Today I went for a recall to my breast x-ray. They did another x-ray on right breast. They found tiny (micro) spots which they told me were calcium. The doctor, who was difficult to understand, felt my left breast for some minutes, then a couple of seconds on right breast. He said that there were calcium deposits in left breast. I told him that I "bloody well hoped not"...as it was my right breast that was x-rayed. He argued, but then checked paperwork, and made grunting noise. There were 4 nurses also in the room. I suggested that if he were ever going to operate, that I would write in indelible pen on my breast "not this one!". I asked him to show me the x-ray, he looked very confused, but said if it helps me. I replied that it did not help" me...but that as it was my body I would like to see what he is looking at. I also asked if he wanted to do a proper examination of the right breast...The correct breast. He said no! It does not give me much confidence. The nurse then told me that I would be having a biopsy done using a scan machine and instrument like an "apple corer". This did not sound nice...she said it would not hurt. The small spots are tiny and grouped together deep inside top of breast, . There are only 5 or 6 spots that I could see....very tiny. The doctor was not happy, and told me that I would not understand what I was looking at. I asked him to explain. He showed me a tiny area then walked out of the room, leaving me with all the nurses, who slowly left the room.
I can not choose my doctor! I asked who would do the biopsy, she said a radiographer. I asked if I could have a doctor to do it. She said it was a consultant radiographer. I asked if they were a qualified doctor. She said yes. I know a "Consultant Radiographer"...he is NOT a doctor, and a very poorly educated person. I have no control over my life....I have to have a man who speaks a different language and feels the wrong breast under the illusion that it is the left one, and I have to have a biopsy done by someone that I suspect the nurse is lying about, and not a doctor. I don't think I have any choices in this matter, What can I do, also...asking questions really upsets them, and appearing calm seems to disarm them somewhat ....if I was a nervous, timid , panicking woman I feel I would be treated better...but I can not act.. what would you do??? Thanks...Annnette
WOW.... what a dilema .... First of all they must have meant a Radioloist ... and they are the Physicians who do this type of biopsy. Where are you anyway .... you must not be in the U.S. from what you said about having no control over your health care providers. Microcalcifications cannot be felt .. they are tiny calcium deposits that occur normally within breast tissue. When they are seen grouped in clusters or certain patterns they are a cause for concern as they indicate that something abnormal is going on with the breast tissue. Many of these biopsies come back benign though. when I had my biopsy I was given a marker and told that I must make a mark at the site of the lump. You will be awake and fully aware for your type of biopsy so there shouldn't be any danger of anything being done to the wrong breast. If you are really overly concerned (and I can see why you might be) are you not entitled to a second opinion ?? I don't disagree with the need for a biopsy since you stated that the microcalcifications you saw were grouped in one area. You will have to sign a consent form before your procedure ... just be sure that what you are having done is spelled out in detail (like which breast is being biopsied) ... I wish you all the best ... keep on talking and make them listen !
I am in Shrewsbury in England. I would like to know if a "consultant radiologist" is a doctor. The one I know is not nearly a qualified as a doctor, so I feel I may have been lied to. Also I would like to know how the biopsy is done. If I have to lie on a table with by breasts hanging through a hole then I will not be able to check if the "Consultant Radiologist" gets a sample from anywhere near the area seen. I have looked and it is the size of the flat end of a pencil, probably smaller, so how on earth they will find something so terribly small with an "apple corer" I don't know. I think the chance is that they will get a sample from a healthy part of the breast, as you need a microscope to see these calcium deposits.
Having had such poor service from the health professionals in the past, and knowing what really goes on I have little faith. I had a bar years ago near the hospital, and the doctors that used to come and want far too much drink, and be certainly "drunk" the next day by what I saw them consume, was astounding. I actually used to limit their intake as far as I could, they would joke that they would have to sober up or they would be amputating the wrong leg "FUNNY".
Then years later the doctor examines the wrong breast, and gets stroppy when I point out the discrepancy. I don't know how I can make sure this is properly done. I don't know how I can check what is going on, and I certainly don't want some one sticking an "apple corer" into my breast and "fishing" round inadequately. Some of these professionals may be good, some may be very poor. I can buy a good quality piece of furniture by my own judjment, no matter how useless or good the salesperson is, but I can't check on the ability of these people. And I have no trust left after today.
How do I feel confident enough to trust these people?
The guy made a mistake; that does not mean he is incompetent. he was probably really embarrassed and then you made him more nervous by the way you treated him. (I am not saying you were wrong, but if you want the doc to be confident, then don't make him more nervous!) I had a great oncologist, and he kept on charting left and right breast interchangeably. (So, he made mistakes, too) I also had a great surgeon but I teased him about not operating on the wrong breast as well. he told me it would be marked ahead of time. now, I don't know what a radiographer is, and whether he is a doctor. but just being a doctor by itself is no guarantee that he will do a better job than a technician.
You won't be lying on a bench with a hole during the biopsy. i had the same thing you are supposed to get. my doctor used something that looked like a gun and the thing shot into my breast and took tissue out. he did this on about 4 different locations and he numbed the area first. The numbing did not hurt. the actual biopsy? The first shot was more a little shocking than that it hurt. i was not prepared for how it's supposed to be but it did not hurt. the second shot did not hurt the least bit. the third a little, and the forth did hurt. still, it's bearable and not excruciating. he also used an ultrasound machine to guide him. and yes, my guy was so cute and handsome and he spoke english, so that made a big difference, and he was a breast surgeon as well and he told me the first minute he saw me that he was sure I had cancer. so, most likely, had the results come back negative he would not have believed the results.
I can understand that you are anxious and I can also understand why you are upset. but if you want the guy to work to the best of his/her ability during the biopsy, try to be smart. guide him if you feel you need to, but also treat him as if he were competent and this way he will much more likely live up to your expectations, and/or anyones for that matter and do a better job. (and let's hope he will know what he is doing, as only in that case can you make a difference.) face it, doctors are human. last, if you do have cancer, make sure you do everything you can in your ability to get a good breast surgeon to do the operation. it's probably what matters the most. i also think with the cluster of microcalifications, the person doing the biopsy will have enough room and sight to get the right place. good luck. you may also consider bringing along a friend or otherwise for support . In my experience, when they know someone else cares about you, they usually treat you better. i would not go by myself.
I really think it should be the other way round. I am the customer, the doctor should be doing his job professionally, he is paid to work hard and concentrate, I am not supposed to cajole him when he make SERIOUS mistakes, and choosing the wrong breast is SERIOUS.
If he were in the Sudan, volunteering, I would appreciate his generosity and think better him than nothing, but this doctor is performing in the UK, under excellent conditions, well paid, in a beautiful part of the country, with the World at his feet. I only ask for the respect that I deserve and enough concentration, (it does not take much) to just look at he notes and choose the correct breast!
We have recently had a removal of a healthy kidney by mistake, leaving the bad kidney in place, the patient died due to a doctors inadequacy.(in the UK)
So my advice to everyone is not presume that the medical profession always know what they are talking about, and double check what they are doing, and if that means taking an indelible pen with you to at least mark the correct item of removal, then do so. It's silly thinking it will EMBARRASS the poor things, once it's removed it' gone, so ask, ask and ask again. If they are good they will appreciate your interest and intelligence, if they are bad then you will know to mark the correct item to be appraised, amputated, investigated etc.
It's time the myth that the DOCTOR has magical healing powers is stopped, and the fact that normal folk go to uni and graduate with some medical knowledge, that they will add to over the years. It's time to take control. I was told what they would do, not asked if I accepted it. I was told to turn up and a core biopsy would be done with an instrument like an "apple corer". I have not been told in which position I will be. I was given a date, not asked, and told to turn up. All of which I have paid for over the years. I was told I would not feel anything, it would not be a problem. Now a friend has told me to get some one to take me as she does not believe I should be able to drive. Of course I do not believe her, as surely the nurse would have said this to me????
I asked the nurse for statistics, she said she did not know any, so I looked them up. I would appreciate any input about these stats. These were published by one medical authority in the UK.
50,000 women invited for screening
Uptake rate 71.4 per cent
Recall 4 per cent
Pre-operative diagnosis rate 89.1 per cent
284 referred for biopsy
238 cancers detected
What are other peoples experience of this, as it looks like if you get to this stage the chances are that you have cancer. I would rather know than being lulled into a false sense of security.Then one day given the result of cancer, leaving me in shock....I'll prepare for it now, then if it's not it will be good. I think that's positive. I don't see why these , nurses are subjected to terrorised women on a daily, probably hourly basis. I may as well go in calmly and take the news that is almost certainly positive for cancer, and get on with curing it, and getting better.
If by chance it's not, and I would be in the minority, then I can go and get drunk...ha ha ha....
what does every one else think...?
Is the medical authority a service we have the right to question, or do we still have the utmost respect for any one with the title DOCTOR, and follow like sheep whatever they say because we are frightened of them?
I don't disagree with anything you are saying. In fact, if this turns out to be cancer, you will hear the answer "i don't know" a lot, if the doctor is good more so than if the doctor is not good. And, you yourself will know a lot of stuff better than anyone else because it's your body. It's a big job to educate yourself about everything, and in my experience, it's hard to do so beforehand. (i.e to know about chemo before you actually have it) Of course the doctors should be everything they can be, but the reality is different. there is also a fine line between questioning them and pissing them off. I don't know what is always the correct thing to do. You sort of have to play it by ear. Sometimes, it takes every trick you can possibly think off to get the doctor to really go out of his way for you.
Anyway, my point is that I don't disagree with you, and that reality is not always the way it should be in a perfect world, because it's not.
nice name by the way...
well...yes it would be good to be able to "manage" the situation to achieve the best results...but I can't help myself....when the doctor examines wrong breast...and tells me its that one with problem...I find it impossible to try to support his ego...and I just let rip...."NOT THAT BLOODY ONE"....sounds like a comedy sketch/....
now if I could stop and think I would just let that slip over my head....but in the heat of the moment....I just couldn't help it....now I think it's ridiculously funny...now I have told all you lot that is......
just take your indelible pen with you...that's what I say........ha ha ha
Hopefully you never have to work with that doctor again. And, I agree that it's almost impossible to 'act right'. I am only concerned about you and how you can perhaps manipulate stuff to work in your best interest. It's not because I feel so sorry for the doctor.
If you are able to dump a doctor, or change to someone else after such an experience, by all means, do everything you can to switch.
And again, make sure you get the very best surgeon you can manage to get, and a breast surgeon, if possible.
It's always so much easier to give advice to someone else.
But as a rule, take what's useful and throw out the rest.
BTW, I had such a great surgeon, and he moved. I also had such a great oncologist whom I loved and who was really respected, handsome, nice, caring, really healthy, and in his early 50's. A few days ago he was climbing a mountain, got hit by a giant rock, fell 1000 feet and dead.
I don't know if we are having the same type procedure, but mine I lie face down on a table with breast sticking out of a hole and a robot will put cutting and vac device into breast to retrieve tissue. With locl anesthesia!
I think the procedure is the same but be done differently with you and maybe not using the gun I had.
My surgeon was using ultrasound as a guide. The position you are supposed to be in I was in during a breast MRI. So it's possible you are having an MRI guided biopsy. But since you are in England, and it's in the middle of the night, I realize...things may work differently. In any event, I would not plan on this being totally painless, just so you don't build up your expectations, and then if it is, you can be glad. But you can drive yourself home, unless you are given a sedative in which case you may or may not. I did.
I think you have the right spirit, though. I would like for you to keep in touch, I really would and see how it's all working out and how you are doing. You can also write me privately. I grew up in Germany, by the way.
Unfortunately here in the uk we have to take what we are guven....if we argue we get worse treatment.
I made a stand once....years ago...nearly 20 years ago....re smear test...that was done in a nightmare situation...wont go into all the stuff,,,,but the glass slides were left out to dry balanced on the edge of the trolley right next to the examination bed....all the woman that had been done before me that day....contamination problems..and one little bump and the whole lot would fall....alll mixed up and damaged,...to the ground....and that was the good part...so I phoned up and made some suggestions....the next time I went for a test...they remembered me...and things were not pleasant..........
I was taught my lesson good and proper for daring to complain....so we know our place...in general....in the uk
I think if I even dare ask who the surgeon will be...there will be an uproar...you just take what you get...
I would love for someone from the uk to answer on this page....to see what they think about having any rights.....
Yes I have read many horror stories for people in UK and Canada where they have to wait so long etc....I am hoping for that reason we don't get Obama for President or we shall be in the same boat.
Actually this steriostatic biopsy procedure is done by a robot so I suppose the cleaning lady could do it too......I have a surgeon consult prior to mine and they said their were two types of biopsy tests, one with am plates and the other ultrasound guided...mine is the first.
Why will it be worse if Obama becomes president?
Here in England we are only told that the poorest people in the states that can not afford to get help medically, will be enabled to have a medical service.
And with that limited information, we all want Obama to win, but you are there, and you have the inside story?????
Just a quick comment about the Presidential candidates here in the U.S. Campaign promises are just that ... promises that often change after one is elected to office. It's not what they promise but what they actually do after the election that counts. There are many un-insured here in the U.S. but the very poor have access to medical care as a rule. Many of the un-insured don't feel they can afford to carry health Ins. but are not poor by the usual standards. Actually the President rarely has much to say about measures such as these .... issues have to be voted on and approved by both the Senate and House of Representatives. Sometimes he doesn't stand a chance. I don't know how this turned into a Political Forum but I thought I'd get my 2 cents worth in ..... Regards ...
Hi! I have read all of the above comments and would like to (hopefully!) ease your mind and let you have a good experience with your upcoming biopsy. An ultrasound guided core biopsy is done while the patient is lying on the exam table in a supine (on her back) position and the ultrasound technician provides guidance to the radiologist performing the biopsy. The radiologist is a board certified medical professional who has received extra training in the performance of this type of test and has also been educated in reading the cells for any pathology or unusual conditions. The radiologist (after clearly marking the correct breast before beginning) will inject a local anesthetic (usually Lidocaine) which takes only seconds to numb the breast tissue. The injection will sting for only a short time and then the core biopsy is done. The instrument used is about the size of a pen and is hollow in order to be able to get the breast tissue inside and removed to be examined on slides for the radiologist/pathologist to determine if there is any abnormality. The use of the term "apple corer" is very misleading and probably adding to your anxiety. The term "corer" is appropriate, but looking at the apple corer I use to make apple pie, there is NO similarity at all.
Again, it is the size of a pen with a hollow "core" and it is injected into your numbed breast with a needle and a piece of tissue is removed. The core biopsy will involve taking small samples in all the areas identified on the ultrasound (usually four to six) in order to be sure all potential areas surrounding the identified "calcium area" are tested. The noise produced by this corer is more unnerving than the actual procedure -- I did not feel anything at all after the anesthesia was administered and the procedure was over in about 30minutes. (I had two areas of my breast biopsied, which required two anesthetic injections -- getting the anesthesia was the only uncomfortable part!) You can actually observe the procedure being done as the ultrasound screen is able to be visualized by you lying on the table. It is really a very safe and comfortable procedure.
Once the radiologist/pathologist examines the removed tissue samples, a diagnosis is provided and treatment recommendations are given. The usual results are benign, non-cancerous lesions such as an intraductal papilloma. This is a benign tissue growth within the milk ducts of the breast and is not even thought to be pre-cancerous. The likelihood of developing cancer from such a lesion is minimal and is usually based on prior history, age of the patient and other idenitified risks.
At the time of biopsy a tissue marker is placed in the area of the biopsy in order for all followup exams to easily identify the areas of concern. Followup is usually done on a routine basis at every 6 months -- usually mammograms and ultrasounds with biopsy only if further changes are noted. Obviously, a self breast exam done monthly will alert you to any significant changes in your breast tissue to bring to the attention of the doctor.
If an excision of the papillloma is recommended, it is usually only done to determine the final pathology and confirm that it is indeed benign. If abnormal findings such as hyperplasia (overgrowth) of tissue cells are identified, the pathologist will grade the sample re: the potential risk for any further degradation and the risk of developing cancer. In most instances, the removal of the papilloma is the only treatment needed and followup mammograms/ultrasounds will be totally sufficient.
If a pathology does show some malignant cells (very unlikely), then further treatment may be required, but very unlikely that a mastectomy or chemo or any radiation will be needed. Just vigilant breast exams.
A stereotactic needle biopsy is done while laying face down on the table and your breast is accessed through a small hole in the table. Again, sufficient anesthesia is used and minimal discomfort is anticipated. (If you feel any pain at all, the procedure is stopped and additional anesthesia is given.) This biopsy is also done under guided imagery to prevent any error in taking the right tissue samples from the right breast.
Following the biopsy, pressure is applied to the biopsy site for approximately ten minutes to ensure no unusual bleeding occurs and then a binding wrap is placed around your breasts to maintain pressure. This stays in place about 24hours and then can be easily removed by the patient. Some bruising may be noted at the site of the biopsy and the area will be sore for about 2-3 days. No heavy lifting or major activity should be done during the first 24hrs after the biopsy, but usual and regular activity can be resumed after that.
All of this is done while you are awake and in no need of additional anesthesia or sedation. You can usually drive home by yourself without problems. Having another person with you is primarily precautionary and usually for moral support rather than an actual need to escort you home.
All this being said, your doctor may be a bit unnerved by your reactions so far --- and well he should be! You are perfectly within your rights to object if you feel he is not doing his job properly (and I am concerned that the nurses did not intervene in your behalf!). If you truly are unable to change doctors (and I would hate to think that this is totally impossible???), try and approach him as calmly as possible. If he is unable to calm you, you will most likely have a more negative response to the testing being done.
Give yourself the credit you deserve -- you are taking things in the order that they need to be done. Try not to anticipate poor results -- it will do much to calm your fears and anxiety.
I will be having excision of my two papillomas done in a few weeks and it is anticipated that no further treatment other than vigilant followup exams will be required. I am hopeful that this will be your result as well.
Good luck and please post with the results!
Thank you for your full and informative description. Could I ask ...are you a health professional?...or self educated in this area?
I am most concerned by the research that I have done, giving me the information that there are dangers in core biopsy where the needle engages the cancerous area, allowing it to have access to the bloodstream, (most breast cancers are quite happy to be left alone for a long time) and then have the ability to travel throughout the body to other organs, and this is where breast cancer can spread. Now my question is...would it be safer to just have a lumpectomy in the first place, which can then be biopsied at leisure, knowing that the "whole" lump has been removed in the first place, stopping the danger of cancer spreading to the rest of the body.
Secondly....you say.... "your doctor may be a bit unnerved by your reactions so far --- and well he should be! "
What reactions are you talking about?
The only communication I have had with ANY doctor is when he examined the wrong breast and told me I had calcium deposits in the left one...NOT the correct one, the right one. My reaction was one of laughter, and the comment...."I bloody well hope not".....This is the ONLY communication with ANY doctor....So what are these reactions...plural ?
Surely a reaction like this is better than a screaming banshee, a crying neurotic, or a quiet and subservient woman that accepts anything that happens, does not have any control over her circumstances and is too frightened to correct a doctor?
At least I saw the funny side....even though he looked like an idiot in front of 4 other nurses. And how many nurses...who want to keep their jobs...do you find speaking up against a doctor...NONE!...and in that situation there was no need for any one else...I did it myself.
As a previous patient who has woken up in the "dying bed" (the one nearest the door), with a priest giving me the last rites, I know how good and how inadequate our system is in the UK.
I am afraid I can not protect doctors from looking stupid if they can't get the correct part of the body.
The only thing that I can think of, re your remark, is that you may believe that I was inconsolable, frightened, distraught or something like that. I would like to make it clear that I was far calmer than the doctor, and my sense of humor, as always, kicked in, and thought that the whole procedure was like that of "CANDID CAMERA"...I looked at my x-rays because it is my body...any decent doctor would have been most pleased to explain...in a lay man type of way....and should have enjoyed the chance to recover his dignity by demonstrating his supreme knowledge. I think the fact that his English was at the stage of ordering a "BIG MAC" only may have hampered that!
Once again thank you for your information, it is sad that we need a web site with people like you to do the work that should have been done in the hospital.
So "thank -you".
My apologies for anything said in my prior post that might have offended you. I may have overstated your response to the doctor when he performed his exam (the wrong breast is definitely not a laughable situation!!). I do not believe that you acted inappropriately nor do I feel that the nurses were supportive enough.
I have been an RN for over 25 years and (in my experience) a nurse is truly there not to just assist the doctor, but to act as a patient advocate. If I had been at your bedside during this encounter, that doctor would be aware of his negligence. I can not believe that the medical professionals in the UK are without morals or scruples -- protect your job over delivering proper care?? I would not wish to be treated by such individuals ---
Again, my only purpose in the response I gave was to give you information about how the biopsies are performed and that you do have control over the situation.
Based on your description of the "calcium deposit" and the size you estimated, a "lumpectomy" is definitely not indicated, as there really isn't a "lump" to remove. All that has been identified is a change in breast tissue, not an actual "lump". It can only be seen on radiographic testing and is not palpable on clinical exam. If it is an intraductal papilloma, it is a benign process and the biopsy will not cause any significant problems, nor will it cause a cancer to develop any faster if one were identified. It would only be able to determine if there are malignant cells within the sample and this is a rare result. If, on the exceedingly rare chance that malignant cells are identified on pathology exam, the treatment for such a malignancy will depend on the type of malignancy identified (the morphology of the cells seen in microscopic detail will provide the pathologist this information and is graded on a universal scale so no individual interpretation by the pathologist is risked.)
This involves determining the type of cell from a series of stains and fixtures used by the pathologist during the review of the biopsy samples.
I hesitate to provide any further information regarding the biopsy procedure --- the end results can not be determined until the pathology is identified. The chances that your biopsy will identify a cancer are very slim.
The statistics you provided earlier (as you obtained them) are based on what pathology reports? The stages of changes in breast tissue range from a benign process to an invasive type of malignancy (which would most likely present with more significant changes in breast tissue than you have identified in your exam.)
The fact that you are scheduled for a biopsy only confirms a change in breast tissue from "normal", but does not in the least anticipate a cancer. I have been an oncology nurse for many years and have had numerous experiences with patients during testing for abnormal breast tissue --- the majority of them do not result in a cancer, so some statistics may be misleading.
When is your biopsy scheduled? Perhaps you need to discuss this with your doctor more thoroughly -- if that is not possible due to the circumstances in the UK (which I am not familiar with), and you are not able to change doctors, I am at a loss as to how to assist you further.
A biopsy is just another form of examining breast tissue for changes that can not be clarified on clinicall exam or mammogram or ultrasound. It is not done only if cancer is suspected --- again, the majority of biopsies result in a negative response for cancer when performed for the reasons/symptoms you have identified.
Good luck and best wishes!
BIRADS stands for Breast Imaging Reporting and Data System and ranges from 0 (incomplete imaging results and pathologist can make no determination -- additional studies needed) to 6 (known malignant lesion and imaging being done to determine type of treatment and/or post-treatment to determine response)
BIRADS 4 indicates a suspicous abnormality not necessarily characteristic of cancer, but indicating the need for further testing, primarily a core or stereotactic biopsy so that individual cells may be examined for malignancy.
Are you scheduled for a biopsy? If so, hopefully the information I presented to Annette13 will be helpful in preparing for this test.
This is the true meaning of the BIRADS scale
Take care.........Annette ;0)
BIRADS Category What It Means
0 More information is needed to give a final mammogram report.
1 Your mammogram is normal.
2 Your mammogram shows only minor abnormalities that are not suspicious for cancer. No additional testing is needed.
3 Your mammogram shows minor abnormalities that are probably benign. The radiologist may recommend follow-up testing in six months to make sure the suspicious area has not changed.
4 Your mammogram shows a suspicious change, and a biopsy should probably be performed. However, less than half of women with category 4 mammograms will end up having cancer.
5 Your mammogram shows a worrisome change. A biopsy is strongly recommended. More than 90 percent of women with a category 5 mammogram will end up having cancer.
I found out that my Birad score was 4a, and that the "a" part means not as bad as b or c .....so I guess I will find out when I get the results of the biopsy...I intend on asking about the likelyhood of biopsy spreading if there is cancer as opposed to removal of suspicious area all together and see what he says.
I had a BIRADS 5 and it was benign. There is some disagreement in the literature about the percentage of BIRADS 5 that end up being cancer. I've seen the number as low as 60% and as high as 95%. But the >90% that annette13 posted is supposedly the "official" percentage, I think. My radiologist was so convinced that I had cancer that he gave me a very heavy cancer talk right after getting the films back, when I had no supportive person with me and nobody to drive me home. I was devastated. The radiologist did NOT explain the BIRADS system to me, nor did he tell me about the couple of benign conditions that can look VERY scary BIRADS 5 on mammos and ultrasound. Mine was one of those. It is called fat necrosis, and it is not nearly as rare as the literature would have you believe.
Being treated as though I had cancer before a biopsy was done caused such severe stress in me that I swear I had PTS for many months afterward.
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