Focal Asymmetry - Feeling Anxious
Hello all,
I am 8 years out from a stage 1 IDC diagnosis, and I don’t think about breast cancer much anymore. It took me a very long time to get to this point.
I do get nervous every year though as my annual mammogram gets nearer. I feel the stress and anxiety but have always been fortunate to have clear mammograms.
Unfortunately this time I have been recalled for further imaging to an area in my other breast and whilst I am trying not to let it consume me I am struggling.
I have been trying to research but not become obsessed. It’s hard. I have to wait 3 more weeks for the second round of imaging.
My report states -
There is a small focal asymmetry in the mid breast in the superior half of the medio-lateral projection of the right breast. Patient requires additional imaging.
My question is should I be preparing that this is likely another cancer or is there a good chance this could be benign? I don’t want to spend too much time googling as it is rarely helpful.
I would truly appreciate any insights or information that would be helpful to my understanding.
Thank you for your time.
Comments
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Hi @lavenderskies , I'm sorry that you got a callback for additional imaging. Focal asymmetry is most often but not always benign. The additional imaging will clear you, put you on a more frequent follow up schedule or trigger a biopsy. Biopsies may or may not have benign results and are the only way of making a definite diagnosis.
Unfortunately the risk of recurrence is something we all have to live with. That fear does fade into the background over time as it should but if something does turn up we have to go through that same period of uncertainty again. You are right that googling is not helpful and trying to deduce the answer from radiology reports is futile. Try to stay busy, hope for the best and realize that you will be able to deal with whatever happens. Let us know how it goes. All the best for good results!
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What Maggie said! I also want to add that no one, not even a radiologist, can tell you if you should be preparing for another cancer at this point (really!). If they could, then you wouldn’t need more imaging.
We all know that waiting is very difficult so try to keep busy and time will pass. Take care
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@maggie15 @exbrnxgrl
Thank you for your replies. I know it could go either way. Just feel I don’t have the mental energy to go through this process again.
I keep looking over the report and wondering if where it says medio-lateral projection means the asymmetry was just seen in one view which would be more favourable. Does anyone have any insight into if this is what it means?
Thank you.
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You are correct in assuming that specifically mentioning the medio-lateral projection means the asymmetry was just seen in one view. It could have something to do with how your breast was positioned by the tech. They will probably redo that view and take additional views at your recall appointment.
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@maggie15 thank you for your quick reply and clarification. I am going to try and hold onto that as being a positive aspect and hopefully that will get me through for now. I just wish I didn’t have to wait for another 3 weeks for more imaging. Seems a long time.
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I just need to vent, I am very teary today and very down. I tried to get my recall mammogram earlier but couldn’t, 3 more weeks to wait due to lack of staff.
We are due to go on a family vacation mid August, I am scared if I need a biopsy I won’t be able to get that done before vacation and I don’t want to have to cancel or ruin anyone’s vacation. My children don’t know what’s going on. Trying to keep it from them. My mind is racing. The wait is taking its toll.
When I was diagnosed 8 years ago I fell into depression and right now I feel a sense of doom with a black hole.
I am researching and trying to find positivity that this could be nothing but with a previous cancer diagnosis and this asymmetry that wasn’t there last year I am convinced this will be a negative outcome. I was trying to clutch to the fact that it looks like the asymmetry is only in one view but recently read that this could just be because it is obscured on the other view. I had a breast reduction on this side 5 years ago so to match more equally with my affected breast and was trying to find out if this could be the reason but it was 5 years ago and I am sure the change would have been seen before. My breasts are now density A, mostly fatty, and have been this way for a couple of years and so this new asymmetry concerns me more. I also had a tattoo on my right lower arm since my last mammo and was thinking maybe this was the reason for the asymmetry but cannot find any evidence for that as no calcifications were seen.
I feel I am at a pity party for one. I don’t want to get consumed but it’s pulling me down further.
I just needed to get that out. Deep breaths.
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I’m sorry that you were unable to get an earlier appointment. If you need a biopsy and it can’t be done before your vacation schedule it for right after you return. A delay of a couple of weeks won’t make much of a difference. I had to wait an extra six weeks for surgery after I was diagnosed since I was on IV antibiotics for a jawbone infection; they wouldn’t operate until the infection was cleared.
It is a stressful situation to be in. Virtual hugs for you.
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Yes, sending big hugs to you @lavenderskies. We know the waiting is torture. Try to be gentle with yourself and focus on your family. We're all sending you the best!
—The Mods
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Just coming back to update my story although not much to say as of now but the tech that did my tomosynthesis mammogram has me believing that there is something there.
I explained that I was extremely anxious due to my previous breast cancer history and the fact that I had to wait a month to get this imaging completed. I asked if I would get results or an update today or whether I could even speak to the radiologist afterwards. She said she would do her best to get some answers as she understood my anxiety. She asked me to wait in the waiting room afterwards which I know is common practice as they like to check they have everything they need but then came in and said that the report would go to my doctor and should be there tomorrow. I asked if there was anything that was seen and she looked extremely awkward and started fiddling with her hands and didn’t really know what to say and then just said that the radiologist needed more time to look at my images. She couldn’t get away quick enough.
The way she was acting has me convinced that there was something seen on my mammogram.
My anxiety is literally through the roof and the last day or so I have had quite a bit of pain in that breast and into my back so am even more convinced there is something going on. I am not sure how much longer I can hold myself together.
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Hi @lavenderskies, I'm sorry the waiting continues but that is par for the course in the bc world. While techs have seen many mammograms they are not qualified to diagnose and interpreting their reactions is about as effective as gazing into a crystal ball. Radiologists don't make snap judgements and want time to compare the images with previous mammograms or ask a colleague for an opinion. At this point you might get a recommendation for a biopsy; only that can determine if the tissue is normal. Hang in there and let us know what you hear.
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I’ve haven’t been on this forum for awhile but glad I got on and saw your post. I was diagnosed with IDC/DCIS in 2019 and had a lumpectomy/radiation along with 2 and a half years of estrogen blockers (all I could handle). I went in for my annual screening mammogram in March and was told I needed a diagnostic mammogram for focal asymmetry - it was in the same area as the previous tumor. Of course I was a nervous wreck thinking the worst - already planning how to deal with a mastectomy. I went in for the diagnostic mammogram and while I was there they looked at the films and sent me to ultrasound which was a lengthy process. The radiologist came in and told me in a serious tone that I needed a biopsy and classified it as Birads 4b and the last time when cancer was diagnosed I was Birads 4c so I was sure it was a recurrence. All the while dealing with scheduling and pulling teeth to get in ASAP because wait times are ridiculous. Fast forward to biopsy almost a month later which went better physically than my previous biopsy when I was initially diagnosed. I received a call 3 days later (late on a Friday) from the wonderful radiologist who performed the biopsy who wanted to give me the good news before the weekend. The spot was benign. So hang in there!
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I was going to write an identical post. To put it simply, reading facial expressions or body movements is not indicative of anything. The techs are simply not trained radiologists.
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@maggie15 thank you so much for your reply and thoughts it is so appreciated and makes rationale sense. The waiting is a lot and hard to handle when I am trying to keep things hidden from my family including my emotions. I am looking for clues and a sign of what the result is. I just found her very uncomfortable and awkward as if she was hiding something that the radiologist may have told her but obviously I am just assuming this and maybe being irrational.
I work the next couple of days so am dreading the phone call tomorrow or the next day as I don’t want to answer a call at work and by the time I finish work the doctors office will be closed.
@bitchonwheels thank you so much for hopping on here and giving me hope! If you don’t mind me asking when they did your diagnostic mammogram did the see anything other than the focal asymmetry at all? I will try and hold onto the fact that I may have a good outcome too!
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Can you excuse yourself to go elsewhere to take the call or return the call during lunch, break or a trip to the restroom? If necessary you could head home with an upset stomach but I sure hope the news is good and doesn’t have that effect. Doctors can be hard to contact so I got creative; a few times I had to put on a brave face and pretend all was well.
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@maggie15 if it’s a good outcome the receptionist will likely call me and if I don’t answer they will leave me a message to say to call them. If it’s the doctor and I don’t answer he won’t leave a message, I will just see a missed call. I am not sure I can answer if they call as I don’t think I can handle the thought of bad news over the phone. I could go outside if I am quick enough to answer but I wouldn’t be able to conceal my emotions and I am an extremely private person. This is a new workplace so no one knows of my previous history.
I am hoping for a good outcome but finding it hard to believe that this will be ok after today.
Thanks for your message, it is so lovely to know I am not alone and can vent and post here.
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Yes they did see something adjacent to the lumpectomy site which is why I had an ultrasound immediately afterward to get a more detailed picture for the radiologist. She read that and gave it a Birads 4B and I scheduled my biopsy as I was leaving the breast care center that day.
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@bitchonwheels thank you for coming back and letting me know your story. It must have been such a hard time for you.
No one called today to let me know anything, maybe tomorrow, but sometimes knowing nothing is bliss as I can still have hope.
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Well not good news at all. Spiculated mass 11mm gave me a BIRADS 4B which I thought they would have graded it higher as a spiculated mass if I am correct is indicative of cancer. Waiting to get the full report later today. Biopsy scheduled for Aug 8. Can’t believe I am here again with a second cancer diagnosis and I may not have such a good pathology this time. Feeling sick to the point of wanting to vomit.
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Many things go into grading a suspicious image so the only way to get an answer is by biopsy. BIRADS4b means there is a 10 - 50% chance of malignancy so nothing is definite yet. I like to look at it the other way and say there's a 50 - 90% chance it is benign. It's hard not to imagine the worst but try to distract yourself in the meantime since the waiting is difficult. I hope you get a benign result.
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Here is the full report:
Irregular mass 11mm in size with spiculated margins. Associated with the mass is a large area of architectural distortion. Bi-Rads 4B
I know enough to know that there is no way this could possibly be benign. Spiculated and architectural distortion all point to malignancy. Not sure why it is a 4B.
I am wondering what the point of the biopsy is at this point? Surgery will be needed so surely I would be better to be referred to a surgeon to get that scheduled?
Could anyone let me know what would be the best plan?
This wasn’t there last year so this concerns me as obviously fast growing.
I am sick to my stomach.
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lavendnderskies,
I am assuming that you have some medical expertise to be able to conclude that this couldn’t be benign. What field of medicine are you in? I must say that even your mo and a radiologist wouldn’t make this pronouncement without a biopsy, so it seems highly unlikely that you would have a surgical procedure without biopsy proven confirmation of cancer, even if they were highly suspicious of malignancy. The biopsy, not the imaging , is the definitive proof.
I understand your concern and worry but try to focus on what is known to be fact right now . None of us has a crystal ball and for this reason alone please have the biopsy so you will know what you’re actually dealing with before you leap to surgery. Also, though I’m no insurance expert, I am not sure if surgery would be covered if there was no confirmation of cancer (if you’re not in the US, please ignore this). We understand how difficult this period of time is but try to stay present with the information you know now.0 -
@exbrnxgrl I was a RN for many years so have a good understanding of some medical matters.
I also had IDC and DCIS in 2016 in my other breast that presented as architectural distortion at my diagnostic mammogram which is the same as my current report but this time a mass with spiculated margins was also noted this time. I of course gained a ton of knowledge that I armed myself with at that time.
Statistically spiculated margins are highly indicative of malignancy unfortunately. Architectural distortion too isn’t great either!
I live in Canada so the health system is a little different here to the US.
It was a rough number of years at my first diagnosis but I was lucky in the fact that I was node negative, had an Oncotype of 7 and had a lumpectomy and radiation and 5 years of Tamoxifen. I wish I had opted for a bilateral mastectomy now and it has been on my mind for several years whether to get it done but I couldn’t bring myself to do it. If I had of done I could have prevented this and now my family has to relive this nightmare again.
We are due to go on a family vacation for 2 weeks a few days after my biopsy so hoping I can work my way towards holding it all together to be able to enjoy it. Not sure how I will get my results whilst I am away or if I want them whilst I am away.
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I tip my hat to your medical knowledge! While I do understand that statistically the odds are tipping toward malignancy, I guess I tend toward the “it’s not over until it’s over” school of thought. Although bc is no fun, and I’m sure a recurrence is nerve wracking, it is hopefully, a local recurrence if you do have bc, and can be successfully treated.
Looking back is only helpful in that it can impact future decisions, but sadly, can’t change the past. That cliche about hindsight is true, so don’t beat yourself up over it.
Biopsy results can come back very quickly. Ask your doctor’s office about timing on that but please do go on your vacation. Take care0 -
Yes it is nerve wracking for sure and I did not do well before mentally at all. I need to find strength but not sure how to do this right now.
This area of concern is in my other breast so it would be a new primary.
We will definitely be going on vacation as it doesn’t make any sense to cancel. 2 weeks will not change anything I doubt.
I am scared that it will be more aggressive this time but don’t have statistics or research to know if this will likely be the case.0 -
Sorry to post again but reread my report and it says this which I had not noticed before:
‘The mass density is the same as an equivalent volume of breast tissue.’
Does anyone know what this means or what it could indicate. I am at a loss.
Thanks in advance.
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Dense breast tissue looks white on a mammogram but masses and cancer can also look white. A radiologist told me during a pre-surgery mammo after I had been diagnosed that since my breasts are more fatty than dense the white stood out as a malignancy (I had been given a BIRADS4c.) I don't know exactly what your radiologist was trying to communicate but it might be that the biopsy is needed since the mass is indeterminate (can't tell if it's cancer or dense normal tissue just by looking at it.)
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@maggie15 thanks for your reply. I wish there was a radiologist that could explain that portion as I understand the other terminology. I did try to contact them after my screening mammo results and left a few messages but they never called me back unfortunately.
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@lavenderskies, The radiologist had to act as tech to get the unusual views my surgeon asked for since they are not ordinarily done; he commented as he did this. Everyone knew it was cancer at this point since it was post biopsy. Radiologists usually don't communicate with patients directly but if something is really perplexing will communicate with the ordering provider. I have a bone tumor in my hip that they are afraid to biopsy since it would most likely cause a difficult to repair fracture. My MO filled me in on what the bone tumor radiologists and their second opinion at another hospital had to say. They are following it by MRI for growth but as of now it's indeterminate, a met or something benign that looks like one. I'm just living with the uncertainty since I would rather not end up in a wheelchair to answer the question. Unfortunately some things are not straightforward.
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@maggie15 yes some things are complex unfortunately. I like to know everything and have the knowledge to understand what’s going on. I feel in more control of my path that way.
How have you managed to find a peace or calm with the uncertainty? I could use some guidance in that area. I want to be able to enjoy each day rather than feel I have a dark cloud overhead. Today I have been breaking down in tears all over the place whilst trying to hide it from my children. It’s hard.0 -
My children are grown and gone. While I live with my DH he wouldn’t be able to care for me if were immobilized so I would most likely end up in a nursing home. I’m in decent physical shape now so I guess I decided there are things worse than cancer. If the tumor grows I’ll have to reassess but the MRI is five months away. I decided not to waste six months of my life worrying about something that is beyond my control.
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