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Tuesday, March 11, 2014
Should I worry or relax?
I AM A 51 YEAR OLD WOMAN, WHO WENT THROUGH MENOPAUSE ABOUT 9 YEARS AGO. A DIAGNOSTIC MAMMOGRAM DONE FEB.6TH SHOWED THREE AREAS IN MY LEFT BREAST. THE FIRST IS A THICKENING BEHIND THE NIPPLE, THAT WAS FOUND ON THE BASELINE MAMMO AT ABOUT AGE 40, AND DOES NOT APPEAR TO HAVE CHANGED. THE OTHER TWO ARE NEW. A MACROCALCIFICATION, NEAR THE THICKENING, THAT THE DOCTOR FELT WAS NOTHING TO WORRY ABOUT. THEN TWO CLUSTERS OF MICROCALCIFICATIONS, CLOSE TOGATHER, "AT 2 O`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`T NECESSARY. I NEVER FELT A LUMP, NOR HAS EITHER DOCTOR. I NEVER HAD ANY SYMPTOMS OF FIBROCYSTIC BREASTS DURING MY PERIODS. THE DOCTORS ACT LIKE I AM NUTS TO BE QUESTIONING WHETHER OR NOT THEY WERE ABLE TO GET AN ADEQUATE BIOPSY. I AM STILL WORRIED, IT JUST DOESN`T ADD UP TO ME. SO, IS THIS NORMAL STUFF? SHOULD I JUST WAIT ANOTHER 3 MONTHS FOR ANOTHER CLINICAL EXAM? AM I WORRYING FOR NOTHING? OR DO I HAVE A RIGHT TO BE WORRIED? I ASKED MY PRIMARY REFERRING DOCTOR FOR A REFERRAL FOR A SECOND OPINION, BUT SHE ALSO WANTS ME TO WAIT THE THREE MONTHS, AS SHE HAS FAITH IN THE SURGEON. THE EVERY WOMAN COUNTS PROGRAM SAID I HAVE TO GET ANOTHER REFERRAL FROM HER BEFORE THEY WILL PAY. I LIVE IN A SMALL TOWN AND THERE ARE NOT MANY RESOURSES HERE.
The core biopsy that you had can be difficult in a small-breasted woman such as yourself. An important determinant as to the accuracy of the procedure is whether there were calcifications removed from your breast (you said they did get calcifications). The standard approach at this point would be to do a follow-up mammogram in 6 months. That is a long enough period of time for the Radiologist to see a change if it occurs but not long enough for a cancer to get out of control if this is malignant (which is unlikely).
It is always hard to wait as a patient, but what you have described is standard of care. The other way to look at this, is that it would be almost impossible for you to have another mammogram right now - it would be too painful and the changes from the biopsy would probably obscure any remaining calcifications.
Jean T Stevenson, MD, FACS
Associate Professor of Surgery
School of Medicine
Case Western Reserve University