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A Little Anxiety Going On...
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A Little Anxiety Going On...

I'm 43, non-smoker, non-drinker, no history of BC in family.  Had baseline mammo done at 35.  Had yearly mammo's starting age 40.  So this year, I get an abnormal report (below).  Going in for magnified views, but wanted to get some opinions. I've made a couple of my own comments below, which will be in parenthesis.  Otherwise, this is the basic report.

Mammo exam reviewed with aid of CAD.  CC, MLO and exaggerated CC views bilaterally compared with mammo from age 35.  (Why wasn't it compared with last years view???)

Dense heterogeneous fibroglandular tissue both breasts.  Several microcalcifications in central portion of right breast on CC view not clearly demonstrated on previous study. (Does this mean they weren't noticed on MLO or exaggerated films? and, "not clearly demonstrated" does that mean it may have been on the earlier film? and, "several" doesn't indicate clustered or scattered so which do I assume?)

There is a group of microcalcifications in left breast which have punctate appearance and are probably benign.  The calcifications are not clearly demonstrated on previous study.  There is no definite focal suspicious mass.  Left axillary lymph nodes are noted. (Well, punctate is usually benign but could later lead to DCIS right? No mass is good)

IMPRESSION:  Microcalcifications in bilateral breasts as described, not clearly demonstrated on the previous study.  Findings probably benign.  However followup spot compression magnification mammos of both breasts are recommended for further eval.

So...... most of my questions are above.  For those who may have had similar findings, what was the outcome?  Since my breasts are quite dense, I may request some type of biopsy even if they say none needed, but not sure.  And why would they not have compared it to last years mammo? Tech thought for sure they had, but no indication on actual report.  I've had 3 kids, had trouble breastfeeding but successfully did so longer with the last child (age 40, nursed almost 18 months with help of domperidone).  How concerned should I be with this report?
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25201_tn?1255584436
Keep in mind that the presence of microcalcifications isn't necessarily a cause for concern. They appear normally as we age and it's only when they are observed in clusters or groups that they need to be evaluated further. Even then a good number of biopsies that are done due to them return a benign result. The spot compression is just a magnified view of those areas that are in question ..... easier to "see" the big picture of a small area. If all your Mammograms were done at the same institution I'm sure ALL the films were in the same envelop and all were studied. If they were done at different institutions then they may not all have been available for comparison. I wouldn't get overly concerned until I had all the testing recommended and had gone over all the reports with your Dr.   By the way .... don't ever assume anything ... several means just that "several".  Keep us posted when you get more information and in the meantime .. TAKE IT EASY.
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Avatar_f_tn
Yes, all mammo's were done at the same place.  I've had the same doc for about 20 years.  It's just been one thing after another this year.  About a month ago, I was diagnosed with what appears to be histoplasmosis, which basically means my lungs have both calcified and noncalcified nodules but at this time they're not suspecting anything.  I took it upon myself to schedule a follow up with a pulmonologist on that, coming up soon.  And I had a ct scan done at that time (focusing on lungs).  I just feel like I'm starting to fall apart! I know that's not true, and probably this has nothing to do with the lungs.  From what I have read, just having the dense tissue of the breasts is classified as a Birad 3, since it could hide things on imaging.  And here I was always told having smaller breasts meant less chance for any development... haha what an old wives tale!
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25201_tn?1255584436
Sorry you've had such a year ... things seem to come that way now and then; I always think "OK, lets just get everything over at once and be done with it." I think there are lots of "stories" out there about breasts ... small-better, large-better, giving birth - better/worse ... I think they are all just "stories" and none really apply to real life. Young women have very dense breasts (that's why mammograms are not useful at an early age) and as we age our breasts become more dense. Let's face it ... sometimes we just can't seem to win.  Take care now ......
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Avatar_f_tn
I have a small, but perhaps important update.  I want to post this so others in my position might have something else to compare their findings with.  I also want to inform others as to what they need to look at on their radiology reports, to make sure everything was done properly and nothing might have been missed.

My baseline was in 2002.  I do not have the actual report.  I do have the radiology report from 2009 and 2010, which are the next in line.  I'm 43, again don't smoke, drink, have 3 children 21, 19, and 2 respectively.  I breast fed each as much as I could, having trouble producing breast milk, I took reglan with my last child but switched to domperidone because reglan literally made me think I was going crazy.

The form letter that is sent after a mammo is NOT the radiology report!  My letter last year said all was well, no problems, see you in a year (paraphrasing).  The radiology report from 2009 DID show some findings, albeit presumably benign.  Also, for those who may find themselves with a callback... get your radiology report(s) and READ them... make sure your personal data is correct... then make sure your most recent mammo has been compared with the last ones done.  This was a problem I found.  Read on.

This year's mammo was abnormal.  I go for additional views tomorrow.  I've been very stressed and tons of anxiety going on.  I had it in my mind I had cancer, but now I feel fairly confident I don't and here's why.  My 2010 mammo reading is above, but it basically started out saying "this mammo compared to 2002".  After two days of phone calls, they finally admitted the radiologist had NOT compared 2010 to 2009.  So I got my 2009 radiologist report and here's what it said (keep in mind I got a form letter with two thumbs up).  

"Compared to study of 2002, CAD enhanced.  Findings:  Breasts radiographically dense w/fibroglandular tissue that is unchanged in distribution.  Loose grouping of small discrete homogeneous microcals is AGAIN (yes, it says again) seen in inferior right breast, approx 4-5.  These are unchanged.  No dominant masses, new clustered microcals, or architectual distortion.  IMPRESSION: No mammographic evidence of malignancy.  Grade 2 (this must refer to BIRAD): Benign, normal w/benign findings. Routine followup."

So, I want all of those who might get a call back to be informed.  Don't assume your facility compared everything.  Get the results and read them.  I now feel fairly confident that my findings, even with the new punctate microcals in the left breast, are benign.  If I had microcals in the right breast in 2002, and again in 2009, and it appeared unchanged, and then a new radiologist read my CAD enhanced film study this year, had a different interpretation, saw some new microcals, and (assuming) unknowingly and unintentionally created perhaps unnecessary anxiety.  I'm not knocking the radiologist per se, or the facility, since we are all human.  But each of us must take it upon ourselves to make sure everything coincides, because everyone makes mistakes.

They re-evaluated my studies today, and called to tell me that they still want additional views mainly because they are more aggressive with diagnosing.  This is fine.  The tech agreed that it "appears" all the findings are benign.  The terms within the two years studies include the words "again seen", "loose grouping" (which is good), "homogeneous", "punctate", "no suspicious mass", and "probably benign".  

I am in the medical field, and grew up being taught to take notes, compare, read, ask questions, and understand.  Yes, I searched the internet when I received a call back.  Yes, it scared the living dahookies out of me.  But it helped me gain the knowledge of what I was reading on my reports, so that I could attempt to put into perspective what was happening.  I do hope I'm right with my own diagnosis/conclusions based on my personal facts, and based on factual data readily available in studies online.  Either way, will update.

I welcome anyone's comments/suggestions.
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Avatar_f_tn
UPDATE... Magnified views were time consuming.  Right breast shows loosely clustered calcifications that were present in 2009, so they're opting for 6 month follow up.

Left breast shows a small new cluster that they want to biopsy.  Now let me ask you ladies something... how many microcalcifications were typically on your films?  Because all I see are four, and they appear punctate.  They are SO far to the lower location, it's where a bra would come in the front.  The tech thought they might have been skin or dermal calcifications, but they couldn't prove it.  But from what I've read, only four loose microcal's may not even fit into what they are classifying me as Birad 4b.  Funny thing is, in order to prove they are skin calcifications, one method is to see if they're the same on two different views.  I looked, and on my MLO and XCCL view they are identical... same spacing and everything.  I have typically quite dense breast tissue (like I'm an A cup, so when they do this biopsy I'm like not gonna have any boob left).  I think they labeled it a 4b because they are unsure if there is a density associated.  I believe it's just my typical tissue, but we'll see.  However, from everything I've seen, a loose group of 4 would have a greater chance of being benign.  If it turns out the other way, I will say the radiologist must have had a "feeling" and it would be an extremely tiny, early case.  My microcal's actually form what looks like the big dipper and the entire circumference is smaller than the metal BB marker they stuck on me.

My consult is 8/30.
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25201_tn?1255584436
I don't know what type of biopsy you will be having but I doubt they will be doing anything other than one of the needle types and will only be taking a minute amount of tissue. I don't think it makes much difference as to the number of calcifications .... it's the distinct pattern or grouping that leaves some doubt. Best to prove them benign than to wait and take the chance that they might indicate something else. You can always refuse any recommended testing or treatment but I know you're smarter than that, right ??  Good luck with the biopsy and I'm sure you'll have ample breast tissue left :).
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Avatar_f_tn
HI... I am commenting on the statement that the number of calcs doesnt make much difference.I was told that it IS the number of calcs that cna determine there is reason for suspicion.One of my clusters has about 13 calcs, and from what I have read is it possible they have formed around a growing tumor?
I am still in flux..as my Contrast MRI, showed inconclusive and they still want to try to biopsy two areas.
I am seeking counsel from an oncologist this week..presenting all my info.Will let you know !
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Avatar_f_tn
japdip:  

There is ample information online and even studies/pictures.  All you have to do is google what you want.  

From the information I've personally looked up, generally speaking there are two to three things that influence more of a malignant looking group versus benign.  While one of those is definitely an increased number, a radiologist also needs to determine "how" they look.  Are they different shapes, are they linear, are they smooth or coarse or do they vary all over the board?  Is there an associated density or mass and if so, what does it look like?  Is it spiculated or or star shaped?  That can indicate concern but even that is not 100% positive indicator.  Even if you have increased number and they seem amorphous or pleomorphic, it doesn't mean they are 100% malignant.  It means there is a greater chance for some type of a malignant condition, but I've seen teaching pictures where they show this type of thing and then say "in this case, it was fibrocystic change".  They're basically teaching radiologists that it's better to ere on the side of caution if something looks the least bit ominous in order to catch it early and therefore knock it out of the ballpark (so to speak), because sometimes you can't differentiate between the two.  

That being said, any new group or cluster of microcal's that pop up on a mammo are to be examined closely... even though I only have 4.  In my case, they appear all the same size and are almost evenly spaced out at around 1 - 1.6 mm.  It's really odd, because they form again what looks like the big dipper.  When I look at the films, I compare them to one another and these calcifications seem to look identical in about every study, no matter how they position me.  Generally, from what I've read, calcifications should appear different with different views because they compress the breast which in turn squeezes the underlying tissue.  Mine appear the same, and the location is extremely inferior, which is why the radiologist questioned skin calcifications.  I still question this, but it will have to be proven.  Overall density of the breast also influences what they see.  With very dense breasts, which is normal for most younger and smaller people, it's harder to read the mammo.  And we change as we get older too.  Last year I had just finished nursing my child, so I had extra density.  This year, some of that went away, but they're still dense.  The area for me in question looks to me like normal density, but because of these microcals, it's harder to differentiate.  So although I have doubt my issue is anything major, the person looking at the films wants to be sure.  I'm not a radiologist, doctor, or fully licensed nurse (although I am in nursing), so I have literally spent about a week (probably close to 25 hours), reading studies, learning what to look for on the mammogram, etc.  

My advice to you is the same advice I'm giving myself.  If they recommend a biopsy, just do it.  80% thereabouts come back benign.  And if it comes back an early cancer, it's treatable.  It's better to find out now than to wait until it may spread and be too late to have a favorable outcome.  
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Avatar_f_tn
Thank you..actually I spoke to an oncologist yesterday and he recommends going for the biospy
He explained things in order of progression, which made sense to me finally.
I am wary of trying to do the steroptactic again however, as since they had such a difficult time seeing the calcs and cancled my biospy, how are they going ot see it now?
he suggested MRI assisted biopsy.
I am going to see if i can simply get an excisional biopsy, so that if this is a malgnancy I do not have to go back for more surgery
And they will put me out! I had this done on this breats in 2006, with needle localization.The radiologist who performed the localization did not give me ANY numbing meds however prior to inserting the needles and i promptly passed out when they were inserted.
So, these negative experiences are why i am loath to go thru this again.
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Avatar_f_tn
UPDATE:  Breast surgeon consult today, at a breast center.  To recap; I am 43, white, non-smoker, with no breast, uterine or ovarian cancer in my family.  My mother, at age 43, was labeled having fibrocystic breast disease (which is a condition, not a disease), and had a needle aspiration done.  This is the only breast condition in any family members, and it can be present with microcals.  I have heterogenously dense breast tissue, am between 34A and B size (depends greatly on how it's made).  I have 3 kids, first one born when I was 21, last one when I was 43.  I nursed all 3 as long as I could, with the last one being the longest at almost 18 months with the help of Motilium (Domperidone).  I have been on birth control pills for 2 years.  I usually drink about a cup of coffee a day, but I am a HUGE chocolate eater.

Surgeon's Impression:  The microcalcifications in the right breast have remained stable for two years, so mammogram in 6 months is what should happen.  He believes those to be benign.  The microcalcifications in the left are at about the six o'clock position, and are WAY inferior meaning they're about where the edge of the bra comes in the front.  There are 4 of them and he didn't really think there was a density.  They were labeled a Birad 4B mainly because A) they are loosely clustered, B) they are tiny (.2 mm each), and C) they weren't clearly visible on the study last year.  The term "loosely clustered" is confusing, and so to give you an idea, my microcal's look like the big dipper.  Two sides are 1.6 mm from each other, and the other two sides are 1.0 mm from each other.  I measured them and doc agrees.  I will have a stereotactic biopsy Wednesday, using an 11 guage core needle, with lidocaine.  It should be a relatively painless procedure, and provided they can find the area quickly, should only take about 35 minutes.

I explained to him that percentages online for malignancy range from 3% to 94% for Birad 4.  This is greatly because there can be so many different things that are seen on a film, from the number of calcifications, to a mass, or the way things look.  In my particular case, I asked him what percentage he would put on it, and he said about 10%.

So there you have it... until Wednesday... my guess is I have the same thing my mom had, fibrocystic breast "condition", with a 90% chance for a B9 result.  Oh, and my results will probably either be in Thursday afternoon or Friday morning.  Will update then.
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Avatar_f_tn
Well I promised to post my results... they're not good.

The initial/preliminary report showed:  DCIS with focal areas suspicious for invasion

The final report showed:  Invasive ductal cell carcinoma, ER-, PR-, Her2 unequivocal, FISH pending

I have an appointment Tuesday to go over results and treatment.  To say I'm ok is far from truth.  I'm not ok at all.  I've read up on the results and I don't like what I see.  They haven't given a stage or grade as of yet, but I keep thinking it has to be early.  There was no mass on mammo and only four tiny microcalcifications.  I'm dealing with Her2 or triple negative cancer, right?  Just judging by the results above?  So that's like what, my chances of having it already in other parts is great and overall survival over 5 years is like what, 75%?  Maybe?

No, I'm not ok.  I'm 43 with a two year old who had planned on seeing him grow up.  I know I have a fight ahead of me and I'm so not up to fighting.  I don't feel strong.  It feels like a bad dream but no one will wake me up.  Petrified doesn't even really begin to describe how I feel.

I know I have nodules in my lungs. I was sick earlier in the year. I'm not sure if it's good or bad about my findings on a ct scan (with/without contrast). At that time, just two months ago, it was noted that I had numerous tiny nodules in both lungs, many calcified which is good, but there were three small ones that weren't.  However, they didn't enhance when the contrast was put in, so the results were low probability for malignancy.  But now?  What should I think??  Thus "petrified" doesn't even cut it...   I NEED HELP cuz I feel like I'm falling apart here.
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962875_tn?1314213636
I am so sorry that your results turned out to be positive for cancer. That is a VERY BIG THING to deal with, and it is not at all surprising that you feel petrified and overwhelmed. However, in time the shock will begin to wear off and very likely you will find that you ARE determined to fight this thing, both for your 2-yr-old son and for yourself.

HER2+ and TNBC are generally more aggressive and do not have as good a prognosis as the more common ER+/PR+/HER2-  type, but the statistics apply to a whole population, and not to the individual. A lot depends on the stage you are found to be in, and your response to tx.

I hope you have a support group of  loved ones, relatives, and/or  friends to help you through this difficult time. If not, your tx team and a BC support group should be of help, and you can also continue to turn to this community, where many, many others have already gone through everrything you are facing.

Best wishes,
bluebutterfly
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739091_tn?1300669627
Hi cc,
I'm so sorry you got a cancer diagnosis. That fear is like no other I've ever experienced. I know you have a small child at home and are terrified. Please don't wait this period out without some help. I had a small prescription of 5mg valium they gave me and since I wasn't fond of drugs I took them but cut the teeny tiny pill in half first and only took half. That little bit helped me cope with something no one should ever have to cope with. I'd also like to suggest you get a small voice activated recorder to put in your pocket book so you can record all of your doctor visits. This way, when your brain stops to consider something that was said, you won't miss what the doctor says next because they don't stop everytime you do. It also helps if you can't remember something. As you think of things, make notes to ask questions of them. If possible, make your first appointment one that has a hematology oncologist, breast surgeon, plastic surgeon and radiology oncologist present so they can all look over your films and reports and can work as a team to help you understand your diagnosis, prognosis and treatment plan as a cohesive unit. This is available to you if you but ask at most breast cancer centers and can also be available if you have your doctor set it up. It makes a world of difference and you will walk out with a huge understanding of the different parts of treatment etc. Please ask questions. And most important, if you don't like any of the doctors please change them immediately. Do not go through this without some degree of trust in your team. We are here and will help as we can. Best wishes.
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Avatar_f_tn
MRI follow up...

Still waiting on surgery.  Wondering if being diagnosed 9/3 with possible surgery 9/28 seems reasonable.  MRI showed right breast is ok.. finally some good news.  However, it did show increased density where they did the biopsy which I assume is not only the small cancer but also the aggravated tissue.  It also showed a density in the upper inner left quadrant.  And my main point of concern was, it had the phrased "small non-specific lymph nodes in axilla".  I don't know if this means there is something they saw or what.  So now, more than ever, I'm worried.  My biopsy report had "absent" for lymphatic and veinous invasion, so I don't know what to think.  Anyone with ideas??  japdip??
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962875_tn?1314213636
Hi again,

The delay until surgery is not an unreasonable, although I can understand your desire to "get it out of there" as soon as possible!

In regard to the lymph nodes, usually a sentinel node biopsy or axillary dissection is done at the time of the  lumpectomy or mastectomy, so if there were any concern about those  lymph nodes, it would be addressed then. (Also, if something worrrisome in regard to the lymph nodes mentioned in your report had been seen, I'm sure that would have been noted, rather than the innocuous description that was used.)

I'm sorry you are going through such a difficult time. Have you sought out anyone for emotional support yet?

Warm regards,
bluebutterfly
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