Birads 4, breast biopsy

[cyndee1st]

I recently had abnormal mammogram with follow up compression showing oval mass in the right breast with an oval density adjacent to the mass, which is less opaque. Ultrasound demonstrates solid 10 x 7 x 9 mm mass within one macrolobulation, borders partially well defined, internal echogenicity somewhat inhomogenous and increased through transmission. Minimal ductal ectasia.  BIRADS 4  Am scheduled for excisional biopsy as this was the only type biopsy recommended. I have had regular mammograms since age 35, I am now 44. I have seen a breast surgeon regularly for problems in the left breast (cysts, nipple discharge, pain), but right breast has always been problem-free. My grandmother had breast cancer with bone mets. My mother died of pancreatic cancer at 43. There is a strong family history of pancreatic cancer, but no other breast cancer that I am aware of.  I guess, due to family history of cancer, I am more than a little concerned.  Could a cancer develop so suddenly, given my regular exams, and is excisional biopsy the most often recommended under these circumstances?   Thank you, in advance, for your response.

[janz]

Yes, breast cancer can develope quickly.  IBC (inflammatory breast cancer) is very aggressive, usually doesn't present as a lump, usually doesn't show up on a mammogram or ultrasound and you can have negative biopsy results.  Women have reported that they've gone to bed one night and woke up in the morning with a breast that displays all or some of the symptoms of IBC.  Many women who are diagnosed with IBC have had it spread to other areas by the time they are diagnosed.  Any time I hear a woman use the word infiltrating or inflammatory when they are discussing their breasts red flags immediately go up.  I always suggest that they go to www.ibcresearch.org and read the symptoms of IBC along with the stupid things doctors tell them is going on with their breasts.  IBC knows no age.  A 16 year old girl died in Sept. 2003 from IBC.  It had spread throughout her body before she realized she had a problem.  I've also known a 93 year old woman with IBC.

[cyndee1st]

Just to follow up.  My results came back and the mass was indeed a benign fibroadenoma.  The surgeon said there were also some inflammatory changes.  I do have lupus.  Not sure if this is at all related, but just so happy with the results. Thank you so much for this wonderful site!

[surgeon]

The description (oval, borders generally well-defined) sounds like something benign. Since it's solid and newly appearing, it makes sense to do a biopsy, even though it sounds very likely it'll turn out ok. Depending on location, stereotactic biopsy is usually an option; it's reasonable to ask your doctors why it's not in this case.

[CCF-RN,MSN-rf]

Dear cyndee1st:  It is theoretically possible for a cancer to develop but that does not mean that this is cancer.  An excisional biopsy is likely recommended to be certain that all of the area in question is analyzed.  A needle biopsy would only take a small sample and an excision will avoid leaving tissue behind that might be abnormal.