Expert: Claes-Gustaf Nordquist, M.D. - 12/1/2011

Question
Sir, my primary care physician is not explaining much to me. I had my 1st Mammo in 2009 when I turned 40. It came back negative for any masses or tumors. But it said extremely dense parenychma. Check again in another year. I had my 2nd mammo this month 2011. They asked for the one in 2009. Now they are telling me I need a left breast ultrasound and special xray to review it again due to "a dark small symmetry found in left breast with very dense parenychma". The wont explain anything to me. I have very small breasts and have never felt anything in then. However my Aunt, my Dad's sister had a full mastectomy. Does this mean I may have cancer? I am so scared. Please explain?

Answer
Well, it happens to be the duty of your doctor to explain things to you! How else can you understand what is going on? And what is going on concerns your body and health, so you have a clear right to know! But in the absence of the fulfillment of that duty I will carry it out. We know from your previous mammographies that your breast tissues are very dense. Such high density there actually makes it very difficult to check your breasts with mammography. So in this situation mammography SHOULD always be complemented by ultrasound and even MRI breast scans! So that ultrasound scans and extra mammography pictures are ordered now is not surprising. What is surprising is that they were not ordered the first time you did it and that nothing was done in 2010! Because in this situation the risk is higher of missing things! Something is clearly seen in your left breast. What is seen is probably not a symmetry but a "small asymmetry" because that is one of the things that is looked for (that there is a lack of symmetry somewhere in the picture). What that means is NOT known at present! That is also a reason for more pictures now. Yes it may be a cancer but it does not have to be. However what it is must be found out. Soonest! If I was in charge I would order breast MRI scans too! I would also order at least needle biopsies of any lesion seen either stereotactically based on your mammographies or guided by ultrasound or MRI. If such biopsies were unclear I would order a surgical biopsy. I think that explains the situation. Good luck! Please do keep me posted!


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