Expert: Claes-Gustaf Nordquist, M.D. - 6/15/2008

Question
QUESTION: I have left breast cancer that was treated w/lump/radiation/prophalactic hyst/ooph. That was 06'-07'. New 6 mo follow up MRI/mammo/us reveal new hypoechoic solid mass right breast (just had b9 result in Nov of calcs in same right breast). Measures 1.7cm x 0.4cm. BIRADS lexicon 3 (probably b9) and follow up with more scans in 6 mo. I dont want to speculate, but isn't it unusual for a postmenopausal 51 yr old to get fibroadenoma? I had several since age 19, all surgically removed, and since I have had invasive cancer already, shouldn't I push for that to be removed? Also appearance of 2 small cysts OR dialated ducts (they cant tell) surround that mass..

Thank you

ANSWER: Yes, I agree with you completely! Why should you have to wait? I do suggest (strongly) that needle biopsies should be done of the mass so that we will know what it is and can decide what to do accordingly! Either thin/fine needle aspiration biopsies or wide bore needle core biopsies. Thos can be either stereotactically directed based on mammograms or guided by MRI or ultrasound. Needle biopsies would be quickest, easiest and simplest for you!. DEMAND IT! If indeed a cancer a new lumpectomy followed by radiation may be possible. Since you have already had one breast cancer you are biologically at a somewhat higher risk of a new cancer in the same or the other breast. Good luck!



---------- FOLLOW-UP ----------

QUESTION: Dear Doctor,
I forgot to mention that my surgeon suggested from the beginning that I had bilat. masts, since the cancer never showed on ANY scans and was an incidental finding when they went to remove calcs (ADH). I am considering it, but am allergic to pain meds and other meds, and am afraid I'd have to endure the agony I did when I had my ooph/hyst. Is there any severe pain that Tylenol wont take care of after mast? I feel the abdominal hyst was probably the worst pain I'll ever have, there's always taking a percocet or two with large dose decadron or benadryl/zantac to prevent allergy. Do you think this is feasible?

Thank you again Dr.

Answer
Well the choice is of course yours. A bilateral mastectomy is hardly something that will happen without some pain. If more than Tylenol can take care of I do not know, too big individual differences for me to be able to predict that! You should discuss this with your surgeon!