Expert: Claes-Gustaf Nordquist, M.D. - 10/9/2006

Question
I am a 40 yr. old woman that has recently had a second mammo due to lumps in my underarm and what my dr. and I thought was a breast mass.  Although the tests (ultrasound and diagnostic mammo) showed these areas to be fine, the mammo showed something else.... breast calcifications.  I have many "specks" through out my breasts, but one cluster.  My mammo results were a Bi-Rad rating of 3 on a scale of 0 to 6.  The rating of three is noted as .....probably benign, on a microcalcification they saw in the upper outer left breast.  Although they say there is a 98% chance that this 'fairly tightly cluster" is benign, I don't like having ANY chance of cancer (even if it is only 2%).  PLUS, they noted in my results that "The very dense nature of the patient's breast parenchyma can obscure abnormalities".  This also isn't very positive. So I went for a biopsy on Friday 10/6/06 to finally ease my mind and find out for sure whether or not the spot is benign, but they were unable to do it based on it's location and the trouble they had getting all the correct views to locate it and biopsy it.  It is apparently in a very thin area above my breast, close to the skin surface AND the chest wall.  There were muscle and other tissues obstructing the views.  I am now being told that it is completely up to me to either wait 6 months to get a new mammo, to show if the stability of the area is ok or if it changes, or have a breast surgeon remove the area in question.  My concern is that no matter if it changes or not, it was there 3 yrs. ago but they didn't know that then, only know it now since they had a new mammo to compare it to.  It is more prominant now than it was 3 yrs. ago, which is another reason why I am  concerned.  I am also concerned because if I wait for another mammo, I am just going to go through the same "not knowing" again in six months based on the location and the inability of the radiology staff to biopsy it.  So, to reiterate..... I am being told my only options are to wait (again, I would just go through the same predicaments again of not being able to get a biopsy and the ongoing worry til March '07), or have a breast surgeon remove the area.  And since my mom did have some type of cancer in her uterous years ago, everyone I talk to is suggesting I go through with the surgery.  I am just very concerned, even more now than I was before the biopsy attempt, since I have no way of knowing if it is benign or not.  Can you let me know what YOU would do?  I am being told by some people to go to an actual breast surgeon and have them give me a second opinion.  A friend of the family has recommended a woman breast surgeon to contact.  Please let me know your thoughts.  Thanks.

Answer
1. Since you have dense breasts your x-ray mammograms SHOULD be complemented with a. breast MRI scans, b. breast ultrasound scans! Apart from that this lesion since it CAN be seen calcifications and all on a mammogram SHOULD be reachable with a mammography guided stereotactic thin needle aspiration biopsy! That should be able to tell if there is anything malignant there! Only if such a biopsy (can be done on an outpatient basis) is unclear will a surgical biopsy be necessary! Good luck! So no waiting should be necessary!