Freaking out: Found a lump… is it breast cancer?

Hi again— just coming back to post an update after a very LONG, stressful few weeks…

After my initial post, I did end up moving my appointment up to the following Monday (8/23) with an NP. She did a breast exam and admitted she didn't do many but would refer me for a mammogram + ultrasound since she did feel the lump as well. That same week, they got me in for an appointment—had the mammogram first, then went back out to that little room to wait, full of nerves. Then I got the dreaded request to come back for some additional images. Afterward, I went for the ultrasound across the hall. I was already crying at this point as I was feeling overwhelmed by the whole process. I kept thinking, "I'm only 33, with three young kids. This is probably nothing."

After the initial ultrasound with the tech, she left the room and came back in with the radiologist, who told me she wanted to take a look herself since the tech was having trouble locating the areas of concern. Afterward, the radiologist put her hand on mine, looked me straight in the eyes and said, "You have a cluster of calcifications in your left side that may be DCIS, a pre-cancer. On the right side, you have a suspicious irregular mass that I'm concerned is a small cancer." I immediately began having a panic attach and crying. Then she said, "I know it's hard to process but I just want to be honest with you so you can mentally prepare for this. It's ok to cry." I could barely understand what she was saying through my anxiety and panic so I instead just wrote word for word what she was telling me in my phone's notes app. One direct quote I captured: "I am very very concerned. It's most likely cancer."

I'm not sure how I made the hour drive home because it's all a blur now, but I did. During the drive, I called my husband and broke down to him, telling him "they think it's cancer." He didn't admit this to me until late but apparently he broke down crying for a long time after we got off the phone but I never would have known—he had on such a brave and reassuring face when I got home. Over the next few days, convinced I had cancer, I fell into a deep depression. I began doing lots of research — reaching out to breast cancer survivors to hear their experiences, researching the various diagnoses and treatment options, pre-registering at the MD Anderson Cancer Center in Houston. I also told my boss (in case I'd need to miss work), our HR team (to discuss short term disability in case I needed to use it for treatment), family and friends… I tried to really mentally prepare.

In biopsy day, they took samples from each breast. The left side was vacuum assisted, the right was CNB (with the same radiologist from the ultrasound a few days prior). During the biopsy, I said to the radiologist: "Please tell me there's a chance this isn't cancer. I'm young, I have three young kids. I need to have hope." To which she replied: "it's a very, very slim chance." I was broken all over again. As I left the appointment, I was told I'd get a call by the next day with results.

The next day (a Friday), I received a call from the hospital and my heart began to race. When I answered, the voice on the other end said, "did you see your results in the patient portal? Your samples all came back benign, no cancer." I began crying, but this time they were tears of relief and shock. I had mentally prepared myself to hear the worst and didn't know how to handle the news. I told my husband, and I could immediately see the weight of the world lifting off his shoulders. He was able to breathe again. Over the next couple days, we shared the good news with family, friends, coworkers. I was feeling better, but I still was having trouble accepting the good news. I was afraid to trust it and then get bad news and fall back into that dark place all over again.

Here's the biopsy pathology report:

"Right breast: ultrasound-guided biopsy, 5:00, 4 cm from nipple: Fibrocystic changes, sclerosing adenosis, usual ductal hyperplasia and associated calcifications. Negative for neoplasia.
Left breast: stereotactic biopsies: Fibrocystic changes with associated calcifications and lactational changes. Negative for neoplasia."

I had an appointment scheduled the following Monday with a breast surgeon (I'll call her Dr. W) to discuss next steps. The first thing she did when I met her was apologize for what the radiologist had told me - she said "that radiologist is a little excitable. You're not the first patient she has done that to unfortunately." I didn't know how to feel about that. Then she told me that since the biopsy results were benign, she feels very confident there's nothing to worry about, and if it were up to her, she would probably just monitor the area for the next couple years rather than operate to remove it. But since the imaging didn't align with the biopsy findings and it was considered a "discordant biopsy" she wanted me to have an MRI done - "as a tie breaker of sorts to decide if you need to have a surgery to remove the area or if we could just monitor it."

I had the MRI done the following week, and the report indicated no suspicious findings on the left but unfortunately the right showed:

"There is nonmass enhancement spanning 3.1 cm in the AP dimension at the site of recent biopsy in the lower central breast at middle to posterior depth. This correlates with the area of architectural distortion seen mammographically, which was deemed discordant on recent biopsy. T2 hyperintense 0.7 cm oval circumscribed mass with dark internal septations and benign kinetics located less than 1 cm immediately lateral to the biopsy site, consistent with a fibroadenoma. Additionally, there is a 1.2 x 0.8 x 0.8 cm T2 hyperintense mass with rapid initial enhancement and delayed washout kinetics in the axillary tail region (series 9, image 94). Mildly prominent level 1 axillary lymph nodes are likely reactive related to recent biopsy given normal sonographic appearance on 8/26/2021.
IMPRESSION
Nonmass enhancement spanning 3.1 cm at the site of recently biopsied architectural distortion in the right breast. Findings remain discordant with benign biopsy results. Excisional biopsy is recommended.
Mass in the right axillary tail region may represent a reactive low-lying axillary lymph node, but warrants further evaluation with second look ultrasound.
Postbiopsy changes in the left breast without MR evidence of malignancy.
CATEGORY BI-RADS: 4: Suspicious
MANAGEMENT:

1. Second look ultrasound for the mass in the right axillary tail region.

2. Pending the above, excisional biopsy of the nonmass enhancement/architectural distortion in the right breast is advised."

I was contacted by the surgeon's office and told they were recommending surgical removal of the suspicious area - and a "second look" ultrasound of the one enlarged lymph node. I went in for the ultrasound and the radiologist (not the one from the previous ultrasound) told me she would recommend a biopsy of the lymph node since it was the only one enlarged and they'd expect more than one to be enlarged if it was just a reaction to the biopsy. I felt this was weird since there were no abnormal findings in my lymph nodes on the previous mammogram and ultrasound.

That day, I decided to meet with a different surgeon (I'll call her Dr. R) for a second opinion - who I was referred to by a couple friends who had gone to her, and she has a great reputation in the women's health community. During that initial meeting, she told me she didn't agree with their decision to schedule the MRI so soon after the biopsy—because it makes it difficult to tell the difference between biopsy-related inflammation and something else. She also told me she was pretty sure the lymph node was only enlarged due to the inflammation from the biopsy. I immediately trusted her and scheduled my excisional biopsy surgery with her for the following week. She told me she would do an ultrasound of the lymph node prior to the surgery and if it was still enlarged she would biopsy it during the surgery. I liked that plan. She also told me during that appointment that she was "leaning toward it being benign" and said "nothing about this screams cancer to me." That was enough to ease my mind until the surgery.

The excisional biopsy was this past Monday (9/13). I was a nervous wreck the morning of the surgery but it was over in 30 minutes and has so far been a relatively easy experience. In the recovery room immediately following surgery, Dr. R said to me: "After a preliminary review, it looks like just some radial scarring" - but that we wouldn't have the full pathology report back for 2-3 days. I questioned her multiple times about whether or not she thought it was cancer and she said "I feel very, very confident that it's not." I hadn't heard the term "radial scarring" before but it sounded harmless at the time, so I felt relieved and relaxed for the first time in weeks.

That was until I began researching "radial scarring" yesterday and found that it can sometimes accompany breast cancer, turn into breast cancer or be a risk factor for developing breast cancer in the future. And of course now I'm terrified again. I've scoured message boards and seen many people report having had radial scarring removed via excisional biopsy only to have the report come back positive for cancer cells within the radial scar. Or people who have had radial scars removed and then a year or years later developed breast cancer. And here I am again—in an anxiety spiral, obsessively researching and questioning everything. I just feel like I'm on the world's worst carousel ride and it won't stop, and I just WANT TO GET OFF. When can I get off? When will it end? I've been an emotional wreck for weeks now. I've been up and down, and now I'm feeling a bit numb—afraid to feel much of anything for fear of my world being turned upside down. All the while trying to still be a relatively present mother to my three kids and wife to my husband. They need me. I need to be strong and stay positive. It's just so hard sometimes…

I should get the final results back tomorrow or Thursday. Just praying and praying for good news.

In the meantime, I'd love to hear from anyone who can weigh in on radial scarring. Should I be terribly concerned?

Additional note: I submitted bloodwork for genetics testing and should get those results back in another week or so. Anxious to see if I have other risk factors

Thank you so much

I got a call from my surgeon with the results from my pathology report last night… confirmed BENIGN!!!! She told me it is a radial scar / complex sclerosing lesion. She also told me the size of the lesion was 7x7x5 mm, in an area of dense tissue - and they got it all with clean margins. I asked her about the risk of related cancer and she told me there are no cancer cells and it couldn't have turned into cancer, but having this does "slightly increase the risk of future breast cancer" (didn't love hearing that).

I asked if there are any preventative measures I can take now, and she said nothing right now—that I'll probably come back in a year for a follow up mammogram and go from there. I'm supposed to schedule a follow up visit appt with her in the next week or so and we will discuss further. I was so relieved when I got off the call! Finally I felt like this nightmare was over.

Then I logged onto my MyChart to check the full report and saw something that confused me. There's a section within the report called "Frozen section diagnosis: Complex sclerosing lesion with possible DCIS." The surgeon didn't mention this to me at all. Is this just from the preliminary review, and upon further review, no DCIS was found? Anyone familiar with these reports and how to read them?

Here’s how the report reads:

“FINAL DIAGNOSIS:

Right breast, 6:00, lumpectomy:

-Complex sclerosing lesion with associated radial scar.

-Previous biopsy site changes.

-Lesion appears clear of margins.

-No atypia or malignancy detected.

Frozen Section Diagnosis:

-Complex sclerosing lesion with possible DCIS. Deferred to routine processing.