Expert: Claes-Gustaf Nordquist, M.D. - 12/6/2008

Question
In March '08 after having a mammogram & ultrasound, a radiologist "thought" he saw a slightly lobulated mass less than 1 cm in length in my left breast in the 3 o'clock position and recommended a biopsy. Note: My mother died of bone cancer secondary to breast cancer in 1991 at age 74. I waited until May, '08 & consulted another or 2nd radiologist who concurred with a BIRAD4a (minimally suspicious)diagnosis from the March '08 mammogram & ultrasound.  Then in July '08, the mass was downgraded to a BIRAD3 possibly a BIRAD2 after another ultrasound.  The 2nd radiologist didn't seem to think the mass was really lobulated at that point.  After much personal deliberation and total fear, I opted for a Mammotome Stereotactic Biopsy with Titanium Clip...which I really didn't want (the clip or that particular biopsy), but it was recommended if I didn't follow up every 3 months to check the status of the mass or fibroadenoma. Had the stereotactic biopsy Oct '08, results being a benign BIRAD2. Great!  But, now I have or own a titanium clip, which I was told I had to have inserted at the time of the biopsy, there was no other alternative.  I don't care if it is a "future marker" to detect "future" breast disease.  It is a foreign object that possibly could dislodge at some point or may not be as inert chemically, as well...perhaps even radioactive from what I have read about titanium clips.  Now, I would like to go back and have the clip removed from my breast as it has not felt right to me since the time it was implanted in my breast.  Will I be able to have the clip successfully removed?  Also, can having a benign fibroadenoma removed compromise or adversely impact a post-menopausal woman's hormone levels?  In retrospect, was it REALLY medically necessary to have all the mammograms I had done this year, per doctor's recommendation, and subsequent biopsy procedure?  I am not trying to be antagonistic, but I am totally flummoxed by this past year's health events? Any ideas that may enlighten me would be appreciated.  Thank you so very much, Dr. Claes-Gustaf Nordquist. RECAP QUESTIONS: Aside from a marker, have there been people who have had allergic reactions to the clip and can it be radioactive?  Wouldn't a needle aspiration of cells served a far better preliminary purpose prior to a much more invasive procedure such as the stereotactic biopsy and clip?      

P.S. I have no problem sharing my email with other women who have had similar procedures or experiences.


Answer
First of all titanium clips are NOT radioactive in any way, are hardly known to cause any allergic reactions at all and are chemically very inert. In fact titanium is most probably the best tolerated metal inside the body. Which is the reason it is used for all sorts of surgical, orthopedic and dental implants! So it is in fact THE "foreign" material of choice for ANY such procedure! We have nothing better! In principle there should be no technical difficulties in having it surgically removed if that is your wish. But a surgical procedure is needed and apart from your wish there are no medical reasons for its removal. No a fibroadenoma removal has NO hormonal impact whatsoever. With regards to the number of mammograms it is hard without the possibility of doing a detailed study of the matter to evaluate if any were made unnecessarily. But I'm rather sure that your drs. at the time regarded them as necessary. However a more liberal use of MRI breast scans may have been of help. But that is not available everywhere yet and IS more expensive too. A thin/fine needle aspiration biopsy could also have been used but a stereotactic procedure may have been necessary in order to hit the right spot and also offers some technical advantages (a histopathological evaluation is possible for example while in the other case only a cytological evaluation is possible). There are no known medical disadvantages of doing a stereotactic biopsy instead of the other. And hardly any of the clip either.