Got a "call back" for more imaging, help!

[curlydog415]

i am 39 years old and had my first mammogram 15 months ago.  it was normal and given a BiRads of 2.  it also stated my density as:  scattered fibroglandular densities.  i also had an MRI 12 months ago because i have BC in my family history and have never had any children (by choice).  it too was normal.  my mom was diagnosed at stage 4 at the age of 66. she hadn't had a mammogram for 20 years and didn't tell anyone about a lump in her breast.  by the time she was diagnosed she was physically week, had an ulcerated breast tumor wound and the cancer had spread to her bones, liver and lungs.  she passed less then 5 months later under hospice care.  i was very close to her and took it all very badly.  she passed away in october of 2012.  my mom's mom also was diagnosed with breast cancer when she was about 69 years old.  she had many other illnesses (diabetes, heart disease, etc) and passed away as a combination of all her health problems.  last tuesday i had my second mammogram (15 months after my first) and i got a letter stating they wanted to do additional views.  i went down to the breast center at my local hospital where i had the mammogram done and got the report it says:  there are scattered fibroglandular densities.
Right Breast:  A 4 mm asymmetry noted within the medial aspect of the right breast, seen only on the CC view, mid depth and approximately 4.0 cm from the nipple.  no suspicious calcifications.
Left Breast:  no suspicious masses, calcifications or areas of architectural distortion are identified.  benign appearing calcifications are seen.  
ASSESSMENT:  BiRads 0 - incomplete:  need additonal imaging evaluation of the right breast.  BiRads 2 - benign finding in the left breast.
Recommendation:  special view mammogram of the right breast.  spot compression CC 3D tomo and LM 3D tomo.  ultrasound if findings persist.  Routine screening mammogram of the left breast in one year.  as an adjunct to mammography, annual MRI can be considered given patient's elevated lifetime risk of breast cancer (20.5%). so what exactly am i dealing with here?  what is "asymmetry"? should i be concerned?  the breast nurse said something to the affect that it means the right breast looks different then the left and that it is good that it was seen on only one of the two compressions.  she said they often flatten out during the spot compression but if not then i woiuld need an ultrasound.  ugh...is this a common finding at my age?  i am having lots of anxiety about this and they can't get me in for the follow-up until this friday afternoon, 3 days from now!  i also told them at the time of the mammogram that i have lost 50 lbs this past year (due to diet and exercise).  i am now a normal weight (5'6" tall and 145 lbs).  

[japdip]

Thanks for the update and congratulations on the good news. We love to hear results and I'm sure others who stop in just to read will appreciate your post too. Kindest regards ......

[curlydog415]

UPDATE:  just wanted to update my post for other's who may be going through something similar.  it's frustrating when you read posts and never know what happened to the person.  anyhow, i went for my follow-up test yesterday.  my original mammogram was done in digital 2D.  the spot compression was done in 3D.  after a short wait in the waiting room (seemed a lot longer i was so upset) the nurse came out and said the radiologist just reviewed it and it was a normal lymph node.  she told me to go home and come back in one year.

[curlydog415]

thanks...  i called and i don't need a referral for the diagnostic mammogram so i'm good there.  i read about summation artifact asymmetry, which i think is what mine is right now (unless they find something else) as i got a BiRads zero:
  http://www.researchgate.net/publication/227258898_Mammography_Asymmetries_Masses_and_Architectural_Distortion

[japdip]

You are going to have to slow down, take some deep breaths and clear your mind of some of this "stuff". I know, easier said than done but TRY, OK ? You can have a screening Mammogram without a written order from your Physician; not a diagnostic but a screening. If you can find a Breast Specialist or get a referral to one I think that would be a good move. With you BC history a Specialist would be able to keep up with your investigative filming. Many women with a strong BC history begin Mammograms in their early 30s even though Family History accounts for only a very small percentage of Breast Cancer cases. Of course when you lose weight you lose it everywhere so it could possibly change the appearance of the breast tissue on film. I would ask at the institution where you are having your Mammograms about a Breast Specialist and perhaps the Radiologist could suggest in his/her report the need for this type of consult. So relax a little now .... sometimes I want my Mommy too but it seems that we somehow muster up the strength to get through whatever is challenging us. Take things one at a time and everything will fall into place eventually. Take care now and I'll be thinking about you on Friday.

[curlydog415]

could losing 50 lbs change the way my breast image on mammogram?  i was almost 200 lbs at my last mammogram and i am now 145 lbs (5'6" tall).  also, what exactly does a 4 mm asymettry mean?  i've googled it and get conflicting info....  i wish i had someone to talk to.  i so wish i had my mom...  :(  watching her become physically week and then diagnosed with stage 4 BC was so hard on me mentally.  in my gut i felt she had undiagnosed cancer and she would not go to the doctor.  we had to threaten to call EMS and then she reluctantly agreed to go to the ER.  right then and there they looked at her ulcerated breast and blood work and said it was stage 4, without even doing further testing it was so obvious.  she spent 30 days in the hospital because the breast was infected then we got her home and she was losing her mind, being forgeful and eventually was in psychosis screaming for help and thinking someone was breaking into the house and that we had guns.  it was heart wrenching to watch my mom lose the ability to use the bathroom, have to wear diapers and lose her mind.  i just had to write this out.  i feel so overwhelmed.  i have the rheumatology consultation this friday morning at 10 and the mammogram reimaging at 3:45, both this friday...

[curlydog415]

thank you so much!  my primary care doctor (clinic) is primarily medicaid and uninsured patients. my primary care doctor sees 'overworked' with many patients and i feel that i don't get the best primary care.  i wouldn't have been 3 months late for my mammogram if she would have listened to me.  i go in every 3 months for medication refill (anxiety related) and i told her it had been one year since my mammogram and she told me i was "not" due.  i told her i was due and she said well...bring it up when i see you in 2 months (she seemed in a rush).  i reluctantly said ok and i brought it up 2 months later and she said "how old are you"?  i said 39, but i have family history.  she then wrote me out the referral.  also it's so hard not have my mom to talk about this with, she was my best friend, and i'm an only child so no sisters or sisters in law's.  my close friends are around my age and haven't even gotten their first mammograms yet or have family history's of BC.  i feel so alone right now...:-(  also, this friday morning at 10:00 i have to consult with a rheumatologist because i've developed Raynaud's in my fingers and toes.  preliminary blood work by my primary doctor was negative for autoimmune but she wants me to follow up with a rheumatologist to find out if my raynaud's is primary (no known cause and not from an underlying disease) or secondary (caused by autoimmine diosorder such as lupus or scleroderma).  i've always had cold hands and feet but this year it's gotten worse, i've developed the color changes when my hands/body get cold.  they sometimes turn a light blue/purple or the tip of a finger will turn white.  again, i'm wondering if i've always had it but never really noticed it (or showed many symptoms) because i was overweight and or obese and had more body fat.  i am much colder now that i am at a normal weight.  so...this friday morning rheumatologist consultation and friday afternoon breast reimaging and possible ultrasound if the mammogram still appears abnormal.  i am a nervous wreck...  i have a long history of anxiety, especially worrying about medical things, especailly test results!

[japdip]

In reading your post, everything the Nurse told you is 100% correct. I see that it was mentioned that the view was almost identical to the explanation given previously noting the glandular densities. Compression views are frequently ordered and as the nurse stated, often the area will compress out and there will be nothing visible. I'm truly sorry for the loss of your Mother and this surely shows why we must keep up with our yearly testing. Since you have only had two Mammograms at this point I suggest that you will be ordered a "Diagnostic" Mammogram which will mean that the Radiologist will "quick read" your films before you leave the institution and any need for additional filming will be done on the spot rather than getting a call-back. Please don't stress over the 3 day wait which would make no difference in any event but I would also suggest that you stick to the yearly schedule rather than every 15 months or so. Yes, I would say this is fairly common at almost any age and you are evidently receiving excellent medical care and nothing is left to chance. Women with a higher risk definitely need a strict schedule for investigation of any breast issues so go along with the program as it's a GOOD ONE ! Keep us posted when you get your results of the additional filming. Kindest regards ....