I was 35, a doctor found a small lump. I got an mammogram/ultrasound and was surprised they wanted me to come back and do a biopsy. I was so surprised I stupidly even asked "for what?" uh, cancer. I was told I had calcifications. I'd have to wait a week before my biopsy. I then could not think of anything else but this, and researched calcifications etc. endlessly. It was draining and depressing. Long story short - if your calcifications are in a cluster, you may have DCIS. Before my biopsy they showed me a picture of my mammogram and it looked like a constellation, I could tell it was more probable that it would come back as a cancer diagnosis but it was hard to believe. I wasn't even expecting to need a mammogram until age 40. Generally, DCIS doesnt' manifest itself as a lump, but it can. If the doctors did not mention a mass, it may be that that lump IS the calcifications, not a full on "tumor." My understanding is that calcifications are the material that abnormal (cancerous) cells shed or discard. People also get them as we age, but they are more diffuse/random/not clustered. Generally a cluster of calcifications is associated with DCIS; which is to say that your lump could just be stage 0 - meaning it is still trapped in the ducts (ductal carcinoma in situ - DCIS). It is still no walk in the park and jarring to face at age 35.

I cut off both my breasts due to family history. Most people tend to get a lumpectomy (cut out the effected area) then radiation, and sometimes take hormonal drugs to try to prevent the cancer from returning. Or mastectomy. They also usually remove 1-2 lymph nodes to make sure it hasn't spread. If you only know your mother's side of the family, if this DOES come back as cancer, you should definitely get genetic testing to see if you have any of the genes or genetic mutations. Having certain genes or mutations means it could have a higher probability of returning, and so keeping that in mind, may effect how you want to treat this. Being younger is also a higher risk because you have more years that it may come back but I am getting WAY ahead of things - this may be benign. But just giving you a vague run down of things. It is difficult, and life changing in some ways, but not the end of the world.

Waiting for a biopsy and the results is the most stressful thing I've ever faced........... try not to worry until you get more information. And try to collect more information at the biopsy.

Unfortunately when I was in your shoes I worried and fixated and obsessed and researched endlessly. It was useful in some ways but also just added to the stress. Luckily your biopsy is soon. While there ask them for more information. Such as, are the calcifications in a cluster? Is the lump/mass a collection of calcifications or a second issue? What BIRADS rating did you give my mammogram? Looking back at my reports (after my diagnosis) I could see they gave mine a 4C, meaning they were almost entirely sure it was cancer and just needed the biopsy to confirm. My biopsy was a BIRADS 5. If I had been able to read that in the 18 days it took to get my results it would have kept me from a lot of uncertainty and limbo. Yours is probably somewhere in the 4s right now, meaning there is a suspicious abnormality that they need to get more information about. A biopsy is the best way to be sure.

The biopsy is a little uncomfortable. They may put your breast in a hole in the table and squeeze it (like you're getting a mammogram - in fact they are using that imaging to guide the biopsy to get the sample). For me laying in that position felt ridiculous and depressing. It is awkward. Try to set it up so you have something nice for yourself to do or enjoy later in the day. Rest. Be kind to yourself. Hope my information helps. Not trying to worry you but sounds similar to what I went through and if that is the case at least you won't be blindsided by the letters D.C.I.S.

Sorry to hear of the news. But at least you got it fast! I had to wait 10 days after my biopsy - was the worst time of my life.

If you have DCIS and IDC, they will usually treat the more serious cancer so basically you have Invasive Ductal Cancer with some DCIS (when DCIS breaks out of the ducts it is then IDC). The grade of it 1-3 is how different your cancerous cells are from normal cells. Grade 1 is the least different from a normal cell, and Grade 3 means your cancer cells are notably different (mutated) from what the appearance of a normal cell looks like. Grade 3 also means it is likely growing faster.

They will most likely schedule you for more imaging soon, like an MRI. From that the doctors will be able to tell you more about what surgery plan is feasible or ideal for your situation. For some women if the size of what needs to be removed is too large, they opt for mastectomy because a lumpectomy would take such a large amount of breast tissue it would be too deforming of a surgery/not worth it. I only had DCIS but got mastectomy due to age and knowing I have higher risk of recurrence due to being younger, as well as family history. I also wanted to avoid radiation/hormonal drugs and removed my opposite breast as well. But if you have lymph node involvement (the IDC is not only in the breast, but tried to leave via your lymphatic system) you may require radiation/chemo anyway so mastectomy doesn't guarantee less forms of treatment. You really just have to wait to gather more information about your situation first. You can read through this forum using the search box or the IDC forum or the lumpectomy lounge etc. the topic of "lumpectomy vs. mastectomy" has been widely discussed!

Again, because you are young and you only know your maternal sides history -- you NEED to get genetic testing, ask for it at your next appointment. If you find out you have the BRCA gene or other mutations, you may want to opt for mastectomy to minimize your risk for the cancer coming back.

We are here for you. I was diagnosed at 34... 3 weeks shy of my 35th birthday. I made the mammogram appointment before work, even brought in my laptop thinking I'd go into the office quickly after. Did not happen. Between my diagnosis and before my treatment plan was final were some of the scariest days of my life. Please reach out if you want to talk. Feel free to PM me, as well. I haven't found many young women to connect with going through this, but know you are not alone. xx

35andWorried

"DCIS in the duct. Level 3. Moved outside the duct. Level 2"

I am assuming you mean grade 2 and 3 but is this two grades of DCIS or grade 3 DCIS and grade 2 IDC?

Our breast surgeon's routine at this point would be an MRI to evaluate the remainder of this breast and all of the other breast for additional areas that may require biopsy, as well as the lymph nodes on both sides.

If no other areas are identified a lumpectomy will follow. The specimen will then be fully sectioned and evaluated microscopically. Receptor status will be determined and your treatment will be based in part on all this post-op information.

They may or may not do a sentinel node dissection if the biopsy showed pure DCIS and the nodes were negative on MRI but that is the surgeon's and/or oncologist's decision. If there is IDC present they most likely will. The conventional wisdom has always been that pure DCIS does not metastasize but I'm not sure if that thought is changing now with improved testing methods for the nodes.

35andWorried

A breast MRI is very sensitive for detecting breast cancer but is limited in scope to the breasts, chest wall, and the axillae. It may not go back as far as the spine, and although portions of the lungs are in the field of view, the imaging sequences are not the ones used to evaluate the lungs. Lymph nodes under the arms and along the back of the sternum will be well seen and evaluated.

If one suspects spread to other areas, separate MRI's would have to be done, tuned specifically to those areas but more common I believe would be a PET/CT which should include almost everything head to toe.

djmammo - not to hijack this thread, but I am having another recurrence scare due to a lump and I was shocked/alarmed when the doctor who felt my lump said she was going to order a CT scan. This immediately sent my thoughts into doom - like it must have spread. I was expecting just an ultrasound and biopsy. How do you think doctors make that decision when they feel a lump on a mastectomied chest? she said it felt "deeper" like in my muscle but I can pull my skin away from my chest and the lump moves with it, but of course I am no expert.


35 -- the MRI will give more insight if they think there is node involvement, BUT the most information will come from the pathology report after breast tissue is removed, and when lymph nodes are removed. They will at least check 1-2 at minimum to see if it has spread. They do this by injecting a dye into your nipple. Your lymphatic system will remove it, when they look at your armpit area the node(s) that are blue are the "sentinel" nodes, the first ones a cancer would also be spread to. They will take those out and look at them during surgery and if they test positive for cancer, they will remove more. That's why you'll see in people's footers on this site 3/10 nodes etc. That means that person had 3 of the 10 nodes that were removed test positive for cancer. When you have nodes that are positive, I believe that pushes you to Stage 2 Cancer. You will gain a bit more info from the MRI, and pathology results will provide even more. For me, the pathology results ended up being the same as what the MRI revealed. But some women have surprises, as the MRI does not pick up everything.

blah333

The standard of care is to use ultrasound to evaluate any lumps found after a mastectomy followed by US guided biopsy if anything suspicious is found. CT does not have to resolution to fully evaluate small nodules.

No, a mastectomy does not eliminate your chances of recurrence.

A MX in many cases may reduce, sometimes significantly reduce, the risk of a local recurrence, i.e. a recurrence in the breast area. But even the best breast surgeon cannot remove every single scraping of breast tissue, so there always will be a small (generally 1%-2%) risk of local recurrence even after a MX. And if the surgical margins are close at the chest wall or against the skin, or if the patient has other risk factors such as being BRCA positive, then the risk of a local recurrence will be higher.

A MX has no impact on the risk of a distant recurrence, i.e. a metastatic recurrence. This is why if a systemic treatment such as chemo is recommended, the recommendation will be the same whether the patient has a MX or the patient has a lumpectomy + rads. Chemo is given to reduce the risk of mets, and this risk is unaffected by the type of surgery.

I will refer you again to this thread, which discusses all of this in detail: https://community.breastcancer.org/forum/91/topics/868997?page=1#post_5329372

djmammo - that's what I thought. That's why I was shocked when she suggested CT. My immediate reaction was that she assumes it has already spread. WTF..... I only had DCIS. I'll be pissed if I have mets. or even a recurrence just 2 years after cutting off my breasts. I've already overdosed myself in this board, that's why I know it's possible to have cancer come back after mastectomy, despite doctors saying the odds of that are low.


Looking around a bit more online I see - "your doctor may order a CT scan to assess whether or not the cancer has moved into the chest wall." which is what could be going on but wtf I "shouldn't" even have cancer (sorry, venting). I also have Medicare and my insurance is free, so there is no insurance issue about getting a CT.