Many, if not most of us, in the US, who have already been diagnosed with and treated for breast cancer have not had an MRI and will not have one for screening purposes in the future. So no, that isn't how you would necessarily be followed/screened in the US. I will have annual mammogram and ultrasound for screening purposes, and I think this is not at all unusual.

I'm sorry you're facing these concerns. Let us know what you find out with your ultrasound results.

sasamat, although the high risk clinics in BC may appear to only be for those who have a BRCA mutation, it could be that they will see other patients as well, if qualified by risk percentage.

I'm in Ontario and when I saw a counsellor at a genetics clinic here, she used the IBIS model to determine if I qualified for their high risk program. I believe their cut-off was minimum 20% remaining lifetime risk (or maybe 25%?) I didn't qualify because of age - once you hit a certain age, unless you have a known breast cancer genetic mutation (I do not), it's pretty much impossible to hit the 20% risk figure. But the counsellor told me that obviously it's easier for younger women without genetic mutations to qualify, if they have other high risk factors, simply because they have more years ahead of them and therefore a higher 'remaining lifetime' risk. At 50, with your family history and ADH, your annual risk might be high enough to get you over the minimum lifetime risk bar.

That might not be how the high risk clinics in BC operate, but it's worth looking into, if you have not already done so.

By the way, with breast density, if you have extremely dense breasts, which is not uncommon for pre-menopausal women, it might take you several years into menopause before your breast density begins to decline. And of course for some of us, it never does.

Hi sasamat!

The differences across provinces can be frustrating sometimes. My own mother in Manitoba was told (before genetic testing was a thing) repeatedly by most doctors she was at no higher risk than anyone else despite her mother, grandmother both getting diagnosed before 50 (her mother with bilateral cancer) and passing away. Her great grandmother died on operating table riddled with cancer but they never determined origination. All three women were only women of their sibling group (ie I have no biological aunts).

My mother was diagnosed at 48, and passed about 11 years later, two years after her metastatic recurrence. Even at time of diagnosis in 2007/2008 the genetic counselor she first went to see did not recommend even testing for her based on their models or indicate my sister or I may be at higher risk, even dismissed it as a possibility.

My sister and I had different experiences based on where we lived. I moved out to Alberta about 2-3 years after my mothers first diagnosis. Wait for genetic testing here was long so I incurred costs out of pocket and went down to US (this was back when the BRCA testing was also still very expensive!) but for multiple reasons my mother did not want to test then so the test was uninformed but genetic counselor there still assessed me at 40% lifetime risk. My doctor here referred me to high risk clinic in Calgary, where I was again given about 40% lifetime risk based on IBIS and studies out of Toronto on family history and risk. They were incredibly informed and supportive of me making a choice as to what was best for me. They gave me option for enhanced screening (which I did very briefly) but ultimately I knew what was right for me based on my family history and I got referrals to breast surgeon and plastic surgeon and had first surgeries the following year.

I forgot to mention though, the genetic counselling appointment for me in Alberta finally came through 2 1/2 years after referral (after I had already had my PBMX) but they would not do testing if my mother didn’t first (which at that point she would not for various reasons) and basically said she would need to pass away before they would test me, so care can be inconsistent for sure.

My sister stayed in Manitoba and even after my mother passed the breast health/high risk clinic there refused to consider her of any higher risk or even run proper models (like IBIS) for hereditary risk, instead using the GAIL model which does not account enough for that kind of history. They would not consider her history beyond our mother, like grandmother, great grandmother. They would not offer enhanced screening despite her age and own breast density. The doctor at that clinic she was dealing with was rather awful in bed side manner to be honest and completely lacked tact or up to date information, even if they could not accept her without a positive BRCA test or something. My sister’s doctor referred her to a plastic surgeon anyway and she had her preventative mastectomies in late 2019.

Anyway, just posting to say you very well may be right about the high risk clinic in B.C., as in my experience protocols do seem to differ, but I encourage you to advocate for yourself on it and get all the information you can.

You ask in the subject line, "if so, what then?" I know you're especially curious about screening, but it's also worth talking about risk reduction. We don't have many tools for reducing risk of breast cancer, and it seems we can only reduce it, not eliminate it. In terms of lifestyle changes, research shows we should make sure we're getting plenty of exercise, maintaining a healthy weight, and getting enough Vitamin D. Very likely having a high-quality, low fat diet is helpful, but research on diet (aside from Vitamin D, which also isn't fully conclusive at this point) has pretty mixed results.

Doing an SNB prior to diagnosis? Not usually done. In fact, an SNB isn't even recommended when the patient is having a lumpectomy after a needle biopsy diagnosis of DCIS. Should invasive cancer be found during the surgery, the SNB can be done later, as a second small surgery. Because of the lifelong risk of lymphedema, even from just an SNB, node removal is not usually done unless it is necessary, which is only after a finding of invasive cancer. (There are complicating issues for those who have a MX for DCIS, but that's another story.)

Inflamed reactive nodes after a stereotactic/core needle biopsy is not uncommon. That could explain the lump in your armpit and the appearance of the node on the ultrasound imaging.

If the Radiologist believes that there might be cancer in the node and that is the basis of the recommendation to do the SNB, then it means that they believe very strongly that invasive cancer will be found during your excisional biopsy. Do you think this is the case? Because if they don't strongly believe this, it is illogical to recommend the SNB. It would make much more sense to watch the node to see if it returns to normal, assuming that your final diagnosis after the excisional biopsy is ADH or no more than DCIS.

You might want to read here:

Topic: Ladies who had only 1 or 2 nodes removed... https://community.breastcancer.org/forum/91/topics...

Lymphedema https://www.breastcancer.org/treatment/lymphedema

"According to the National Cancer Institute, anywhere from 5-17% of women who have SLNB develop lymphedema."

If nodes need to be removed because of invasive cancer, as part of the diagnostic process, then it has to be done. But to remove nodes because it's convenient since you are going into surgery anyway.... that might work for the doctors but it does not consider the potential long-term impact to the patient.

I realize I was unclear. When I wrote "But to remove nodes because it's convenient since you are going into surgery anyway..." I was referring to the Radiologist's recommendation to do the SNB; I know it's not your idea.

If you weren't having the excisional biopsy, what would the Radiologist recommend about the node?

Sasamat, if you want another opinion and can make it to Surrey, see Dr Rhonda Janzen at the breast health clinic at Jim Pattison. All she does is breasts - for benign and otherwise conditions.

Moth, that was my thought. Or a core needle one. Doing it while they already had her there, rather than making another appointment just for that-but a regular needle biopsy, not a sentinel node biopsywith removal.

Yes, it makes sense that your PCP would follow the surgeon's lead. But in the end, it's your body and your decision. You have to sign a consent form prior to surgery and the doctor can only do what you agree that he can do.

Doctors don't have much awareness of lymphedema. They tend to under-estimate the risk of lymphedema from an SNB - some go as far as to say that there is no risk, which is a blatant lie - and they have little understanding of the complications of living with lymphedema, and frankly, the complications of living to avoid the development of lymphedema - I can tell you, that in itself is a pain in the a&&.

To the posts from moth and MelissaDallas, you need to ask about why type of biopsy is being suggested for the node. Is it a needle biopsy or is the plan to remove the node?

If your doctor's office has a soft copy of the ultrasound report, which is probably the case these days, they should be able to email it to you. Seems like a reasonable thing to do in our Covid world.

sasamat, the core needle biopsy of the node makes much more sense. Glad you got that cleared up.

It is really interesting these days how some facilities have completely opened up their communications, information and reports to patients, while others remain shut tight.

I had an appointment recently at a hospital I'd never been to before. I signed up for their patient portal while I was waiting, and upon arriving home after the appointment, the doctor's notes and imaging report were already available to me on the portal. By the next morning, the actual imaging was available; I put in a request for a downloadable copy and within 5 minutes had an email saying that it was available for download. By going into the portal and requesting a security code, I can give that code to any doctor or facility that requires the reports & imaging and they can download it too.

The bad news is that this hospital isn't near me. The facility closest to me for imaging is still in the dark ages - no patient portal, and you have to go in person to request copies of the reports and imaging. It drives me nuts because the place is so convenient from a location standpoint, but I hate not having access to my medical information. My PCP's office falls in between. No patient portal, but a secure email system that my doctor uses to immediately send me every report she receives; great that she does that but I'm sure other doctors in their practice don't.

It really is time for every medical office and facility to enter the 21st century and put up patient portals. The days of keeping information from the patient and passing it only to the doctor are long gone - or should be, anyway.