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How long is too long to wait? Canadian Wait Times and BI-RADS 4B

waitingaway
waitingaway Member Posts: 17
edited January 29 in Waiting for Test Results

I’m concerned about the wait times for basic diagnostic appointments…best practices is symptoms to pathology (in Canada) in 7 weeks. BC recommends 4 weeks as their standard. I have waited 6 weeks for an initial mammogram/ultrasound after finding a large, new, hard lump in my right breast. I am now on week 2 of waiting for a biopsy appointment, with no insight as to how many more weeks I will have to wait.

Are these typical of the wait times you are experiencing? I have pasted my radiology report below (radiologist said she is concerned and came to speak to me immediately after my ultrasound). I obviously know it can still be many things at this point, but so worried that it shares a lot of features in common with triple negative breast cancer and wanting the biopsy ASAP…I am only 37 years old and have a toddler that I am thinking of.

Are any of you experiencing these wait times? Am I worried unnecessarily for bi-rads 4B or should I be exploring biopsy options in other provinces/regions?

I don’t feel any pain but do feel friction/heat/slight burning only at the lump. I do believe it is increasing in size, but I can’t measure it. I have no family history of breast cancer.

The breast composition is scattered fibroglandular. BI-RADS B.

At the site of palpable abnormality there is a partly obscured lobulated
opacity. No suspicious microcalcification or distortion. The left breast is
unremarkable.

Ultrasound was targeted to the palpable lump. At this location, there is a
hypoechoic heterogeneous and predominantly hypoechoic mass with slightly
irregular margins. There is some internal blood flow. The mass is 3.5 cm
lateral to the nipple at 9 o'clock. The dimensions are 2.5 x 2.2 x 2.3 cm. No
shadowing. It is near equal tall as wide.

IMPRESSION:
Moderately suspicious palpable breast mass at 9 o'clock.

RECOMMENDATIONS:
Ultrasound guided core breast biopsy.

Comments

  • maggie15
    maggie15 Member Posts: 766

    Hi @waitingaway , I'm sorry that you have to go through the stress of waiting for the biopsy and then the results. From what I have read a wait anywhere from three to six months can make a difference even though the standard of care is shorter. I live in the US now but have lived in seven countries including Canada (Ontario and Quebec) so I have experienced the pros and cons of different medical systems. Canada is wonderful in an emergency and care is good as well as paid for by taxes. The downside is the wait for nonemergent procedures which you have no control over.

    My bc experience was in the US. My tumor was missed for 2.5 years; there were clues but a mass did not show on mammograms and symptoms were dismissed. It was actually an oral surgeon who was convinced I had cancer who caught it. My stage 2 IDC tumor was probably DCIS on my first callback mammogram. In spite of the long delay it is still considered early stage. Breast cancer tumors grow relatively slowly.

    Only a biopsy can tell if it's cancer and what the hormone features are. While your wait might be longer than 4 weeks I don't know the implications of joining the queue in another region (something you could look into.) BIRADS 4B has a malignancy rate of 10 - 50% so chances are that the result will be benign. I hope that you get an appointment soon and the results are good. Come back and let us know.

  • waitingaway
    waitingaway Member Posts: 17

    Thank you for sharing your experiences @maggie15 and for your wise perspective. I am sorry for the oversight in your care and grateful for your attentive oral surgeon, and hoping your treatment is proceeding well.

  • waitingaway
    waitingaway Member Posts: 17

    Update - I got the call today, ultrasound guided core needle biopsy happening this week! I also saw my GP who agrees that the lump has changed since she last felt it in early December - it is larger, harder, less round/has ridges, and she sees some puckering of the skin around it. Super happy to be getting some more conclusive insights soon!

  • maggie15
    maggie15 Member Posts: 766

    Good news about the appointment! At least you will have some information in the not too distant future.

  • doodler
    doodler Member Posts: 34

    Hi @waitingaway - I'm in eastern Ontario, and that was pretty much the timeline that I was looking at this winter. It was a month's wait for the mammogram (which happened in late November), then there was a callback mammogram (which showed birads 5). The biopsy was Dec. 15. I had an initial meeting with a surgeon Jan. 2, and had many scans and tests this month. I met the medical oncologist Jan. 8.

    Turns out, there will be no surgery for me at this time. But I've since started medications, as of last week. After feeling like there was endless waiting, I found the past 3 weeks of going to appointments, getting test results and a treatment plan, that all happened like a whirlwind.

  • sssiminel
    sssiminel Member Posts: 11

    Your ultrasound sounds a bit like mine. Mine was classified as Birads 4A. I had my biopsy on 29 January, waiting for results. Fingers crossed for both of us!

  • moderators
    moderators Posts: 7,683

    Hi! Just wanted to drop a quick note to say good luck to both of you as you await your biopsy results. Take care and stay strong! And remember, this wonderful community is here for you whatever the results may be.

    Best wishes,

    From the Mods

  • waitingaway
    waitingaway Member Posts: 17

    Thank you @doodler and @sssiminel for sharing your experiences. I had my biopsy yesterday. The gist:

    • no changes in size or morphology since previous imaging
    • concern is primarily because of the lobulated margins and rapid growth
    • 2 samples were taken using ultrasound guided core needle biopsy
    • a clip was inserted to mark the margin/where the samples were taken and I had a mammogram immediately after to confirm clip placement and get another image for my file
    • none of it hurt, not even the freezing. Nothing was uncomfortable.
    • Hospital Radiologist confirmed he is aligned with previous radiologist in terms of level of concern, neither more nor less and no changes of additional concern
    • the lump is confirmed non-cystic, it is solid
    • conversation referenced benign growths and cancers equally - neither was emphasized. Clip inserted would be helpful to indicate that lump has been biopsied (if it is benigned and no future actions needed), or to mark the area for removal, or to mark the area in case it is cancer and require treatment before surgery that may altar the size
    • pathology results should be available in a week

    I hope this provides some peace of mind to anyone experiencing something similar. Questions I am glad I asked:

    1) can you help set my expectations so I don’t panic but so I can understand where we are at? Are we still in an information gathering stage, or are we at a point where we are concerned? (He answered: concerned)

    2) ok, I understand that. With these new images and sampling, are we the same level of concern as the other radiologist previously commented, or are we now more concerned or less concerned? (He answered: he is aligned and is the same level of concern as the other radiologist, not more, but not less)

    3) are you able to comment on whether there was liquid in the sample / can we comment on whether the lump is cystic? (He answered: we can confirm it is non-cystic, it is solid).


    I felt like that was a good balance of setting my expectations and understanding where in the process we are at without putting the doctor on the spot for an impossible diagnosis without more information. Good luck to everyone waiting for results, @sssiminel let us know how it goes (if you are comfortable with that!).

  • waitingaway
    waitingaway Member Posts: 17

    First update this morning. Preliminary pathology indicates an invasive carcinoma, as well as an involved lymph node. Will have to wait for the rest of the pathology results as well as pre-op with a general surgeon to have a lumpectomy/mastectomy and then radiation and/or chemo. So…my cancer journey begins.

  • moderators
    moderators Posts: 7,683

    @waitingaway, we're so sorry for the unwelcome news. Perhaps you might post your situation in the Just Diagnosed Forum to connect with others who share similar situations. There you'll find also a few places to start from the main Breastcancer.org site:

    We hope this helps! The more you learn about your diagnosis and plan your treatment, the better you will feel, even though it is difficult at first.

    Stay in touch with us and use this community for support and encouragement as you start your journey. We're all here for you!

    The Mods

  • salamandra
    salamandra Member Posts: 725

    So sorry to hear that, waitingaway, and wishing you the easiest possible path forward!

  • waitingaway
    waitingaway Member Posts: 17

    Thank you @moderators and @salamander2023 .


    I’ll head over to the newly diagnosed discusssions, thank you for highlighting some relevant resources for me.

  • maggie15
    maggie15 Member Posts: 766

    Hi @waitingaway, I'm sorry the result was what nobody wants to hear. All the best for figuring out a treatment plan and navigating it.

  • waitingaway
    waitingaway Member Posts: 17

    Thanks @maggie15 for the kind words while you navigate your own challenges!

  • waitingaway
    waitingaway Member Posts: 17

    update for people still check this thread or wondering what my BI-RADS 4B ended up being. Not to discourage anyone here, but I have some bad luck and it is triple negative breast cancer, grade 3, stage 3 (T3, N1, M?). Hoping my disproportionate bad luck will mean much better luck for anyone else here - I mean, statistically, it has to! Hope that brings some peace to some of you :)

  • moderators
    moderators Posts: 7,683

    Hi @waitingaway,

    That is poor news. How are you coping with the diagnosis and treatment so far? We have free weekly meet-ups over Zoom with members who are actively in treatment that could be a helpful source of support in addition to our discussion boards. If you are interested in joining, you can come as frequently or as infrequently as you'd like. There's really no pressure.

    We have the dates/times and registration links here:

  • maggie15
    maggie15 Member Posts: 766

    Waitingaway, I’m sorry about your diagnosis. There are other threads on this site specifically for those undergoing treatment for TNBC. I hope things go as well as they possibly can.

  • waitingaway
    waitingaway Member Posts: 17

    Thank you @moderators and @maggie15