Expert: Claes-Gustaf Nordquist, M.D. - 11/21/2008

Question
I'm a 35 year old woman with 3 children.  My grandmother got breast cancer at age 90.

After weaning my youngest a couple of years ago, my breasts have become fibrocystic.  They are quite lumpy, and twice now I've gone to the doctor with concerns about lumps, only to have mammograms and ultrasounds come back normal.

Recently I had a thermmogram (scores 50 and 55 for R/L breasts), and then a screening breast ultrasound.  The u/s reports "a focal abnormal appearing parenchyma measuring 1.5x1.3x0.9cm is noted with inhomogeneous appearance with poorly defined margins and small 0.4x0.3x0.3cm cystic structure at lower peripheral margin.  
No visible calcifications, no doppler vascularity.  u/s is indeterminate and requires mammogram and if required, needle biopsy to rule out pathology".
I am scheduled for a mammogram, however, I'm wondering if I should skip the mammogram since I'm young with dense breasts and go directly to a biopsy.  The anxiety of this waiting period is difficult, and I'm not sure an "all-clear" from a mammogram would ease my mind since they are not 100% accurate especially with young dense breasts.

I'm not able to tell if the u/s report indicates a high or low risk - but as other writers have indicated, even a low-risk probability is scary and I don't like the idea of waiting or wondering.

Thank-you!

Answer
In my opinion you SHOULD do BOTH! Have a mammography done but INSIST too on having an ultrasound guided needle biopsy of this lesion done! That way you will KNOW what it is and can act accordingly. In the future always do mammography TOGETHER with ultrasound breast scans AND MRI breast scans. INSIST on this! Unfortunately I do not have much faith in thermography as a good method to find breast cancers! Too many false both negatives and positives! Not really reliable. Good luck!