Mammogram, Ultrasound... is MRI recommended?

I'm 43 years old and recently had a mammogram that identified a 4 mm lesion, confirmed by a 2nd mammogram and ultrasound.  BIRAD score was 3, and the radiologist said because of its small size it was hard to characterize, but said the lesion appeared to be symmetrical and was likely a cyst but that repeat imaging was recommended within 6 months.  Because of a strong family history of breast cancer (maternal grandmother and sister both had pre-menopausal breast cancer), she said I should discuss the possibility of MRI and/or genetic cancer counseling with my ob/gyn provider who hasn't gotten in touch with me as yet.

With a 4mm lesion, is there any utility to pursing MRI?  
At what point is biopsy recommended for an 'uncharacterized' lesion?  
Would there be any advantage to pursing genetic cancer counseling if I wouldn't pursue prophylactic measures?
Any advice or opinions appreciated.  

[japdip]

Did you mean "your" sister ?? If so then perhaps Genetic Counselling would be of some value but only if you want to know if you are + for the BC Gene. If you are then more frequent investigation than normal would be recommended and your Daughters would also be positive and the same more frequent "watching" would be wise for them. MRI though useful can return false positive results. I see no reason not to wait the 6 months for a re-check. If you have questions and concerns then there is no reason why you shouldn't get a second opinion and have your films read by another Radiologist and/or see a Breast Specialist for his/her opinion. The more information you get, the easier it will be for you to make a decision about which path to take.   Regards ....

[eureka254]

Yes, it was my biological sister who was diagnosed at age 45.
I'm still on the fence about genetic counseling, as it would only be applicable for me (my sisters are not interested in testing, and we all have sons, no daughters), especially as I'm still unsure at this point if I'd pursue brca testing. I'll have to think on that some more... perhaps it'll be something I'll look into if at a later date I don't think surveillance is frequent enough (now that guidelines are mammos every 2 years...)

I've heard of a high rate of false positives on MRI, so I didn't feel any immediate urgency, but it's good to get validation that no further investigation at this time is necessary.  Thanks for providing reassurance that waiting for the 6-month recheck isn't a bad course to follow, and I do feel fairly confident in the care I received.  Very much appreciate your input and quick response!

[SueYoung55]

The sister that has cancer should get the genetic testing. Once identified, if she's BRCA positive, the testing for you would be much less expensive since they would know exactly what mutation they are looking for.

As for sons, please read up on BRCA mutations. Males get breast cancer but more often, BRCA males get prostate cancer, melanomas etc...

Please look into this. It's a simple blood test and knowledge is power. If I was BRCA positive I certainly would find a gynecologic oncologist who understands and works with BRCA mutations to help guide me. The genetic counselor could help you more than you know.

Best wishes.

[eureka254]

Thank you for the pointers and advice.  Indeed I will have to read up and learn more about BRCA mutations and their significance -- it had not occurred to me that males might also be at higher risk for carcinomas if the mutation is present.  I'll definitely look into that as well.

I completely understand that it makes most sense to have my sister undergo testing first, but it is unlikely to happen.  Though I am in agreement with you that knowledge IS power, other members of my family (sister included) do not feel the same, and thus far that conflict has caused me to hesitate to seek cancer counseling for myself.  The recent finding on mammogram and ultrasound has me reconsidering the option seriously, and I appreciate your info and feedback.  Thanks again. ~eureka