Expert: Claes-Gustaf Nordquist, M.D. - 2/9/2007

Question
Just wanted to let you know I saw another surgeon this morning for a 2nd opinion in regards to the shadowing on my breast u/s and need for bx.
He said he felt my surgeon ( the first dr I saw) was being reasonable to wait a month and if I had come to him originally, he would probably wait for 2 months. He said the shadowing only represented a possible increased density that was probably nothing to worry about. He only did a breast exam and reviewed the mammogram films ( which showed dense breasts).He has not seen the u/s pictures.
So, I guess I have no choice but to wait until Mar 1 when I have appt with the original surgeon for another u/s.He also explained that waiting is not going to make any difference even if it is a malignancy- which he said he seriously doubted.He did say if the shadowing persisted, then I did need a biopsy. But in his opinion, shadowing alone was nothing to worry about- especially with no family hx of breast cancer.
So, now I feel kind of stupid.He said the one thing they should have done differently is to explain things better to me- since I am a RN and could understand things better possibly then someone with no medical background.
I guess I am back to where I started. Any other suggestions? I appreciate all your help and patience in answering my questions. I will keep you posted.

Answer
No need for you to feel stupid! 1. Your first dr. SHOULD have explained his position better! 2. I - like I have said before - agree on the point that the time from a prognostic point of view, even should it be a cancer, really does not make any difference. I even agree on the point that a cancer is not very probable. BUT 3. I do NOT agree on the point of waiting being of no importance from the point of view of the patient! ANY UNNECESSARY waiting time (some waiting times can unfortunately not be avoided) should be avoided by all means! Very simply because it is a burden to the patient! And it can so easily be avoided in a case like this! A thin needle aspiration biopsy (check it with a Google search) done immediately after - or even during , guided by it - your ultrasound scan could have given you the information of this was something to worry about or not very quickly! Unfortunately such needle biopsies are still - after around 50 years of use in parts of Europe - not very common in the USA - except in some university centers. They do suffer from the "not invented here syndrome"! A former boss of mine, Professor Sixten Franzén, M.D., Ph.D. of the Royal Karolinska Institute and the Royal Karolinska University Hospital, Stockholm Sweden, was one of its developers. Well unfortunately you will in this situation probably have to wait. I have, I'm sorry to say, nothing better to suggest at the moment! If a biopsy is done it will probably be a surgical one too. That may be another reason why the needle biopsy has not become more popular in America. It is quick and it is cheap! No surgery! Good luck! Please do keep me posted!