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Got mammography reports: says focal asymmetry

Kris10mo
Kris10mo Member Posts: 2

Hi Ladies,


So I went and got my mammography records from my recent mammograms, ultrasound and biopsy.  in it I read that they are concerned about area of focal asymmetry that has changed since my mammogram last year 2012. 

I just read on the internet(maybe I shouldn't do this); that a developing asymmetry has a high likelihood of malignancy is quite high between 10-15%.  So now I have myself scared again.  Why would the second radiologist send me to a surgical consult without even seeing me or doing another stereotactic biopsy?

Any ladies here have focal asymmetry turn out to be benign?  I have another week to wait before I see the breast surgeon.  This waiting is killing me.

Kristin

Comments

  • melissadallas
    melissadallas Member Posts: 929
    edited December 2013


    most focal assymetries turn out to be benign.


    10-15% is a low percentage, not a high one.

  • beesie.is.out-of-office
    beesie.is.out-of-office Member Posts: 1,435
    edited December 2013


    Kristin, you've been sent for a surgical consult because a breast surgeon is the doctor who is the expert about breast conditions - whether they are benign or malignant. Sometimes a radiologist will recommend a biopsy (or in this case, a second biopsy) but more often they will leave it to the breast surgeon to decide if a biopsy is necessary or not. So being sent for surgical consult does not mean that anyone thinks you have cancer or that you need surgery - it just means that you are being sent for an expert opinion. And that's exactly what you would want to happen. I suspect that since you've had the one biopsy, the radiologist probably doesn't want to subject you to another biopsy if it's not really necessary, and that's why you are being sent for the consult.


    Focal asymmetry simply means that something looks different in one breast vs. the other. Usually this turns out to be nothing at all, just normal breast changes.


    "Asymmetrical breast tissue is an observation made with respect to the same area on the other breast. It is a fairly vague finding in which there is no focal mass, no distorted architecture, no central density, and no associated breast calcifications. Usually about 3% of breast screening mammograms will show asymetrical breast tissue. Only a very small percentage of women with asymmetrical breast tissue will actually be sent for a biopsy, and typically only a very small percentage of these will ultimately be diagnosed as breast cancer. Asymmetrical breast density should really only be viewed as a concern when it is also associated with a clinically palpable breast asymmetry. Otherwise, a certain amount of asymmetrical breast tissue should be considered a normal variation which occurs in some women. In some cases, the asymmetrical breast density can be attributed to pseudoangiomatous stromal hyperplasia, which is mostly benign." Breast abnormalities typically discovered by mammogram


    I don't know where you read that the likelihood of malignancy is 10% - 15%, but as MelissaDallas said, if that is true (the figures seems high to me) that is not a "high likelihood" at all. The other way to look at it would be to say that 85% - 90% - a very large majority - of cases of focal asymetry turn out to be benign.

  • Kris10mo
    Kris10mo Member Posts: 2
    edited December 2013

    Thank you Ladies for the information you have provided me.  I'm just so new to this that everything is scary.  Does asymmetry grow/change over time?  Is that normal with age?


    Kristin

  • melissadallas
    melissadallas Member Posts: 929
    edited December 2013


    it isn't a "condition" to grow or change. It is simply a description of the appearance of the mammogram image. It can be something as simple as a benign cyst or a denser area of normal glandular breast tissue.

  • Laura_E
    Laura_E Member Posts: 18
    edited May 2014

    Hi.  So, this is all somewhat new for me, and i am more than a little concerned.  I went for my annual mammogram last week, and when they called me back, it was due to a "mass with asymmetrical lines not seen in previous films".  I have been going to the same place for several years, since I was diagnosed with DCIS in the right breast.  The new "mass" is in my left.  I am very scared, due to the fact almost all of my immediate relatives (dad, mom, sisters) have had one form of cancer or another.

    I am schedule for a diagnostic mammogram, and was told I could be there all day, and it will be at least until the doctors and I know exactly what it is.  Any insight would be greatly appreciated.  I'm sorry if I put this in the wrong chat.

  • sarahjane7374
    sarahjane7374 Member Posts: 23
    edited May 2014

    Hi Laura

    Well, the diagnostic mammo will focus on the breast and area where they saw the mass.  They'll get a few different views and then the images will be read by a radiologist.  Where I go, I usually get to talk to the radiologist afterwards, and if they are telling you that you could be there all day (!), it sounds like you'll be able to as well.  If the radiologist feels it's necessary, you may end up having a biopsy of the mass.  That procedure isn't really a big deal, although it depends where the mass is located - when they are close to the chest wall, sometimes it's a little more difficult to get at them.  The radiologist will numb the area and then use a core needle to take samples of the mass.  You'll be sent along with a band aid and an icepack in your bra, most likely.  They may leave a biopsy clip in place to mark the area, and take a second mammogram afterwards to document the placement of the clip.  I never experienced any pain with my biopsies, just some minor bruising at the site. It depends on the facility, but I usually got my results within a week.  Sometimes sooner if I called and pestered my doctor.

    This stuff is really scary, but try not to get too far ahead of yourself.  The majority of breast lumps are benign, and most biopsies are as well. 

    Hang in there. Happy

  • Laura_E
    Laura_E Member Posts: 18
    edited May 2014

    Hi, Sarah.  And thank you.  To make an even more stressful time more confusing.  my primary would not sign the order or the diagnostic, since I have not been in to see him in a year.  That's what I get for being healthy, I guess.  When the woman from the office called, I asked her to read the report to me.  My ex mother in law is an oncology radiologist, so I know some of these terms. Apparently, the big deal is because it is a "developing focal asymmetric density".  The biopsy part, I'm familiar with.  Thanks to the clip that was put in 4 years ago, they were able to tell me the "solid nodule in the right breast is stable".  Due to my family's history, I go  to a place where I have some comfort/confidence level.

    I will keep you posted.  :)

  • Laura_E
    Laura_E Member Posts: 18
    edited May 2014

    Just wanted to update you, Sarahjane.  I am still very confused.  The diagnostic mammogram yesterday showed a VERY white, irregular spot with fuzzy edges on every view.  I waited about 20 minutes for them to be read, then was told I needed an ultrasound.  The spot on the mammo is on the lower right side.  When the tech did the ultrasound, though, she called it the 12 o'clock position.  She did the u/s, left the room for no more than 2 minutes, and came back to say it was "probably benign" and come back in 6 months.

    I am not sure why she did not u/s the area where the spot is, though?  My mom said I should wait until my primary gets the report and ask her what to do.  She said the radiologist will have a closer look at the pictures.  But shouldn't they do that while I'm there? This may sound dumb, but it just doesn't feel right.

    In the meantime, though, I am trying not to be concerned.  I am a very black and white kind of person, and "probably" isn't doing a lot to put my mind at ease.  Sorry if I sound like a big baby.  I tend to worry, as cancer seems to run rampant in my family.

  • Laura_E
    Laura_E Member Posts: 18
    edited May 2014

    Not sure anyone can help, as I have tried to find info on this, but can't find any.  Little history:  3 weeks ago, had screening mammo which came back with developing focal asymmetry.  Diagnostic mammo and ultrasound came back "probably" benign, with a 6 month follow up.  Since then, I now have a palpable lump, so my dr sent me to a surgical consult today.

    The surgeon, who did not appear to go over my history (sister and aunt with bc, I have dcis in the right breast), felt the lump and told me it's from one of my ribs?  Makes no sense to me.  He also told me, after I told him it does not hurt, that "scary things are usually painless".  He also stated the original diagnosis of "probably" benign shows the facility is not confident with their diagnosis, and I should keep the 6 month follow up?

    I'm so confused!!  I feel like my concerns are not being taken seriously, because I am "only" 40.  Please, tell me someone has at least HEARD of this?

  • leaf
    leaf Member Posts: 1,821
    edited May 2014

    Of course you're concerned.  You have DCIS and a sister and aunt with bc.  You don't know if the same thing will happen to you.

    Can you feel the lump in your breast tissue?  Some people do feel their ribs, or their inframammary ridge.  Can you feel it when you press on the side of it?  I have never had any breast lumps (besides after breast procedures), but I've certainly heard of women here who say they can feel a lump, but when they go to their doctor their doctor cannot feel the lump.  I've certainly seen posts here of younger women who have been told 'You're too young to have breast cancer.'  As you know, of course you're not too young to have breast cancer.

    The surgeon, with the 'scary things are usually painless' remark, was probably referring to the fact that the most common symptom of a breast cancer is a painless lump.  But breast cancer can present in many different ways: a painful lump, a thickening, pulling of the nipple, no symptoms at all, etc, as you probably know.

    I don't really understand his 'He also stated the original diagnosis of "probably" benign shows the
    facility is not confident with their diagnosis, and I should keep the 6
    month follow up?'. 
    Perhaps he is convinced it is benign, but knows you are worried so wanted you to get it re-checked in 6 months?  If you are pre-menopausal, then you may want to measure (with a ruler) your lump, and see if the size changes with your monthly cycle.

    Some doctors, notoriously surgeons, do not have good bedside manners.  (Though I have had several non-breast surgeons who had excellent bedside manners.)  Would you feel better if you got a 2nd opinion?

  • Laura_E
    Laura_E Member Posts: 18
    edited May 2014

    Hi, Leaf, and thank you for responding.  At this point, I just feel so lost.  The lump, which I can feel, is in the tissue,  not near a bone, from what I can tell.  The problem I am facing, other than no insurance, is that my family seems to think what he said is terrific news.  However, my ex mother in law is a radiologist, and has advised me to call him and request a biopsy. I'm on a state screening program, and the order was written for a diagnostic mammogram, ultrasound and biopsy if needed.  Unfortunately, I live in the middle of nowhere, so that isn't helping matters at all.

    I don't know if I should just give up, even though I know something isn't right, or risk everyone thinking I am just a drama queen?

  • leaf
    leaf Member Posts: 1,821
    edited May 2014

    Maybe its because I grew up in a fairly nutty family, but whatever everyone else thinks would be the last thing on my agenda.  You  have the power to tell other people if and when you choose.  No matter what you decide to do, you can just not answer questions or change  the subject if you choose.

    Obviously your breast surgeon and your ex mother in law have a lot more experience than I do.  Since they disagree, its hard to know what to do.   I presume your ex mother in law is unlikely to order or do a biopsy on you.  It sounds like your breast surgeon is very inclined not to do a biopsy.  

    If you do want to try to persuade him to do a biopsy, would it make sense to ask him to verbalize his thought process in coming to his conclusion?  As you probably know, from what I understand, its often possible to do a fine needle biopsy during a clinic appointment for palpable lumps.   Point out to him that you feel the lump is in the breast tissue and not in any bones or at the inframammary ridge.  I am presuming that the ultrasound showed it is not a cyst.

  • Laura_E
    Laura_E Member Posts: 18
    edited May 2014

    Hi, Leaf.  I called the doctor today, and asked him to explain his rationale.  Instead, I was told a biopsy is not needed "at this time", however, he wants to see me again in two weeks.  So, what the heck?  If it is nothing, leave me be.  If it is something, get rid of it.  That's how I feel.  He also said if it has not gone away, or if it has changed at all, we will "discuss options".

    I know others are going through the same, or similar situations, and I can truly empathize with them.  I try to smile and be cheery with the kids, and at work, but it's hard when my mind is in a million places.

    I really appreciate you letting me vent here.  I am just very scared.  I realize the "stats" say it's probably nothing.  But that one tiny part of my brain will run in circles, until I know what it is/is not, rather than what it might be.

  • RobinJoy
    RobinJoy Member Posts: 8
    edited May 2014

    Hi Laura. Sorry you're going through this.  I would suppose the surgeon is wanting to make sure that it's a lump that won't resolve on its own. He can't really tell if it's something or not until he biopsies it and sends it to pathology and more than likely doesn't want to cause you anymore pain than is necessary.  The waiting is the worst part. Hang in there.

  • leaf
    leaf Member Posts: 1,821
    edited May 2014

    Of course you're scared. The 'what ifs' can be like squirrels running on their exercise wheel.  Going nowhere fast, like the Red Queen's race.

    "Well, in our country," said Alice, still panting a little, "you'd
    generally get to somewhere else—if you run very fast for a long time, as
    we've been doing."

    "A slow sort of country!" said the Queen. "Now, here, you see, it
    takes all the running you can do, to keep in the same place. If you want
    to get somewhere else, you must run at least twice as fast as that!" 

    To me, the anxiety felt surreal while being diagnosed, like a game that had no logical rules.  Some people feel exercise helps.

    It sounds like he did feel your lump? I'm glad that you have an appointment in 2 weeks.  Let us know how it goes, OK?

  • Laura_E
    Laura_E Member Posts: 18
    edited May 2014

    I will, Leaf.  The anxiety I seem to have down to a dull roar.  It's just all very mind boggling.  When I went for the initial yearly mammogram, I was fine!!  Now a month later, I have this lump, which 2 doctors have agreed is there.  Both have felt it, even.  Perhaps in 2 weeks I can explain to this dude that it does NOT hurt, other than a nerve zinger every few days.  As for being "only" 40...this is aging me quickly.  LOL.

  • WolfsLady
    WolfsLady Member Posts: 5
    edited May 2014

    I'm sorry that you are getting the run around.  The waiting is so frustrating.  I'm not sure what 2 weeks is going to do.   I do hope that you get answers soon.  I'm not sure why in your case they don't just do the biopsy since it's the only way to be sure.  

  • leaf
    leaf Member Posts: 1,821
    edited May 2014

    Just speculating, but 2 weeks might be about 1/2 of an average menstrual cycle, so you might see a possible effect of hormones on the lump.

  • Laura_E
    Laura_E Member Posts: 18
    edited May 2014

    Waiting is frustrating.  And I agree about the hormonal changes, Leaf, except the lump has stayed put, with no change, for the past few months.  I am trying my best to just not think about it, and hope it will just go away.  I have to admit, I am unsure what "options" we can discuss.

  • Laura_E
    Laura_E Member Posts: 18
    edited June 2014

    Just wanted to update everyone.  I haven't been on lately because the husband has been sick.  Had the biopsy today.  The surgeon found the lump with no guidance from me beforehand this time, too.  When he did the ultrasound, he stated it looked more worrisome than it did a couple of weeks ago.  When he got the needle in position, he commented that the lump was very hard, and when he saw the first sample, he stated that is was very dense.  Not sure what, if anything, any of this means.  He did say he will call by the end of the week with results, though,

  • leaf
    leaf Member Posts: 1,821
    edited June 2014

    So sorry you have had to worry about your husband's illness as well as your own health concerns.  

    They won't know for sure until the pathology results come back. 

    Reaching out my virtual hand to you.

  • Laura_E
    Laura_E Member Posts: 18
    edited June 2014

    Thanks, Leaf.  This group has helped so much.  This is just nerve wracking.  And I quit smoking a week ago, too.  Maybe lousy timing, but so far, so good.  Now, I just find myself working more that usual, and taking the phone with me everywhere.  Luckily, we are close to the end of the week.

  • Laura_E
    Laura_E Member Posts: 18
    edited June 2014

    Ok.  Update.  Atyical ductal hyperplasia.  The nurse was kind enough to let me know this is considered high risk, although it is not cancer, and may never be.  Since the DCIS was found in 2010, I have been high risk anyway.  So, now I go to being checked every 3 months.  I don't mind, though.  Thank you to everyone for helping me calm down.

  • Laura_E
    Laura_E Member Posts: 18
    edited June 2014

    Biopsy results are benign.  Fibrocystic, with ductal hyperplasia.  So, I still have to be monitored more closely.  Thank goodness I can devote my time to taking care of my husband!!

  • leaf
    leaf Member Posts: 1,821
    edited June 2014

    Great news, Laura!  'Plain' ductal hyperplasia may put you at higher risk, but its barely measurable. (Of course, I encourage you to get screened as they recommend.)  Its the adjective 'atypical' (as in atypical ductal hyperplasia) that puts you at definitely measurable increased risk.  Best wishes as you take care of your husband.