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Unsure about what to do - mammogram or just fibrocystic breasts?
Hello,
I am 31 years old. A few months ago I was experiencing pretty intense breast pain as well as a bit of fluid (a drop or two) leaking from my nipples (the fluid only occurred during menstruation, the pain was all the time). I went to my gyno. She gave my breasts an exam and felt nothing, but sent me in for an ultrasound for peace of mind. I received the ultrasound while I was pre-menstrual. The ultrasound results were as follows:
Ultrasound images of both breasts demonstrate small complex cysts and/or solid nodules bilaterally.
To summarize the rest, the largest was 1cm in greatest diameter, upper outer aspect 10 oclock position 3cm from nipple. Largest in left breast 7mm, lower inner aspect at 7oclock 4cm from nipple. Dense fibroglandular tissue in both breasts.
It also say the assessment is incomplete and requested a bilateral diagnostic mammogram. I was told that before I even received the ultrasound, the lab requested from my gyno, that I also receive a mammogram (apparently regardless of results, they require a mammogram for a complete workup). My gyno had denied this, because I have been exposed to a lot of radiation and she wanted to review the results herself first. The woman who performed the ultrasound ensured me that this was a completely normal result for a 31 year old and "most women do have fibrocystic breast changes".
Upon going back to my gyno, she did another breast exam (again I was pre-menstrual) and she said that I definitely have fibrocystic breast changes, but she feels absolutely nothing of concern and thinks that a diagnostic mammogram is unnecessary, but that she will give the go-ahead for one if I need more peace of mind. She also said she doesn't want it to lead to unnecessary biopsy, as, since I was 16, I have suffered a lot of medical trauma. I am aware that it's not entirely genetic, but breast cancer does not run in my family at all. There is no woman on either side of my family, who has had it (strangely). I am in shape, don't drink, don't smoke and eat a diet that most of my friends call "too healthy" ha. That is just some background.
My real question is this... in your opinion, do you think my doctor is being too lackadaisical? She doesn't tend to be that type. I have had paps that have shown HPV on and off (mostly on) for the last 6 years. She has me come in every 4 months for paps and always follows with a colposcopy. She's always been very thorough. My mom has fibrocystic breast changes, as well as the majority of the women in my family. From what I've read, mammograms show less detail than an ultrasound does. I am wondering why the person who read the ultrasound, didn't say if the shapes were abnormal or anything to that extent.
The breast pain is no longer present except sometimes when I am pre-menstrual. The fluid from the nipples is no longer present.
What would you do in my situation? Would you get the diagnostic mammogram?
I am 31 years old. A few months ago I was experiencing pretty intense breast pain as well as a bit of fluid (a drop or two) leaking from my nipples (the fluid only occurred during menstruation, the pain was all the time). I went to my gyno. She gave my breasts an exam and felt nothing, but sent me in for an ultrasound for peace of mind. I received the ultrasound while I was pre-menstrual. The ultrasound results were as follows:
Ultrasound images of both breasts demonstrate small complex cysts and/or solid nodules bilaterally.
To summarize the rest, the largest was 1cm in greatest diameter, upper outer aspect 10 oclock position 3cm from nipple. Largest in left breast 7mm, lower inner aspect at 7oclock 4cm from nipple. Dense fibroglandular tissue in both breasts.
It also say the assessment is incomplete and requested a bilateral diagnostic mammogram. I was told that before I even received the ultrasound, the lab requested from my gyno, that I also receive a mammogram (apparently regardless of results, they require a mammogram for a complete workup). My gyno had denied this, because I have been exposed to a lot of radiation and she wanted to review the results herself first. The woman who performed the ultrasound ensured me that this was a completely normal result for a 31 year old and "most women do have fibrocystic breast changes".
Upon going back to my gyno, she did another breast exam (again I was pre-menstrual) and she said that I definitely have fibrocystic breast changes, but she feels absolutely nothing of concern and thinks that a diagnostic mammogram is unnecessary, but that she will give the go-ahead for one if I need more peace of mind. She also said she doesn't want it to lead to unnecessary biopsy, as, since I was 16, I have suffered a lot of medical trauma. I am aware that it's not entirely genetic, but breast cancer does not run in my family at all. There is no woman on either side of my family, who has had it (strangely). I am in shape, don't drink, don't smoke and eat a diet that most of my friends call "too healthy" ha. That is just some background.
My real question is this... in your opinion, do you think my doctor is being too lackadaisical? She doesn't tend to be that type. I have had paps that have shown HPV on and off (mostly on) for the last 6 years. She has me come in every 4 months for paps and always follows with a colposcopy. She's always been very thorough. My mom has fibrocystic breast changes, as well as the majority of the women in my family. From what I've read, mammograms show less detail than an ultrasound does. I am wondering why the person who read the ultrasound, didn't say if the shapes were abnormal or anything to that extent.
The breast pain is no longer present except sometimes when I am pre-menstrual. The fluid from the nipples is no longer present.
What would you do in my situation? Would you get the diagnostic mammogram?
Best Answer
The thing that bothers me is the "cysts and/or solid nodules". Solid nodules are not a part of Fibrocystic Breast Condition as a rule. I suppose it's possible that these nodules could represent future Fibroadenomas (benign breast tumors) BUT they could also represent something else. Family history only accounts for a VERY small percentage of Breast Cancer cases so I certainly wouldn't rely on that; no one in my family as far as I could trace had BC either but I did. If the Radiologists cannot determine absolutely without further investigation I wouldn't question it. They do this every day and they surely know what they don't know. I personally would have the Mammogram ... the radiation from this is so minimal it shouldn't even be considered when put up against the possibility of something being malignant. It is true that probably half of all women have Fibrocystic Breast Condition and changes but even that needs to be watched closely by some method other than breast exams. Keep in mind that this is your choice and only my opinion and perhaps a Breast Specialist would have more insight into the situation than another type of Specialist. An Exam and a reading of your films by a Breast Specialist might be of help in your situation if you are truly confused about whether to go ahead with the Mammogram or not. Breast pain and some slight discharge are nothing to be concerned about as you have described them and are usually as a result of hormone levels. If you do have the Mammo it would be best after your menstrual period. Regards ....
Oh I understand. I still will get the mammogram. I'm just finding more information that I hadn't before, and sharing it/conversing. I was reading the website of a breast specialist said that a result stating a solid nodule, is in most cases, a solid mass consisting of fibrocystic tissue and is common amongst those with very dense breasts, especially those who are pre-menstrual. I also just spoke to my cousin's husband who is a radiologist just now (how I didn't know he did this, is beyond me) and he told me the same thing. That it would be more likely that if it's a complex cyst, it would need a biopsy, and that if they're solid nodules, they're just indicative of fibrocystic breast changes. He feels certain this is the case. The info is just making me feel a bit better. Of course, I will follow up and complete the protocol of mammogram. He also confirmed that a mammogram will tell me less than the ultrasound did, but I guess I'd just like to have it on paper that I completed the "process". Again, appreciate your response and have of course chosen it as the "best answer". Wish you the best as well.
Solid masses and nodules are not the same thing in my book but as I said it is your decision to make and whatever makes you comfortable is the thing to do but I wouldn't do it for protocol alone. . Remember now that it isn't "their" opinion or "my" opinion that counts here ... it's your feeling, concern or whatever you care to call it that is the most important. Either way I wish you the very best.
Just found this online, I thought you might be interested (as you had stated that fibrocystic breasts do not contain solid nodules as a rule)
"Focal fibrocystic changes may appear as solid masses or thin-walled cysts. About half of these solid masses are usually classified as indeterminate and will eventually require a biopsy."
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2766883/
Definitely not trying to challenge what you have said, and TRULY appreciate your response more than you know. I just see that you respond to a lot of posts and have had breast cancer, so I assume you're very interested in the subject and in findings that one comes across. Once again, thank you so much.
"Focal fibrocystic changes may appear as solid masses or thin-walled cysts. About half of these solid masses are usually classified as indeterminate and will eventually require a biopsy."
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2766883/
Definitely not trying to challenge what you have said, and TRULY appreciate your response more than you know. I just see that you respond to a lot of posts and have had breast cancer, so I assume you're very interested in the subject and in findings that one comes across. Once again, thank you so much.
I also find it weird that these results (complex cysts and/or solid nodules) are in both breasts. That was another thing they said is a reason why it's less concerning... in addition to other factors, including my age.
Thank you for your response. The radiologist told me straight up "It's nothing to worry about, but we're not allowed to say it's conclusive without the mammogram, because it's protocol". The woman who performed the ultrasound said the same thing, as did my gyno and my stepfather who is also a doctor. The woman who did the test said she gets the exact same results every time she's tested, because she has fibrocystic breasts and has had countless unnecessary biopsies. I guess I should just do the mammogram to fulfill the protocol. I just don't understand how they couldn't determine if they're solid nodules or complex cysts via the ultrasound, since everything I'm reading says that a mammogram, even diagnostic, is less specific than an ultrasound. Very confusing.
Do you know if "solid nodules" generally always means certain breast cancer?
Do you know if "solid nodules" generally always means certain breast cancer?
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