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Diagnostic Mammogram and Ultrasound came back as BIRADS-3 -Need advice & guidance

dasily Member Posts: 3
edited August 2023 in Not Diagnosed But Worried

Hello all, I'm hoping that you all might be able to place my mind at ease a little bit. I'm 45 years old and was placed in the high breast cancer category at age 40 based on my DNA genetics test. I do not have the BRCA gene. I have a maternal aunt that had breast cancer later in life and 3 paternal great-aunts that had breast cancer, one passed away.

I've been getting yearly mammograms ever since and have been seeing a breast care specialist yearly. Fast forward to this year, in March, the NP at the breast care stated that according to their two models, I do not fall into the high category for breast cancer and that the DNA test that I previously did doesn't mean much in ways of being in the high-risk category. But said to keep following up yearly.

My yearly mammogram in July came back incomplete (BIRADS-0) need more information stating that a 4mm oval mass was found. I went and got a diagnostic mammogram and ultrasound. The diagnostic mammogram and US came back as there is a 5mm density in right breast, ultrasound demonstrates a 5mm lobular lesion that appears to be at least partially anechoic. This is difficult to fully characterize sonographically. A six month follow up mammogram. Impression: incomplete: need additional imaging evaluation, ultrasound probably benign. The 5mm probably cyst in the right breast is probably benign. (BIRADS-3) probably benign. When I was at the appointment the Radiologist tech/sonographer said that the radiologist said that my spot is too small to tell but they think it's nothing and to come back in 6 months.

I don't find this acceptable! Is this normal?

I was to go back to the office and see the NP to discuss options. I inquired about seeing the Dr at the practice and at this time the Dr is only seeing patients that need surgical procedures. When I got there, I was told exactly what my diagnostic mammogram and ultrasound stated from the NP. Said that protocol is another diagnostic mammogram at 6 months, that this category is less than 2% cancer and that she could see if a biopsy could be done but that has a lot of consequences and it might be too small. But, when I inquired about what the radiologist stated about its being too small to tell, I was told that size doesn't matter and that cancer can be detected even if it is small. I stated that I don't like probably benign and partially anechoic. I want assurance. The NP said that if the radiologist categorized me at a BIRAD-4, then they could do the biopsy. I even went over my history again and stated again that I had 2 previous cancer scares, cervical and uterine (both were found to have cancerous cells on them were taken care of). I left that appointment feeling worse than when I got there. I wrote the NP a mychart message and said that I don't have a good feeling about any of this and asked what further testing can be done. Now the NP called a different radiologist and is on to getting a biopsy. This other radiologist has agreed to do a ultrasound guided biopsy. I'm trying to get it scheduled.

I want some reassurance that I'm doing the right thing about getting the biopsy through this NP and different radiologist. I'm worried and my gut tells me not to wait with 2 other previous cancer scares and the history in my family.

Have any of you been in this situation? What was your outcome?

Thank you so much for your advice and guidance!



  • maggie15
    maggie15 Member Posts: 942

    Hi @dasily , The standard of care for BIRADS3 is six month surveillance based on the very small rate of malignancy, economic factors and possible harm caused by unnecessary biopsies. Very small does not mean zero, however.

    This is theoretically fine except when you happen to be one of the affected 2%. If a diagnosis is made six months later the increase in size is probably not going to be that great. However the study referred to in the link had some malignant tumors identified two years after the first BIRADS3 mammogram.

    My situation was different in that I had a callback which showed architectural distortion on just one view and then 3 subsequent BIRADS2 mammograms with "stable asymmetric density." It wasn't until 2 1/2 years later when a jawbone infection wouldn't clear with IV antibiotics that my oral surgeon was convinced I had cancer in spite of a benign bone biopsy and ordered a diagnostic breast ultrasound. I ended up having a 3.2 cm IDC tumor with 1/3 nodes which had been hidden on mammograms by numerous radial scars in the margins. I figured this was still not too bad until radiation wiped out one lung and has changed the way I have to live to preserve the other one. The hidden tumor and the rare radiation reaction are both highly unusual but illustrate the limitations of imaging and medicine in general. Unfortunately, delays and rare occurrences can have consequences.

    I'm glad your NP found a radiologist to reclassify the mammogram and do a biopsy. Hopefully it will be benign and you will have peace of mind.

  • dasily
    dasily Member Posts: 3

    @maggie15 Thank you for replying! I'm nervous and worried and I know what the statistics say about Birads-3 only being at the most a 2% chance. And I think about all that I've been through and that I was undiagnosed my entire life with lady part issues. This has made me question everything and Doctors in general.

    I'm not positive that the new radiologist reclassified the mammogram and ultrasound Birad-4, they just agreed to move forward with the biopsy.

    Thank you for the reply again!