mammogram

I had a mammogram on 10/23 which was routine, but I'd also been having clear to yellowish discharge from the left nipple while performing BSE over the last 2 months. My PCP who ordered the exam initially refused to give me the results, and faxed them to my gyn, and he refused to give the results to me  as he didn't order the test. I eventually got a "normal" report from the PCP's nurse, who didn't have a hard copy of the report in front of her. I managed to obtain a hard copy, and the findings are as follows; "extremely dense breast tissue limits mammographay for detection of malignancy. No finding on mammo. to account for yellow left nipple discharge. Clinical follow up is recommended until resolution and decision to perform further eval in the form of MRI or biopsy must be made on clinical grounds" It also says mild asymmetry of fibroglandular tissue projected in the extreme upper RT breast posterior to the parenchymal cone on the LT CC projection. Is this normal? I do realize at age 43, having "extremely dense and heterogeneous breast tissue", also on the mammo, and having started my period at age 10 with 3 maternal aunts and my paternal grandmother with histories of breast CA, along with having had a vaginal hyst. a year ago for a precancerous uterus does make me a higher risk. Can you help me with the read on this mammo? Thanks, and I apologize for the length. I wanted as much info as possible for you.

[Fernando Roque, MD]

Hi. Some points of clarification regarding your mammography report:

1. It is not reporting “normal findings” as the nurse claimed.
2. What the radiologist who made the report is actually saying is: your mammogram can’t tell you if a cancer is present or not, and it cannot tell you if a malignancy is possibly causing your nipple discharge.  Why is this so?  Cancerous lesions usually present in mammograms either as masses or microcalcifications.  When a woman has dense breast tissue, as you have, it becomes hard to delineate discrete masses or microcalcifications from the surrounding normal breast tissue.
3. Since the mammography findings are equivocal, the report is actually recommending other tests like MRI or biopsy be done to investigate if your nipple discharge is coming from a possible cancer or not.

If your nipple discharge is persistent, my suggestion is to have a biopsy done.  This would be the best procedure to settle the question of whether a cancer is causing that discharge or not.

[sonu78]

Hi,
Mammogram is a screening modality for any cancerous spot.
It is never reported as normal. But reported in lines with BIRADS scale. It will be reported as
0-Incomplete evaluation
1-Negative
2- Benign finding
3- Probably benign finding
4-Suspicious
5-Highly suggestive of malignancy.

If the mammogram is inconclusive,other modalities may be tried.
Do have an culture done for the discharge as well as send the discharge for histological examination.