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Category:

Breast Abnormalities and Other Symptoms

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Question:  #31 11/7/2009		Q:	In the middle of august I noticed a darker area of the areola on my left breast – looks like a bruise. It’s on the outer edge of the areola between 12:00 and 1:00 position. The area has almost doubled in size, comparable to the size and shape of a lima bean. I haven’t felt anything unusual until last week while I was in the shower. There is something unusual adjacent to the discolored area (between the 11:00 and 12:00 position of the areola), but I can’t tell if what I am feeling is an enlarged milk duct, normal breast tissue or something else. It’s also hard to tell if it’s fixed or movable. I only feel this while standing or sitting and not when I am lying down. I guess I have a two part question. 1) Should I be concerned since I only feel the lump while standing/sitting and not while I am lying down? 2) Should I be concerned about the discolored area? Sometimes I feel like I may over react to issues and I would hate waste my doctor’s time. I am 40, no chance of being pregnant, total hysterectomy 8 years ago. I have been on the hormone Evamist since February 2009. Thank you for your advise.
		A:	time to see the doctor and get some breast imaging studies done. not odd to only see or feel something when doing breast self exam standing (or only to feel something when lying down for that matter.) Make an appt this week. L
Question:  #32 11/7/2009		Q:	i had tram bilaterals in jan 07 rads in april 07 ,left breast has shrunk a vast ammount and fat necrosis,had fat injection 13 oct 09 to left breast to give bulk to match the rightbut it is still misshapen and smaller han the right. allso the crease line under each breast is not level the right seems lower down this breast hangs approx 1 inch lower than left,i am really traumatised by this what could be done to rectify plese need some info bfore i see my surgeon.this was all done on nhs as i had invasive lobular cancer
		A:	this is the downfall of radiation to a flap. we used to think it was not a problem but we've learned over time, 1-2 years, that it usually does shrink the flap reconstruction. so time to see a plastic surgeon familiar with correcting these problems. it might even require doing reconstruction again-- such as S-GAPS and taking down the tram flaps. if you want to come our way, and many many women do, just call 443-287-2778. we have done such "re-dos" before and certainly can help you. L
Question:  #33 11/7/2009		Q:	i am 43 and just had my first mammogram (digital). besides benign appearing calcification in both breasts there was indeterminate calcification in the left breast (mag mammo recommended) and ''multiple nodules'' in the right breast (spot/compression and u/s recommended). my quuestion is: is it usual to have ''multiple nodules'' in only one breast?
		A:	its not unusual. and given this is your first mammo, they will want to investigate everything thoroughtly to establish these images as your baseline films. glad you went. plan on going annually now. L
Question:  #34 11/1/2009		Q:	Due to a "probable" increase in clustered microcalcifications in one breast over a 6-month period, DCIS is suspected and a stereostatic biopsy has been recommended. I have since been reading about the high rate of false positives, the unknowns about when DCIS is truly problematic, and that the US - which opts for agressive actions - finds cancer in only only 20% of biopsies. Based on my reading, in Scandinavia, actions are more conservative. By the time they recommend biopsies, cancer is found in over 80% of biopsies. (Unfortunatley, survival rates were not included.) My question is what might the Scandinavians be looking for that gives them a higher assurance that cancer will be detected? If I know what to have monitored, I''d rather wait and see if signs of cancer become more sure.
		A:	easy, they are waiting for the tumor to be bigger, and for there probability for it to be invasive cancer by the time biopsy happens. not what would be recommended here but quite common for socialized medicine countries. there is not an issue with false positives. dcis is dcis. what i think you are questioning is that we don't know which patient's dcis would progress into invasive disease and be life threatening. that is research that still is in progress. the rate of biopsies positivity varies by institution. 20% is low. ours for example hovers between 35-40%. dcis, when isolated to one small area, is fairly easy to treat today with lumpectomy and radiation. additionally, if the calcs are plentiful, its not unusual to find invasive cells already there.
Question:  #35 11/1/2009		Q:	I am 50 and had my first mammogram last month. The findings needed more imaging. I went for further imaging which was a spot compression. Then more imaging was needed. My family physician thought this was not necessary because their report indicated that they wanted to investigate the nodes in the maxillary tail. When speaking with the radiologist he believed it would be a great idea because they did not have prior reference films to judge against. I fought for the ultrasound and got it. There were multiple masses and what looks to be several nodes. Radiologist said that a biopsy could be considered if I do not want to wait 6 months for further imaging. I feel that the sooner the better. You know the family physician would say no. What do the experts believe should be done with imaging and biopsies?
		A:	first time mammograms run a high incidence of needing to have more and more imaging done because there is nothing to compare these (first) images to. if they radiologist is expert in breast imaging and the images were captured as digital mammos then this provides the radiologist a lot more information than an anaolog mammogram (on films) and a radiologist who doesn't specialize just in breast imaging studies. if the bi-rad score is 3 then this means it is reasonable to wait 6 months. if it is a 4 however then this signifies the need for a biopsy.
Question:  #36 11/1/2009		Q:	HI..I WAS DX WITH STAGE 1 .6MM IDC WITH DCIS ALSO IN SAME BREAST . i HAD A BILATERAL MASTECTOMY FOLLOWED BY 6MOS CMF CHEMO DUE TO HIGH ONCOTYPE SCORE OF 30...DESPITE MY STAGE 1 ER PR + STATUS , NO NODES, I CANT GET THIS HIGH ONCOTYPE SCORE OUT OF MY MIND WITH REGARD TO FEAR OF RECURRANCE.I AM PRESENTLY ON TAMOXIFEN WITH THE ONLY SIDE EFFECT BEING HOT FLASHES. I AM 50 YRS OLD AND WAS DIAGNOSED AT AGE 48 ON NOV 2007...COMING UP ON 2 YEAR ANNIVERSARY. ANY THOUGHTS ON THIS HIGH ONCOTYPE SCORE YET SMALL TUMOR AND NEW STATS ON RECURRANCE BASED ON THIS HISTORY??? THANK YOU FOR YOUR WEBSITE AND FOR ANY INFORMATION THAT YOU CAN PROVIDE.
		A:	if you are coming up on your 2 year anniversary then you should be preparing to celebrate. risk of recurrence is its highest during the first 2 years. after that it drops down a lot. you were aggressive with your treatment--- bilateral mast, chemo, hormonal therapy. try to embrace life now and stop focusing on the number of "30". statistically the odds are in your favor now!
Question:  #37 11/1/2009		Q:	Had breast biopsy in Dec. of 2008 - negative however, in March 2009, incision area re-opened and has consistently re-opened since every 4 to 6 weeks. Original surgeon stated chronic mastitis (I am 53 yrs. old & in menopause). Went to another surgeon for 2nd opinion. Agreed with 1st. In August, he did surgery to remove inflamed tissue. It is continuing to re-open - I am at a loss as to what to do. It is frustrating, affecting my daily life - I am at my wit''s end - your thoughts?
		A:	oh my... that is frustrating. not sure there is a good solution. people either stay on antibiotics for many months, make sure they aren't diabetic that can impair wound healing and hang in there, or they take more drastic steps-- prophylactic mastectomy with reconstruction. if you want to come to us for a 3rd opinion you can. 443-287-2778. just let sheila know you had email correspondence with "Lillie" over the weekend.
Question:  #38 11/1/2009		Q:	Hi Lillie I completed chemo three years ago, can I take vitaming C now. Thanks
		A:	yes
Question:  #39 11/1/2009		Q:	im so sorry for so many questions. but ive waited so long to get to the bottom of this. that im trying not to leave anything out. my lab revealed that i had high grade dcis. but they were suppose to sent out for the re report.but over looked it. 3 weeks later. they are now saying that the tissue was to small to test anyways. how important is this er report. again thank you.
		A:	i'm not able to connect previous questions with new ones so am not sure what your original information was. I'll attempt to answer it based on what you have written at this time however. If someone has DCIS and it is a very small area, so small that it is hard to get receptor status, then sometimes another pathology dept at another institution who specialize in breast cancer can potentially do it using the tissue block. knowing the hormone receptors of dcis is important to determine if tamoxifen is needed for future prevention.
Question:  #40 11/1/2009		Q:	I ama47 years old female, still have my periods regular every month, but I notice like a month ago that my breasts are tender specially around the aerolas there is no discharge when I squeeze them,but the sensation is like I am pregnant,but I am not because I had my tubal ligation done 10 years ago and still got my periods every months. Is this some thing to be concern about or it might be something related with getting close to menopause? Thanks.
		A:	when we see this happening in someone and it is happening in both breasts it usually is due to hormonal changes. so your body is perhaps entering peri-menopause, or at least your breasts are!
Question:  #41 11/1/2009		Q:	I am a year out breast CA survivor (had radiation after). In August, I had a core biopsy with athypical hyperplasia with complications from the biopsy. I had to wait for healing and just had surgery the beginning of October. This path shows focal columnar cell change, small cysts with apocrine metaplasia, focal intraductal hyperplasia without atypia. I have been on Tamoxifen and they feel that is holding the cells where they are, but cannot put me on another med, bcause even though the body seems to have hit menopause, the labs have not. My original tumor was estrogen fed. Is it possible that my body is still pumping too much estrogen causing the abnormalities? Should I consider checking into BRCA1 & BRCA2 testing (mother had endometrial ca with mets to ovaries a year ago) and possibly be looking at ovary removal? Is it possible these cells are through both breasts and consideration should be given to bilateral mastectomy? The Tamoxifen has been messing with my stomach to the point that I have lost 13 pounds in the last year (down to 109), so they are now thinking we need to reconsider chemo - not what I want to do!! I''m just feeling a little over whelmed and frustrated. Sorry to ask so many issues in one, but they are all related. Thank you for your time.
		A:	it would not be unusual for atypical cells to still be in the breast tissue. after all, these cells are not cancer. they are a marker for predicting risk. you already have been diagnosed so this is no longer the red flag it would have been prior to your diagnosis some time ago. it would be very very unusual to look at doing chemo now, post radiation and being a year out. chemo is given in that manner. given you are premenopausal and your mother had uterine/ovarian cancer, you might want to meet with a genetics counselor and discuss this further. some women do opt to for ovarian suppression too (which doesn't require removal of ovaries but instead a shot to suppress them). then they go on an aromatase inhibitor if recommended by their oncologist.
Question:  #42 11/1/2009		Q:	My friend has done breast usg & have a report " One heterogeneous area noted in upper part of right breast in peri-areolar region at 12 o''clock position. Fibrodenosis changes". she has done an operation recently of lymphoma in axilla in both hands. is the usg report indicates any chance of breast cancer?? what is the report means?? waiting for ur kind reply...
		A:	the report implies that she has no abnormalities of concern. sounds like she is ready for some good luck to come her way too having had lymphoma. good for her that these are favorable results on her ulrasound.
Question:  #43 10/18/2009		Q:	I Had a blitlateral matectomy at 36, I am now 43. Had DCIS with no clear margins. 2 years after mastectomy I found a lump in the same area, pathology came back with ADH and microclacifcations. Dr''s said they could not remove all the breast tissue, but basically I am ok now. I have been is so much pain in the same area for years now, and the pain radiates down my arm. Dr''s said that is because I have had so many bx''s and because of the scar tissue. So I will learn to live with it. But,I just found a lump on my wrist 2 weeks ago, which is most likeley a gangular cyst. I just found another lump in the same area. Now I am bit nervous. I am going to schedule an appointment this week for a consult. Do you think an ultrasound of the lumps is something that I should insist on, and would not be unreasanable to request?
		A:	personally i've never seen breast cancer form as a lump on the lower arm. remember you can still get abnormal things like the rest of the world. getting breast cancer doesn't make us immuned to having other conditions. ganglion cysts are relatively easy to take care of too. have your family doctor look at our other new bump.
Question:  #44 10/18/2009		Q:	I am 45 years-old in a family with too much breast cancer. My mother was diagnosed at age 54 with Stage IV in 13 lymph nodes (she is a survivor!!). My sister was diagnosed at age 40 with extensive DCIS that required a masectomy. My paternal aunt and grandmother also had breast cancer. My sister and mother both had genetic testing and do not have "the gene". At age 19, I had a lump in my left armpit that was removed and found to be excess breast tissue. I have very dense breast tissue. About 1 1/2 years ago I had 3 lesions in my left breast which where biopsied and found to be benign. The breast surgeon I saw is a higly reputable breast surgeon. At that time, I also had a small lump in my right armpit. It was a little smaller than a quarter and it did fell a little hard in the center (but the hardness could be bone or cartalidge or whatever else is in your armpit) and sometimes a little tender. The breast surgeon examined it and said it was "nothing". This lump has grown much bigger now. I went for my routine mamogram and was called back for additonal views and ultrasound..though not for my breasts..but for this lump in the left axilla. The woman doing the follow up mammo, touched it and said it feels like "soft tissue". She did poke it a bit and it was tender at one spot (but I also think that could be from shaving over the lump??). I am not sure. The Dr. at the radiology office came in and told me I have a "lipo..something or other"..the word sounded longer than lipoma..but from his deion I think that''s what he was referring to..he said it''s a "fat" thing you can get in different areas of your body. But he said he saw something on the mammo, but can''t see it on the ultrasound...that I need and MRI of the left axilla area and probably a needle biopsy. I asked him how it could be that he couldn''t see it on the ultrasound, as I can see the thing looking in the mirrior..without an xray device! He just said they need to reconcile the mammo with the ultrasound and need the MRI and needle biopsy. I told him about the excess breast tissue in the other armpit when younger and he said it didn''t even occur to him that it could be breast tissue..that that is usually found in younger women. I was not concerned when I left there, thinking ..okay they are just being careful and thorough..they know it''s just a fat tumor and want to be safe. Well, now...of course..all kinds of things are running through my head. What could they possibly see on a mammo that would not show up on an ultrasound?? They said they wanted the ultrasound to confirme what they see on the mammo..but it didn''t. How could a lump so big not show up on an ultrasound? It''s visible to the eye..about 2 inches?? Does this sound like they are just being good Dr''s and playing this safe? Or is there any cause for me to be concerned? I do have an appointment with my breast surgeon but not for 2 weeks....is that okay to wait that long? Thanks for any feedback!!!
		A:	you are letting your brain think bad thoughts and should be thinking what you thought when you left the office-- that they are simply being thorough and that it is no big deal. sounds like a lipoma and they are confirming this. no one method of breast imaging tells all. if it did we would only use one method!! relax. don't lose sleep over this.
Question:  #45 10/17/2009		Q:	I am 55 yrs old and went for my mammogram the end of Sept. I have had them done for past 11 years. Mammogram said: Clinical Histroy, developing density upper outer quadrant left breast seen on mammo 9-22-09. Findings Computer aided detection(ImageChecker R2) was used in assessment of this mammmo. Spot magnification CC and MLO view performed as well as true lateral view left breast. The nodular density upper outer quadrant left breast persist on spot magnification. Portions of the margins appear smooth, although no discrete cyst visualized on followup ultrasound. The findings are suspicious for malignancy. There are no associated microcalcifications or architectural distortion. Bi-rads 4.Utrasound said:Possible intramammary lymph node 2o''clock 6cm from nipple measuring 7mm in length.Additional 5mm hypechoic area 3o''clock approx.11cm from nipple.No suspicious shadowing .The two structures have uncertain significance and do not likely represent patients mammograpic findings. What the heck does that all mean
		A:	kinda hard to guess without the ability to look at these films and examine you. so you might want to consider: coming to us or at a minimum sending your films to us for a second read. The mammogram implies there was concern this could be cancer. The ultrasound is less suspicious that it is though. I am wondering if the radiologist reading the images specializes just in breast imaging????? ask. Given the R2 device was used it makes me think he isn't an expert at breast imaging. our team is. that is what you now need. call 410-955-7288 and Sharon can arrange for your films to be re-read at our facility.
Question:  #46 10/17/2009		Q:	I had a 2.3 X 2.1 cm Invastive intermediate grade ductal carcinoma removed with lumpectomy. Moderate amount of associated DCIS. Margins free of invasive neoplasm with closest margin (anterior) 0.3cm and medial margin 0.4cm Focal microscopic DCIS present at (within 1mm) of medial margin. Re-excision with residual intermediate nuclear greade ductal carcinoma in situ. Dcis measure 2.7 X 0.5 cm in greatest margin No evidence of DCIS at new inked margin with in situ neoplasm 0.4cm from inked margin but microscopic DCIS present at apparent tapered edge of re-excision. Additonal Path: focal microscopic lobular carcinoma in situ. My question is stay course with chemo and radiation or request double mastectomy based on findings left breast.
		A:	doing more surgery doesn't get you out of doing chemotherapy or other systemic treatment. and doing more surgery doesn't increase survival either. picture the breast cancer being a dandelion in your front year. if a seed blew away and landed in your BACKyard you need to put down weedkiller to kill those dandelions before they blossom. you've already dug up the dandelion in your front yard and have dug it up by its roots. digging up your whole front yard does nothing to help you with seeds that are growing in the back yard.
Question:  #47 10/17/2009		Q:	what is superimposed fibroglandular elements
		A:	merely dense breast tissue. nothing of concern
Question:  #48 9/6/2009		Q:	Hi and Best Wishes: This is a follow-up regarding the question about the word "deion". Whenever you use a word such as des-c-r-i-p-tion, it comes out "deion" for security reasons, because the word s-c-r-i-p-t can cause problems. It comes up quite often in the questions and answers here. And thanks for the wonderful service you provide! :)
		A:	oh my goodness. i had no idea. thanks for letting me know.
Question:  #49 9/5/2009		Q:	Is it a common occurrence for breast cysts to increase or double in number (seen on 2 US done by the same operator - within a 3 week timeframe) in a woman when she''s in her mid 50''s? I thought that a few cysts may have been there for a while - but they seem to be multiplying quite quickly. I am not on any hormones and am post menopausal.My concern is, doesn''t it make it harder to see what is going on in the breast? I know that I need to check my breasts but I do not want to be running to the Dr every few weeks. What is the best approach to this please?
		A:	it is very common to have multiple cysts in the breast(s). the ability to see then on ultrasound is operator dependent, meaning who is holding the ultrasound device and pressing on your breast with it can result in sometimes seeing none, one, or several. I would not be concerned about having cysts. all women have cysts in their breast. they are benign fluid filled sacs. not a concern.
Question:  #50 9/5/2009		Q:	Hi, I am 37 and i had a lumpectomy in march 09. I was told it was benign. He said i would have to have a check up mammo every 3-6 months. I recently had my mammo and an ultrasound. I was a rad 4 with a mass within a mass and it is back in the same breast and in the same spot as the mass they took out before. The mass is in the left breast at the 9:0''clock position. I have a nipple discharge, nausea, weakness, itchy left breast, nipple change, tiredness, sharp pains in the left breast. What do you think all of this means? Do you think it could of been cancer the first time, because it is in the same place? Maybe they missed all of that before?
		A:	Gee, hard to say without seeing you. first review : 1. the pathology report and see if any words like atypia were used. 2. double check to see that there was verification by the surgeon and the radiologist that the correct area was excised in march 09. (this should have been called an open excisional biopsy and not a lumpectomy. lumpectomy by definition means cancer was removed. too many people misuse this term) 3. it sounds like another biopsy is needed. see if it can be done as a stereotactic or core biopsy in breast imaging and not by the surgeon. 4. nausea and weakness may be anxiety related. it would be highly unusual to have such symptoms from breast cancer within the breast.
Question:  #51 9/5/2009		Q:	Is it advisable to be tested for the BC gene if you have a family history of maternal grandmother and 2 of her siblings die of BC - (in their 60s)? So far, it has not shown up on my mother or her 2 sisters - can it skip a generation? Should they be tested, as they are now the same age?
		A:	ideally the person to be tested is someone who has had the diagnosis of breast cancer. if all of these women have passed away now however, then the next step is to see a genetics counselor and medical oncologist for an assessment to determine your genetic risk, then decide if you want to proceed with testing. it doesn't skip generations however not 100% of people who carry the gene get breast cancer (risk is 65-80%). so follow up on this. your family history is significant enough to pursue this.
Question:  #52 9/5/2009		Q:	Hello, Please tell me what Deion means? I see it being used throughout the forum, but I have no clue what it means.. Thanks.
		A:	Deion???????? i think you mean something else. recheck the spelling.
Question:  #53 9/5/2009		Q:	I am 46 years old no history of breast cancer, I have been going for mammograms since 35 since they said i WAS FIBRACYSTIC. well i went last month and they called me backed due to overlap in tissue, they said the good news was it turned out ot be nothing but th bad news is they see a perfectly white shadow at 6:00, so they immediately took me for an ultrasound and they said nothing showed up, now at that time they gave me a amnaul breast exam they found nothing neither did I, but they insisted on a sterostatic biopsy, well after many films they could not locate it so they brought me back for more spot compression films and after 10 more films they said it must be gone since they can''t find it, well on the 11th fim there it was again same as before. So they labled me birad 4 based on the fact they saw nothing last year there and said I need a core biopsy wire inserted next week, I spoke to my cancer surgeon and she reviewed everything and said my chances are 90 percnet that its benign but she would not tell me how she came to that conclusion.. so in the meantime last night since my period is very much over, I felt that area at 6:00 and I felt a lump,, its movable and squishy but its there i can take 2 fingers and kind of slide it around,,, but its exactly at 6:00, but yet remember nothing showed on ultrasound so what is it?... by the way that round thing they saw on the mamogran was not spiculated or has any calcifications around it , she told me that.... so based on this what could it possibly be,, are my odds since 90 percent or after finding the lump are they higher? I need to know what to prepare for since I am not eating or sleeping very well,, thank you so much for reading this for me --I will tell them on 9-9-09 that I feel the lump now so they can feel it too before they do anything - they will msot likely still want to biopsy it though,,,,,also please spare nothing let me know if this is a type of cancer I could still have ... thanks again
		A:	don't sweat over this and don't lose sleep. you were already told that there is a 90% chance it is nothing of concern. based on deion i agree. there is no need to panic. (and please only post your questions in one category. multiple postings of the same question can result in the question not be reponded to at all since they all need to be deleted.)
Question:  #54 9/5/2009		Q:	My 20 yr. old daughter has had a pain on an area on one breast, a feeling that she describes as a "pinch". The feeling has been there for about 4 months now and hasn''t gone away, although it tends to heighten with feeling leading up to her period. Her GP has given her an exam, felt no lump, and she has had a normal ultrasound of the area. My daughter has never been genetically tested, but I am BRCA1+, already had b/c in my 50''s. She has very dense breasts and as I understand, a mammogram won''t be of much good, may even expose her to unnecessary radiation at an early age. What would be a means of diagnosis in this situation? I worry about the length of time that she''s had this pain...wouldn''t a cyst be gone by now if that''s what it is? Thanks!
		A:	ultrasound and MRI would the way to evaluate and diagnose an abnormality. so pursue that with her and make sure she is in the hands of high risk specialists given your genetic history.
Question:  #55 9/5/2009		Q:	My lumpectomy breast surgery on 08/07/09 showed invasive ductal carcinoma, 0.8mm, with no lymph node involvement (Stage 1) Eight hours after surgery I had emergency surgery for a hematoma and internal bleeding. I continue to be in pain since the initial difficult large core biopsy on 7/21/ 09. Soon after my drain was removed at two weeks post surgery- 70cc of serous fluid was removed. I am now 1 month post-surgery and I have a very large red, warm, hard, swollen area below the incision. My breast has pitting, orange peel effect and the nipple area is very sensitive and shows flattening.I do not have a fever. The oncologist gave me antibiotics indicating that I should follow-up with the surgeon. There is no change after 3 days of antibiotics and it appears worse. Can inflammatory breast cancer occur soon after lumpectomy surgery?
		A:	personally i haven't ever seen inflammatory breast cancer daignosed right after a lumpectomy. this still sounds like infection or inflammation from the surgery and the repeat surgery that took place. you need to return to the surgeon this coming week.
Question:  #56 9/5/2009		Q:	what does the notation on my lab mean that reads: AJCC pTNM Stage (6th ED): pT1b pNO (sn) pMX
		A:	AJCC is staging 6th edition is referring to the breast cancer staging chart that factors in diameter of the invasive tumor, if cancer is in the nodes and how many, and whether there was any metastatic disease in other organs found through biopsing these organs. you have a stage 1 breast cancer. early diagnosis. if you want to look at the staging charts go to www.nccn.org
Question:  #57 9/5/2009		Q:	Hi, I am a 46 yo. whose mother died at 46 from breast CA (tyoe unknown).I , also had a hysterectomy at 29 and have been on HRT since.I had a mammogram in Feb, that was irregular and repeated in August. Here are the results of the mammogram. CC view shows persistence of irregular a symmetry centrally in right breast. It''s appearance is very similar to 2/20/09, but the appearance has changed since 2007. The MLO view shows an asymmetry in the upper central portion of the right breast, but is unchanged since 2006. Impression: Persistent asymmetry in the central portion of the right breast, but visible only in the CC projection.However, findings are suspicious of possible infiltrating or lobular carcinoma, given the change in the CC appearance since the previous years. Recommend MRI. I had an MRI done and here are the results of that. There has been an area of asymmetry in the deep tissues of the right breast on the CC view which appears slightly increased in density compared to prior exams. It is noted that the area does appear somewhat similar to prior exam. No change in MLO views. A focus of increased density in the upper aspect of the right breast in the mediolateral oblique view is similar to 2006 but is more prominent that 2005. T1 weighted images reveal scattered fibroglandular elements. T2 weighted images do not reveal a prominent cyst. There are multiple foci of enchancement bilaterally, the largest measuring 4 mm. This can be seen with adenosis or intrammammary lymph nodes, but is unlikely significant.The axial vibrant infusion images which are delayed demonstrate focal confluence, non-mass like enhancement in the lateral aspect of the right breast. Because no abnormality is seen on the dynamic sagittal images, it is most likely confluent fibrglandular tissue. Impression: Probably benign findings. No definite MR finding to correspond to recent mammogram. Overall small foci of enhancement, probably benign. Repeat mammogram in 6 months. Here are my questions. 1. Should I be worried? 2. Should I go off my HRT, just to be safe? 3. Should I be tested for the breast cancer gene? 4. Should I get a second opinion? My surgeon said, not to worry, but with my mom, they kept putting things off and she eventually got breast CA( she had a lot of cysts) and it makes me nervous. Thank you for your time.
		A:	1. the changes are subtle but worth a second look in the form of a second reading of these images by another breast radiologists. 2. yes. you are at higher risk of getting breast cancer by staying on them 3. go get genetic counseling first, and consider testing. 4. yes
Question:  #58 9/5/2009		Q:	I just had my annual mammo (now back to yearly) and they found a lesion on ultrasound birads 4 (breast specialist said do to my history of bc and that its new to have a biosy). The report didnt say much except that the lesion appears more prominent and more complex then before 1.2x0.7x0.9cm and appears predominantly solid though there is now a cystic component. I have a history of a papilloma and fibroadenoma in same area that i been able to feel. I saw the lesion it was a round circumscribed lesion that had what looked like a half moon shape cystic section on the left side and part of the bottom of the lesion. I had the biopsy it was begin with no hyperplasia I dont hv the path report yet.I was wondering how it cld be begin the rad. thought it was most likely cancer. Have you seen these types of complex lesions and what have been the outcomes now and in the long run. Would love to have the whole 11:00 upper inner breast area removed but breast surgeon said she doesnt want to start removing alot of areas do to it wil make it hard to see on mammos ( I already have extremely dense breasts). Oh they did a core needle biopsy on the solid partabt 3-5 cores and left a clip.
		A:	a fibroadenoma can be felt. a papilloma cannot. way too tiny. minute in size really. that said, without the path report its hard to comment. whatever it is, it is small. there are complex cysts that are part solid and part liquid. that may be what this is.
Question:  #59 9/4/2009		Q:	After a mastectomy (2 years ago) I have a very small noduel near the scar -- have consulted with my surgeon and last week he said wait a couple of weeks, come back to see me, if still there we''ll biopsy. If it is positive, it may be RCW as detailed in your recent Artemis. How is Recurrent Chest Wall breast cancer treated at JH? Treatment/surgery? Prognosis and life expectancy?
		A:	sometimes it can be resected. other times it is treated with radiation for local control and consideration for systemic treatment is also part of the evaluation. many factors here. if reconstruction was done or not; of radiation was previously done. if it has the same prognostic factors as the original tumor and can be confirmed it is a recurrence of the original disease. what the prognostic factors are. what stage the original disease was and what kind it was. how old you are. when its a tiny spot it obviously is easier to manage than a larger area.
Question:  #60 8/30/2009		Q:	Lillie, I had double mast in Feb 09 for stage IIb, er pr 3+ pos breast ca (2.5mm sent node). (age 49) FInished ACT late June. My gyn recently did gene testing and I was stunned to find out that I tested positive for brca2. My mother was diagnosed with breast ca at age 72. She was the only relative with breast ca, no one in family has had ovarian cancer. Now I am definately having oophorectomy. Is it true that risk of ovarian ca for brca2 is about 25%? Isn''t the risk higher for brca1? Also, how much more of a risk is there for pancreatic ca and melanoma with the brca2 mutation?
		A:	well, sure am glad you went ahead and got tested. surprising that you were positive. wow. risk is elevated for both BRCA 1 and 2 genes for women to develop ovarian cancer. risk ranges from 25-40%. so you are doing the right thing in getting ovaries (and fallopian tubes) out. this also will help reduce your risk of breast cancer returning too given you were hormone receptor positive. L