_F.pdf?la=en

    Biopsy: I would call your insurance directly to check on coverage. If paid for out-of-pocket, a biopsy can cost several thousands of dollars.

    The cancer history differs for different genes: for BRCA gene mutations, cancers of the breast, ovaries, fallopian tubes, peritoneum. Mutations on other genes can also increase breast cancer risk such as ATM, PTEN, etc. and may be associated with other (non-ovarian, fallopian tube) cancers. http://www.breastcancer.org/risk/factors/genetics

    Family history factors associated with increased likelihood of potentially harmful BRCA mutations include breast cancer diagnosis before age 50 years, bilateral breast cancer, family history of breast and ovarian cancer, presence of breast cancer in ≥1 male family member, multiple cases of breast cancer in the family, ≥1 family member with 2 primary types of BRCA-related cancer, and Ashkenazi Jewish ethnicity. https://www.uspreventiveservicestaskforce.org/Page...

    Any person should be able to get a copy of their radiology report. There may be a charge for copying it.

    Best wishes for the best possible results.


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  • MTwoman
    MTwoman Member Posts: 2,704
    edited October 2017

    I do NOT believe that a biopsy would be "diagnostic laboratory", although the pathology component would be. The actual biopsy procedure will have a procedural CPT code which would vary depending on whether it is a core or fine needle. I also agree with muska about following the radiologist's recommendations. I'd start with having a conversation with your doctor whom you trust, including the BIRADS score and what that means.

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  • jliznelson
    jliznelson Member Posts: 8
    edited October 2017

    Hey friends, I got my radiology report. One mass is 2.3 x 1.5 x 2.6. One is 1.3 x 1.2.

    The report says "Focal masses within the breast likely to represent benign fibroadenomas. Given the irregularity within the larger mass seen in the upper quadrant of the right breast, short interval followup with right breast ultrasound in 3 months is recommended to confirm stability.

    BIRAD category is 3.

    They won't do a biopsy due to my age and the unlikelihood of it being cancer, and also because if it is cancer it grows very slowly in young women.

    Just soaking it all in.

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  • MTwoman
    MTwoman Member Posts: 2,704
    edited October 2017

    jliz, BIRADS 3 means that the findings are "probably benign" and have less than a 2% chance of being bc - based on their characteristics. They don't biopsy BIRADS 3 findings (insurance typically does not reimburse for that as it isn't indicated), but do watch them on an increased interval for at least one year to confirm stability. so Congrats! on your b9 findings. Follow up on the interval screening, but you've gotten good news. Go celebrate and live your life!!

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  • jliznelson
    jliznelson Member Posts: 8
    edited October 2017

    thank you ☺ I feel better after talking it through w/family and reading. Praise God!

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  • jliznelson
    jliznelson Member Posts: 8
    edited November 2017

    Hi everyone, in about a month I go back for my 2nd ultrasound. I am having anxiety and wanted to talk it through with you all. I've noticed that my lump feels bigger and sore around my period. I also have noticed (off my period) that I can now feel the 2nd lump. Is this concerning or is it a good thing to have pain around your period? Also, I had norovirus and it has taken me a very long time to get over that -- a virus that should only last a few days lasted 3+ weeks for me (the symptoms were not as strong but I had constant diarrhea for a good 2 weeks and am now getting over constipation)... I called the ER doc (went in because of violent vomiting/stomach pain) when it wasn't going away and they just kinda told me I have to wait it out. I think that is unrelated but not sure if it is alarming that it took so long for my immune system to fight it off? And one more thing, I've been getting weird headaches sometimes. Like last week, I had a headache that was in my eyes whenever I moved them. Like I said I have no idea if any of this is related, I have anxiety disorder so I just wanted to vent to you guys and see if you had any thoughts. Thanks:)

    Edit: something to add - yesterday I felt a small hard little pea-sized "ball" next to the big lump. This one feels harder than the large one. I never felt it before. When I went the first time they said there were 2 but I could not feel the 2nd one. Not sure if this is a new tumor or the old 2nd one and it grew?

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  • MelissaDallas
    MelissaDallas Member Posts: 7,268
    edited November 2017

    If there are any changes concerning to the radiologist they will recommend biopsy. The other things you mention, your virus and headaches, are not an indication of anything "bad" regarding your breasts.

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