Asymmetric Tissue Mass

I recently have had two high resolution CTs for my lungs, and an asymmetrical tissue mass was noted in the tail of my left breast.  This finding was followed up with a mammogram last Friday which was extremely painful on the left side, the right side was fine.  I have had pain in this area of my left breast for quite some time, I am a bone marrow tranplant patient for myelofibrosis, having had my transplant in December of 2002.  I have chronic skin graft vs. host disease (GVHD) issues which are sclerodermic with the area around both breasts being affected in addition to other locations on my body.  My first question is what is the likelihood that the meds I have taken for the transplant and follow-up could be carcinogenic - busulfan, cytoxan, methotrexate, medrol, prednisone, voriconazole, cyclosporin, foscarnet, valcite, gancylovir?  And my second question is what is the likelihod that this persistently painful area could be cancerous or some complication from the scleroderma?  My third, and final, question is should I insist on a follow-up ultrasound and/or biopsy?  I trust my bone marrow docs whom I see every week due to the chronic GVHD, however, I have found it helpful to be informed and proactive in my treatment.  Thank you.

[CCF-RN,MSN-JS]

Dear sistervikki, 1) The medications that you list in themselves are not known as carcinogens as for instance smoking is a known carcinogen.  Some of these medications can increase risk of secondary malignancy such as high dose cytoxan has shown increase risk of bladder cancer.  The immunosuppressant medications - cyclosporin, or prolonged use of steroids are suppressive to the immune system which can increase a persons risk of developing cancer.  None of them are specifically associated with increased risk of breast cancer.  2) The findings from the MRI and mammogram would be correlated with any physical findings, if there is question regarding what this mass is or any suspicion that this mass may be malignant a biopsy of the area would be recommended.  Pain is not necessarily associated with breast cancer, the most common "symptom" of breast cancer is a non-painful lump.  3)You may want to seek a second opinion from a breast specialist to review the findings, to get there evaluation of this mass and proceed from there.

[sistervikki]

Thank you for your timely response.