Expert: Claes-Gustaf Nordquist, M.D. - 12/18/2008

Question
Hello Dr.,
On 10/22/08 I had a screening mammogram the findings were: "There are scattered fibroglandular densities in both breasts.  No apparent suspicious calcification or adenopathy.  Asymmetric density in the medial left breast on the craniocaudal view appears to represent a change from earlier exams."  The following week I had a diagnostic mammogram and an ultra sound.  The mammograms were digital.  The findings were:  The asymmetric density seen in the medial left breast on the craniocaudal view on 10/20/2008 is not as prominent on the additional images.  It is not visualized on the 90 degree lateral view.  It is not visualized on some of the rolled views.  This may represent superimposed vessels."  Conclusion:  The asymmetric density identified in the medial aspect of the left breast is smaller on the additional views.  The ultrasound findings:  Real-time grayscale and color Doppler sonography of the medial aspect of the left breast is performed.  There is no evidence of mass or cyst.  No sonographic abnormality is noted medial aspect of the left breast".

The radiologist first suggested MRI, then said he didn't think it would show anything, then suggested biopsy. 2 hours later (I was there for 3 hours total) he told me I didn't need a biopsy, do MRI but if not, get another mammogram in 6 months.

He changed his mind too many times to suit me so I consulted a breast surgeon.  She said she had no trouble looking at my xrays, you could see clearly through them, could not give me a biopsy because she wouldn't know where to biopsy.  She said she feels it's nothing but wants me to have MRI and even then she told me it shows a lot of false positives and she still may not be able to biopsy anything.  She gave me an examination and said I had healhy breasts.

I am leaning toward not getting the MRI and moving up the mammogram to 4 months.  I do not want any chemicals injected into my vein, no matter how small an amount.  I also have Meniere's Disease and have not been able to sleep on my stomach the last 5 years without getting vertigo, so I doubt if I could take the MRI.  This has me all very upset to the point I am getting more vertigo attacks than usual.

I would like your opinion on the results of these mammograms, especially the diagostic one.

I thank you for taking the time to read this lengthy letter.

God bless you,
LuAnne

Answer
You have asked me a straight question so I'll give you a straight answer regardless of if you like it or not. If I decided this I would have ordered BOTH MRI breast scans AND ultrasound breast scans from the very beginning as a complement to your mammography. From your mammography report it is obvious that you have a fibrocystic breast condition and that always will make mammography less reliable so it MUST be complemented by those other 2 modalities! I would not decide on any biopsy or not until I had studied all 3 reports. Besides it is a well known scientific fact that the diagnostic ability to find breast cancers is improved by the combination of mammography and MRI breast scans. The further addition of ultrasound does not hurt either. However the choice is yours!