Expert: Claes-Gustaf Nordquist, M.D. - 6/21/2011

Question
QUESTION: I recently had a breast mammogram,which lead to a breast ultrasound, because of a family history of breast cancer,anyway this is the report on both:

Mammogram:Bilat Mammogram:Findings scattered fibroglandular densities are seen, which may obscure a small lesion on the mammogram. There is a 1.5mm stable nodule in the upper aspect of the right breast. Asymmetry is also noted in the upper-outer aspect of the left breast.
Impression: No monographic evidence of malignancy. However, a targeted ultrasound of the right breast is recommended to further evaluate the clinical findings of a lump. BI-RADS category 0

Then the ultrasound report:Right breast only

Findings: Heterogeneous echogenicities are seen, consistent with fibroglandular tissue. There is no evidence of a discrete solid mass or cyst in the retroareolar area where the lump had been felt. There is a 9.1x6.3x6.1 mm oval nodule with mantle with blood flow through the hilum. it remains unchanged as compared with examination from 2010.

Then suggest's a screening mammogram to be done at age 40 which is in about 9 months, my major concern is this

My sister, had breast cancer she is now in remission, however they did not think that her's was breast cancer but she went for a second opinion and they found that it was cancer, my mother had cancer in her left breast and they had also to preform a lumpectomy, and had no suspected her's to be cancer either but it was found to be cancer when biopsy was preformed, my sister in law which I know is not blood related, but still scares me because of how her breast cancer was found, by accident  and she is now in stage 4 breast cancer. so I am worried that they may not be seeing something that could be there, or that some of the things in my breast are already cancer and they just think it is okay as has been the case with both my mother and sister should I get another opinion on this and what type of a Dr. should I contact if I need another opinion?

ANSWER: According to your reports you have dense breasts (excessive fibroglandular breast tissues). That makes interpretations of mammograms difficult. When that and your family history are considered I think that you also SHOULD have breast MRI scans AND at least needle biopsies of all unclear lesions seen or felt! That way you would be much more secure! I'm a Swede living in Sweden so I can not recommend anyone where you are wherever that may be! If it turns out that you need a second opinion to have the things I mentioned above by all means do have it too! Good luck!



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

QUESTION: What type of a Dr. would I need to see for a second opinion? would I need a surgon, or just a regular MD?

ANSWER: An experienced breast (breast cancer) surgeon is most probably best! Good luck! Thanks!



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

QUESTION: I have gone to the surgeon, and she suggested that I have a breast MRI because of the abnormal results of my mammogran, and family history, so I had the MRI done on 6/16/2011 my next appointment with the surgeon is not until 6/23/2011 anyway today I called the local hospital that preformed the MRI and ask for a copy of the written report This is what that report says:


FINDINGS:
The examination is somewhat limited.

There is an approximately 11mm oval shaped smoothly marginated enhancing nodule within the posterior aspect of the upper outer quadrant of the right breast and corresponding well with the mammographic finding and which has been presant as far back as 2008 and on prior sonogram has been described as a lymph node. There are small benign appearing axillary lymph nodes seen bilaterally.

There is noted some asymmetric breast parenchyma within the upper outer quadrant of the left breast and corresponding well with the mammographic findings. There is otherwise no focal mass or area of archeitectural distortion.


IMPRESSION:
1. No MRI demonstrated malignancy.


BI-RADS Category 2- Benign Finding.

Breast MRI DISCLAIMER:
"A normal MRI report does not exclude the presence of DCIS. Invasive lobular carcinoma or cancers under 3mm in size. MRI does not replace mammography and should be used as an adjunct to mammography and physical exam"

Ok here's my thing, like I said my sister had breast cancer so did my mother, and neither of them had any reports from either mammogram or MRI that clearly stated that they thought it was cancer, my sister had DCIS, which this MRI says it does not detect.. so should I request that they do a biopsy if the surgeon does not suggest it? I am so worried that something will be overlooked until it is to late, my sister's cancer was DCIS and was caught early, but I don't want to be like my sister-in-law and not have it caught until it is to late. Thank you

Answer
Based on your mammography, ultrasound breast scan and MRI breast scan there is no lesion suspected of being malignant anywhere in your breasts. I think that biopsies are probably necessary in order for you to feel secure. Surgical biopsies of all possible sites are not possible. So I suggest that you have ultrasound or MRI guided needle biopsies or stereotactic needle biopsies based on your mammographies but discuss this with your surgeon. Good luck!



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