Is it really necessary?

[daylt]

I am a 28 yr. old female.  I have had a lump in my right breast since I was 16 yrs. old.  Back then, I had two mammograms within a 6 weeks time that showed I had fibrocystic breasts and a lump that did not seem malignant.  I was offered a biopsy, but decided not to do it.  The doctor said there was probably no cause for concern.  Recently I visited my obgyn and he asked if I wanted to have another mammogram done.  I said yes.  Same results, except there's also a new, small cyst, about 3x 1.6mm in size, if I remember correctly.  Of course, a biopsy was suggested because my breast are still very dense and, I'm assuming, because of my age.  I have not felt this bigger lump--about 1 to 1.6 cm in size--change at all in the 12 years I've had it.  If this were malignant, wouldn't it have grown somewhat in 12 years?? My biopsy is scheduled for tomorrow morning, but I am really afraid to go through with it.  Mostly, I feel like it's not necessary since I have not detected any changes in the lump.  Also, I'm afraid to go through the pain of a core biopsy if it is unnecessary.  I haven't decided whether or not to show up tomorrow.  I would like another surgeon's medical opinion.  Thank you.

[daylt]

Thank you for your advice.  I wish I would have written in sooner.  I did not read the last message until after my core biopsy.  I went through with it (the results were negative)and it was not painful due to the local anesthetic, but it was a scary situation.  The surgeon only got three samples and on the third one I started bleeding too much.  He had to apply pressure for a few minutes and told me that if it didn't stop they would have to take me to the ER.  I was originally told the procedure would all take about 5-10 minutes.  I knew this sounded suspicious to begin with and I did expect it to be a bit longer, but because of the bleeding I was at the breast center for about 2 hours.  Everything turned out okay.  I am thankful that it did.  I don't think I was in the greatest danger (maybe that's just my lack of medical knowledge), but if I could have avoided the excess bleeding part I would have been happier.  Thankfully, the results are negative and now I won't have any doctors pushing me to biopsy for a few years for this particular lump anyway.  Thanks for your prompt responses to my initial question.  I appreciate your availability and help.Thanks again.

[surgeon]

For the record, I'd NEVER order a mammogram on a 16 year old -- they're virtually useless at that age; and on any age I'd never order them 6 weeks apart -- absense of change in that amount of time means nothing. I'd rarely order them in a 28 year old either; it's a matter of density of tissue making interpretation nearly impossible. I can't say I'd NEVER order at that age, however. A lump present in a 16 year old, and stable for 12 years is absolutely not cancer, and needs removal or biopsy only if the owner decides she wants it out. If the biopsy is on that lump, it's my opinion it's not necessary. I'd add that one can't diagnose a "cyst" on mammogram; only that there's a round shadow that could be a cyst. The imaging technique to see if it's a cyst or not is ultrasound. Moreover, calling shadows in a 16 year old "fibrocystic" is a misnomer, since fibrocystic changes almost never occur at that age. If the biopsy you refer to is a stereotactic biopsy of the smaller shadow, the so-called cyst, and if you really meant it's 3mm x 1.6 mm (did you mean cm?) it's so small (less than 1/8th inch) as to be inconsequential and not easily biopsied. It sounds to me you ought to hold off on the biopsy and rediscuss it with your doctors and ask for a surgical opinion. I can't tell from the way you worded it if you were discussing only stereotactic biopsy, or if you were scheduled for surgical biopsy but also had been given the option of stereotactic. If there's not a surgeon involved in your care so far, I'd suggest you see one, one who does lots of breast surgery. I'd say your management could use some additional input. And whenever a patient has reservations, it's best to hold off. Don't just be a no-show, however; let them know what's on your mind, and that you want to cancel and get more input..

[CCF-RN,MSN-rf]

Dear daylt:  Mammograms are usually graded according to degree of suspicion.  A BIRAD score of 1 is normal, and 5 is highly suspicious.  If your score were 3, close follow up would likely be recommended.  If your score were 4 or 5, biopsy would likely be recommended.  If a biopsy was recommended, I assume it's because the only way the doctor can be certain it is benign is by doing a biopsy.  Without viewing your mammogram, and perhaps doing an ultrasound, it is impossible to make specific recommendations.