Donnie, I agree with you. I've been hanging around here a long time, and I've had fibrocystic breasts all my life - first fibroadenoma at 16, another after that, and more cysts than I can count. I have never heard that evening primrose is guaranteed to make fibrocystic masses disappear - if only it was that simple! I have also never heard of someone being told that they have to get a biopsy after 6 months for a BI-RADS 3 lesion that is not suspicious and has been stable.

What was the BI-RADS number on your repeat mammogram? And have you been getting ultrasounds in addition to the mammogram? With a BI-RADS 3, an ultrasound should be done before a biopsy.

Who originally sent you to the breast surgeon 6 months ago? Normally with a non-suspicious BIRADS 3, the radiologist is in charge of the recommended next steps and follow-up and there is no reason to involve a breast surgeon. This is a radiologist's area of expertise. What next step did the radiologist who did the mammogram recommend?

Hmmm.... I probably shouldn't say this, but my guess is that the breast surgeon is looking for the revenue from the biopsy. If the surgeon agrees that the lesion is stable and that the imaging remains a BI-RADS 3, then by definition no biopsy is necessary. That's what BI-RADS 3 means - short-term imaging follow up, no biopsy required. Usually radiologists and surgeons are reluctant to do biopsies for BI-RADS 3s, but will do them if a patient insists. But sometimes insurance won't pay if it's a BI-RADS 3.

The evening primrose explanation is, frankly, absurd. There is some evidence that evening primrose might in some cases alleviate fibrocystic pain or reduce the size of cysts but it's definitely hit and miss.

If you don't want the biopsy or are questioning whether it's necessary, perhaps go back to the radiologist and ask for an ultrasound to see if there still is no correlation with the mammogram, or if something now shows up and either confirms a benign appearance or raises concerns. And you can ask the radiologist if he sees any reason for a biopsy.

Donnie, it sounds as though the doctor at the walk-in clinic was kind of clueless, and that's what's started the ball rolling towards where you are now.

From having read posts here for so many years, what I've seen is that there are a lot of primary care doctors - generalists - who don't understand breast imaging. They see anything noted on a report and figure that for the sake of caution, the patient should see a breast specialist (i.e. breast surgeon). That sometimes leads the patient down the road towards extra testing and procedures that are unnecessary. I've seen it happen dozens of times. What some PCPs don't understand is that when it comes to imaging, the expert is the radiologist. The radiologist is a doctor who specializes in imaging and biopsy procedures. The breast surgeon is a doctor who specializes in surgery. So when something shows up on breast imaging, the assessment of the radiologist and the follow-up recommendations from the radiologist don't usually need a second opinion from a breast surgeon, a doctor who is less specialized in this area. Unfortunately some PCPs treat the radiologist's report as though it is written by a tech, not a doctor, and feel that confirmation is necessary from a 'real' doctor, i.e. the breast surgeon.

That's not to say that second opinions aren't valuable in some cases, where there are several options about what to do next or where the assessment could go either way, a BI-RADS 3 (no biopsy) or a BI-RADs 4 (biopsy recommended). While the radiologist is an extensively trained doctor, there is a level of subjectivity in reading imaging. So having another set of eyes (ideally another radiologist) look at the imaging to confirm a BI-RADS 3, or to confirm stability, can be a good idea. But if the BI-RADS 3 is confirmed, then the follow-up action should be consistent with that, not contrary to that. In your case, you had two sets of eyes (or 3 - the original radiologist, the breast surgeon and the breast surgeon's radiologist) all view both your original imaging and your 6 month imaging, and all agree that it you have a stable BI-RADS 3 mass.

If you go ahead with the biopsy, who will be doing it? The surgeon herself or her radiologist? If it's the surgeon herself, I'd advise against. If you do want the biopsy, I'd suggest you ask for it to be done by her radiologist or go back to the first radiologist. Yes, sometimes surgeons do core needle biopsies and they go well. But I've seen too many cases on this board of surgeons who insist on doing core needle biopsies or patients who choose to go to a surgeon because they wrongly think the surgeon will do a better job, and then the biopsy isn't properly done (the location of the needle has to be extremely precisely placed), the results are discordant (i.e. the biopsy results don't reflect what was seen on the imaging) and in the end the patient is sent to a radiologist for a repeat biopsy. Not saying that would happen in your case but if it were me, I wouldn't take a chance.

Let us know what you decide and how it goes.

As per usual great feedback from Beesie! Yes it sounds like overkill to me. Which really sucks for you. I second what Alice says, I'd look for a new doctor honestly.

Okay, that's even more confusing. You've had a mammogram and ultrasound, and the lesion only shows up on a mammogram. So IF a biopsy is to be done, that suggests a stereotactic, i.e. mammogram guided, biopsy. But the surgeon is questioning whether an ultrasound or MRI guided biopsy might be better? That would require first sending you for an ultrasound or MRI to see if the lesion is even visualized, which it previously wasn't on the ultrasound. So more unnecessary tests.

Honestly, none of this passes the smell test. And it starts with the evening primrose being the sole explanation for the need for the biopsy. BI-RADS 3 masses are monitored for stability for 1 - 2 years precisely because there is no intervention, other than surgical excision, that can make these masses go away. Many shrink naturally on their own over time, and something like evening primrose might be able to speed that process (but it's a very questionable "might") so all anyone can do is wait and monitor. To say that a biopsy is necessary after 6 months of monitoring for a stable 4mm well-circumscribed mass... it doesn't compute.

I think you should directly ask why the doctor thinks the evening primrose should have made the mass go away, when there is no scientific evidence to suggest that it would.

Evening primrose oil https://www.komen.org/breast-cancer/survivorship/c...

Hi, it may be overkill but why not do the biopsy. It's a little uncomfortable but it will be worth it to know for sure it's not cancer. Are you doing an ultrasound biopsy? It's not that fun but it's not at all as bad as an MRI biopsy. Basically, the radiologist finds the spot, then you feel a tiny sting. The worse part is that it sound like a gunshot but then it's over. The worst part will be waiting for results but once you have them you will feel better. If you do have breast cancer you will want to know asap. It's worth doing! Finding something early makes a huge difference.

Another reason, for most people it is expensive out of pocket