Developing Asymmetry at Screening - Tech Consulted Radiologist
Hello All - I'm 52 and have heterogeneously dense breasts and got my first baseline mammogram at 35. I've been fairly consistent with mammograms since 40 aside from last year, so it was 2 years since my last screening when I went a week ago.
I've had recalls here and there and have learned not to get too upset about them as they have all turned out to be some sort of summation artifact.
However, this time feels a lot different.
First of all, the technician asked me if I could wait while she talked to the Radiologist and asked me not to get dressed after she finished scanning my breasts. This is not the normal procedure of my Breast Clinic.
She returns and tells me that the Radiologist would like another view of my right breast. When she's doing the positioning she casually asks if my breast has any tenderness or if the pressure bothers me. I tell her no. Then she asks if I have had any issues with my breasts. My mind went blank. My right nipple had been having a weird "burning" sensation; almost an itchy-burning feeling, the last few months, and I'd had a vague ache in my upper chest but that was above my right breast, but no visible physical changes.
She again goes to talk to the Radiologist then he asks for a spot magnification view, which she does and again asks if there is any pain with the pressure, which I tell her no.
She again goes to visit with the Radiologist and when she returns she has a piece of paper in her hand with 3 dates and times written on it. She tells me that there is an area of concern on my right breast that was not present on my scans from 2 years ago nor from previous years and they would like me to go for additional views and a mammogram. She had 3 dates for me to choose from. I selected the earliest, which is the 17th.
In all my years of having mammograms, I've never had a technician go ask a Radiologist to view the mammogram right then. This clinic is not one that views them on the spot.
Before I left she asked if I wanted to see what they were looking at. Of course I said yes, but by this time, I was a mess and didn't really process what I was looking at. It was a bright white spot in the middle of grey. That's all I really remember.
The report the Dr sent to my MyChart is, to me, kind of vague, but probably standard for a screening report.
"Developing asymmetry within the slightly lateral right breast on cc views 8 cm from the nipple. This demonstrates incomplete effacement on spot compression tomosynthesis imaging. This is suboptimally localized on MLO view but appears to be located either along the nipple pectoral line or superior to the nipple pectoral line corresponding to estimated 11:00 location 8 cm from the nipple."
Impression:
1. Developing asymmetry of the right breast on cc view likely corresponding to the 11:00 location 8 cm from the nipple. Further characterization with right diagnostic mammography is indicated. Right breast ultrasound can be performed if needed.
Right diagnostic mammographic images should include tomosynthesis with true lateral view and spot compression CC and MLO views.
BI-RADS Category 0
I have just recently found my paternal birth family and found out that my paternal grandmother and great-grandmother both died of breast cancer, at 63 and 71, respectively.
So how worried should I be?
Also, should the additional mammogram images confirm whatever they saw on the scans from last week, will they go on to ultrasound and possibly a biopsy? If they do a biopsy will they normally do it that day?
I was given two appointments, back to back, for the mammogram and the ultrasound.
Thank you!
Comments
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My mammos ALWAYS had call backs for additional screening & an ultrasound. And over 30 years, at several different clinics, the radiologist was often consulted before I got dressed so they could take more views.
Bi-RADS Category -0- is probably nothing to worry about. But since each of us is unique, there's no way to know what your particular group will do.. When after 35 years they finally recommended a biopsy for the first time, I went to see my GYN first and she recommended a different team to follow up. But no - it would be unusual for them to do it the same day.
Waiting is hard but it's good that you've been so vigilant. Try to find something to occupy your mind - like binge watching TV or walking in the woods. Hope the next batch of tests go well. Do let us know.
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The fact that the breast clinic is doing things differently may be due to changes they initiated in the last two years due to Covid, and not be something specific to you. Or it could be just an update in their procedures. I know I'm getting faster results on all my imaging, not just mammograms, in the last few years. I used to have to wait three or for days for results, and now they're available pretty much instantly. It seems like the radiologists are more available to interpret results on the spot.
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I know this is very concerning for you, but at this point, they just don't know what they're looking at, so it's good they will take another set of views with 3D, and US if needed.
As to doing biopsy, different clinics have different procedures, and also it might simply depend on what kind you might need (US guided or mammo guided, for example) and whether or not they have a slot open that day. Once I had an immediate biopsy, because they happened to have an open spot in the schedule for both the room and the radiologist, and once I waited a few days. You could check with them by phone tomorrow and ask if they have a standard way of scheduling.
Also, it's great to have more info on your family history. A pretty small percentage of breast cancers are genetically linked, with your greatest risk coming from having breasts. However, you'll want your medical records filled in more completely, regardless.
Good luck.
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Thank you all for responding. I had the diagnostic appointment this morning and the report appeared in MyChart this evening. I'm not left with warm fuzzies over it, but I guess I'll trust the professionals. (First of all, they indicate there's no family history of breast cancer - I have reported numerous times there is). The spot persisted on the 3D mammogram and only partially dispersed with one of the two spot views (the tech showed me each view as she completed them). It persisted with the other view.
Dumb question, but if one has large, dense breasts, does ultrasound go all the way through all that to see everything? I told the US tech where I felt the small spot (at the same area as the DA) but that it felt deep to me. She didn't "dig" around. She just lightly ran over my breast. Could the architectural distortion on the US be hiding something deeper? Guess I'll know more in 6 months.
Anyhow, here's the report.
Impression
1. Probably benign right breast slightly outer asymmetry corresponding to
heterogeneous glandular tissue at 11:00 8 cm from the nipple. There is question
of subtle architectural distortion sonographically at the site although none is
seen on mammogram. Recommend short-term follow-up in 6 months with diagnostic
right mammogram and targeted right breast ultrasound.
BI-RADS Final Assessment Category 3: Probably benign
Management Recommendation: Short interval follow-up or continued surveillance.
Recommend diagnostic right mammogram and targeted right breast ultrasound in 6
months.
Primary care provider will be provided with written results. A letter will also
be sent to the patient.
FACILITY: SA
This facility utilizes a reminder system to ensure that all patients receive
reminder letters and/or direct phone calls for appointments. This includes
reminders for routine screening mammograms, diagnostic mammograms, or other
Breast Imaging Interventions when appropriate. This patient will be placed in
the appropriate reminder system.
*Reading Radiologist: Schroeder, Tram on 02/17/2022 at 6:41 PMNarrative
3-D MAMMO RIGHT DIAGNOSTIC, US BREAST RIGHT LTD 2/17/2022 10:50 AM CST
History: 52 years Female Diagnostic mammogram. Patient reports no personal
history of breast cancer. There is no family history of breast cancer. Call
back from screening mammogram.
Tyrer-Cuzick lifetime risk for developing breast cancer is calculated at 10.5%.
Technique: MAMMO RIGHT DIAGNOSTIC, US BREAST RIGHT LTD. Supplemental views were
obtained with 3-D tomosynthesis mammography. Computer aided detection software
is utilized. Real-time focused sonographic examination of the right breast is
performed and representative images are permanently recorded.
Comparisons: Mammograms 2/2/2022, 9/18/2020, 9/3/2018.
FINDINGS:
Breast composition: Heterogenously dense tissue, which may obscure a small mass.
The report to the patient will include the state mandated discussion of dense
breast mammography.
1.0 cm asymmetry in the slightly outer right breast, middle third, 8 cm from the
nipple on the screening CC view again partially disperses with spot
compression. This is estimated in the subareolar/periareolar region,
approximately 11:00 to 12:00.
Focused sonographic exam of the right breast was performed in the
subareolar/periareolar region and from 9:00 to 12:00. There is prominent
slightly heterogeneous glandular tissue at 11:00 8 cm from the nipple which may
correspond to mammographic asymmetry; there is question of subtle architectural
distortion at this site although no architectural distortion is seen on
mammogram. No discrete mass is seen. No abnormal lymph nodes in the right
axilla.0 -
One thing that drives me crazy about the medical world is we have to advocate and push so hard for decent medical care
I would call wherever you had the mammo and tell them you want the report changed to reflect your family history of breast cancer. That's important and they should most certainly have noted that in the report!
If I were you I'd push for a breast MRI. Just for peace of mind. There are people on this forum who's cancer has been missed on ultrasound. Some like me have had cancer missed on a mammogram. (Even after feeling a lump and knowing something was there!)But it's very rare almost non existent to have cancer missed on a mri.
Do you have a breast specialist? If not, I'd get a 2nd opinion with a breast specialist. I'd tell them about your family history.
This is just my thoughts. You make the right choice for you tho!
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I would echo Jons girl to have a discussion about the density of your breast tissue and whether or not an MRI would be appropriate at this time. I would also communicate to them the sensations you have had, just to make sure they have all the pertinent information. Who is coordinating your care? Are you seeing an actual breast specialist? That might be a good next step. As far as procedures, I would agree with Alice that a lot of places are becoming quicker at evaluating results so that if you need additional imaging you are simply taken back in so try not to over read that. I had many call backs over the years because my breast tissue was so hard to image.
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Thank you ladies for your responses. I'm still confused as to how they can find the asymmetry on the screening and diagnostic mammos (something that was not on my prior mammos), it not disperse with spot magnification, then on ultrasound, decide it's probably just glandular tissue, but oh, hey, there's architectural distortion in the same area! I get that it's not seen on the mammo, but with dense breast tissue, would it be seen every time? I don't know, I guess I'm probably over thinking it. My grandmother had a situation exactly like this and was just told to return in a year and by the time those 12 months had passed it had metastasized and she died 9 months later.
I was seen at a breast center but at this point, everything is coordinated through my primary care physician.
I will call the breast center tomorrow and insist that my family history is added to the report.
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Sounds good. If I were you I think I'd tell your primary care the experience of your grandmother. Tell them why your concerned. If you don't want to wait 6 mo for the follow up diagnostics, I'd push for breast MRI. I would think it would be covered by inbecause they can't say in the report definitively that it's benign and because of the distortion. I'm over cautious tho. So maybe others here would say they'd wait 6 mo. But if something similar happened to your grandma, if I were in your shoes, I would ask for the mri.
Keep us posted, we are here to support you.
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hello , if you still in this forum can you please tell us what happened to you ? I have similar issues and I’m worried! thank you
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Anny777 they are not still on the forum. "Latest activity: Aug 10, 2022"
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Hello anny777, and welcome to Breastcancer.org! If you want to contact kshellokittygirl, you can always reach her via private message and see if she is still around. Or, you can also start your own thread if you prefer, in the Not Diagnosed But Worried forum. It will help you get support from others regarding your situation. It's easy to do: just click the link to the forum, select Start a New Topic, fill out the Subject and Body of the post, and click Submit. Be sure to mark the thread as a Favorite, so you can receive notifications when someone responds! Let us know if you need help with that.
Wishing you well!
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