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Category:

Breast Imaging

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Question:  #1591 02/19/2003		Q:	what percentage of breast cancers do mammograms miss? What percentage of invasive breast cancer (lymph node involvement) are able to be cured?
		A:	85% of women diagnosed today with breast cancer, invasive disease, will be long term survivors. if you look at survival charts by stage you will see some variance associated with size of tumor and number of nodes involved. The more nodal involvement the more concerning sometimes. Mammograms can miss cancer as much as 30% of the time-- this is for 2 reasons-- density of breast tissue looks white on a film and tumors are also white so we are looking for the polar bear in the snow storm and can't see it; the other is who is reading the mammograms. if a general radiologist is reading the films he/she will miss a tumor that is there as much as 35% of the time-- this has been statistically studied
Question:  #1592 02/19/2003		Q:	I had a small lump discovered a little over a year ago. The doctor at the time said it was benign. I follwed up six months after and about nine months later. Now it has been discovered that it has become larger in size and I am in the process of setting up the biopsy in the comming weeks. If the mass has become larger it is most likely cancer?
		A:	Noy necessarily,though it is a concern. There are other factors that the doctor will also consider in evaluating it prior to biopsy- its shape is an indicator of its probability of being cancer too. Remember that 80% of the time biopsies are negative from cancer. we will hope you fall into the 80%. I'm assuming that this will be a stereotactic (core) biopsy so that you don't have to have an excisional biopsy unless absolutley necessary.
Question:  #1593 02/11/2003		Q:	I felt a lump in my right breast about two months ago and went to my doctor two weeks ago. The lump is about the size of a marble, maybe a little larger. She sent me to get a mammogram and then an ultrasound. The mammogram came back normal. The technician doing the ultrasound said she could not locate the cyst and after two minutes showed the images she had taken to her supervisor and said it was normal. It has been a couple of weeks now and the lump has not gone away or reduced in size. Should I follow up on this or insist on having a biopsy? I also have fibroids in my uterus, can this be related? Thank you.
		A:	you need to follow up on it because the origin of this lump remains unknown. Fibroids in the uterus are unrelated to lumps in the breast. Pursue it so you know what this mass is... hopefully something benign, but until you know it remains a worry
Question:  #1594 02/11/2003		Q:	I am a 36 year old female and in Sept. of last year noticed a real dark green and pus looking liquid coming from several ducts in the right breast nipple.. Went to M.D. was check for all types of conditions all the way to find out if there were a brain tumor which there is not... In the beginning I did have a high prolactin level, but was ok later when tested again. Hormone level was normal as well. This leakage went on for months as well, I had found a lump aprox. 4 to 5 months earlier and kept watch on it which it was getting larger... My M.D. suggested to go to see a Surgeon which I did and then had a byopsy which was non-cancerous... The Surgeon expained that she would remv. all milk duct's and the conclusion of the operation. When I went back to my first visit after surgery and was told that the leakage would stop in about two weeks... Well, surgery was in Nov. 2002 and the green liquid and today a little bit of blood is still coming out. I was treated again w/two strong antibiotics to try and clear this up and has not. Now my surgeon is telling me I will have to a mastectomy to fix the problem. Is this so or is there anything that can be done? Please let me know something in regards to this. Thank You,
		A:	Time for a second opinion with a breast surgeon to see if this is really necessary-- ie, mastectomy. Mastectomy is a drastic step so get another opinion at a comprehensive breast center.
Question:  #1595 02/04/2003		Q:	I recently had a breast ultra sound done due to a pain in my right breast. I was told I have fibroidenoma (5mm sized nodule)and was asked to return in six months to monitor its growth. What is fibroidenoma? Do I eventually have to get it removed?
		A:	it is spelled "fibroadenoma" and means you have a benign mass in the breast. they are quite common. The need to remove it or not is based usually on location, if it is causing symptoms (ie, pain for example) and if it blocks the view of other parts of the breast for imaging purposes.
Question:  #1596 02/04/2003		Q:	Can you please tell us a bit about radiation-free clinical thermography as a breast cancer screening tool or whether thermogrpahy can provide information about breast cancer prognosis? Please note that some new approaches aslo involve neural network software and thus may be substantially better than the 1970's version.
		A:	Go to our electronic medical journal, Artemis, and use the search feature there-- www.hopkinsmedicine.org/breastcenter/artemis type in "thermography" and I believe an abstract on that subject will pop up for you. We are not using it here to provide you any information about our experience...
Question:  #1597 01/31/2003		Q:	My Grandaughter has a Fibridenoma. What is this condidtion? I have never heard of it before.?
		A:	It would be a "fibroadenoma." This is a benign mass in the breast... very common. Glad that it isn't cancer! thanks for worrying about her as a loving granddaughter should.
Question:  #1598 01/29/2003		Q:	I have had yearly mammograms since age 36 and they were always read as numerous microcalcifications and very dense breast tissue. On 11-29-01 my mammogram was read as normal. On 3-10-02 I felt a lump and had an ultrasound and biopsy which showed invasive carcinoma with positive lymph nodes. I have read that if breast tissue is dense they can often find cancer by doing an ultrasound not picked up by mammogram alone. Why didn't they suggest an ultrasound be done with the dense breast tissue I have had for years. Sounds to me that they aren't really doing all the tests they could and not giving a woman the option to have an ultrasound even if insurance doesn't automatically pay for it. Now that I have had breast cancer, I still have to demand to have an ultrasound for my own peace of mind.
		A:	Not sure why ultrasound wasn't used previous years for you. You'd need to ask them... Right now you are angry, and understandably so, that you have now been diagnosed and question how long it has really been there. For now, don't spend your energy on being frustrated with it-- you can't change the past-- focus on what you need to do to get well going forward. You can pursue your concerns about appropriateness of care after your treatment is behind you. We wish you well dear.
Question:  #1599 01/24/2003		Q:	I had a mass biopsied 18 months ago on my right breast and it was a fibroadenoma and there was a fluid filled cyst that had blood in it. I was told they were benign with some hyperplasia in the fibroadenoma and calcifications. There was not enough cells available from the cyst to tell much and I have since read that they should also check cells around any blood filled cyst so could use your opinion on that too. I had another ultrasound last week and they put in their report: The previously noted hypoechoic mass is, again, seen. However is appears smaller from the prior exam measuring 4x4x4mm (measured at 7x5x8mm on 6/5/01. Now is a hypoechoic mass the same as a fibroidenoma? What should I be asking my breast surgeon when I see her. Should I have this biopsied? I did have DCIS high grade in the other breast 3 years ago and had lumpectomy and rads with no further treatment. My mother died of breast cancer at the age of 38. I am 48.
		A:	Usually bloody fluid aspirated from a cyst is sent for pathology to rule out abnormal cells, especially with someone with a personal history of breast cancer. The area in question could be a fibroadenoma or even a cyst or something else. It seems worth exploring further given your history. Your doctor will probably recommend biopsy and probable removal to provide a definitive diagnosis.
Question:  #1600 01/24/2003		Q:	They found "something unusual " on the nipple of my left during amammogram. They called me back to do a "cold com pression" check. What is this and is it painful. Someone said it was a compression of the breast very tightly. Is this true and what does the cold mean? I have some moles underside of the breast and the last time they asked me about them. This time they did not. Do you think this is on my record or should they have asked again?
		A:	First, be sure to point out the moles you mentioned in your email post to me as these will appear on a mammogram and can look like trouble when they aren't! They plan to do some spot films of the area in question and will compress your breast as before, possibly using the same amount of pressure or maybe slightly more-- a good mammogram requires compression to flatten the tissue and make it as thin as possible to see what is inside. These films are enlargements of the area that they want to visualize in more detail. For women who have tender breasts and don't deal well with compression, taking tylenol 1 hour beforehand usually helps.
Question:  #1601 01/16/2003		Q:	I was told that I have a fibroadenoma the surgeon wants to remove it. I mentioned, in passing, that I wanted to have a breast lift done. The surgeon seemed to jump at the idea and said the procedures could all be done at the same time. Is this routine? Complicating the matter, I am also brestfeeding. The plastic surgeon wants to wait 3 months after I stop breastfeeding.This will delay the surgery. Is it ok that I wait noting that the breast surgeon believes (of course she does not know) that the lump is begnin. Is this long enough? Will all the milk be gone or at least "gone" enough to get good results in a breast lift?
		A:	It is usually best to wait several months after completion of breast feeding before operating on breast tissue otherwise a healing problem can result. The doctor can usually tell if it is benign or malignant based on its shape and contour on mammogram and ultrasound but it is also true that a definitive diagnosis isn't possible unless a fine needle biopsy or actual removal of the mass is done. Waiting sounds reasonable given the circumstances but you may want to have a second radiologist read the mammograms and ultrasounds to agree that this is clearly a benign mass and nothing more than that.
Question:  #1602 01/13/2003		Q:	I recently underwent a needle localization biopsy. All went well, and I will get the results in 4 days. I had a tiny cluster of calcifications removed. They were very posterior in the breast. Before the needle was placed, a mammogram was taken. The radiologist, while preparing to insert the needle, was reviewing the new mammogram. She said "Looks like they moved down. That's good." The technician agreed. I should have questioned it at the time, but I was too focused on what was going on. I assume she was referring to the calcifications?? If they moved down, why is that good? If I may ask a non- BC question please - I really like my breast surgeon and would like to give her flowers when I next visit her. Do you think this would be appropriate? Thank you.
		A:	Not sure what the individual meant by saying that they "moved down"--- calcifications don't move around in the breast-- they stay put! so ask her what she meant by this so you have clarification. Bringing or sending flowers to your breast surgeon is a lovely thing to do and no doubt will be appreciated.
Question:  #1603 01/09/2003		Q:	After many mammogram views the Radiologist informed me that he was having a hard time determining whether the calcifications that he was seeing were on the skin or in the breast. He did see some on the breast, but another group was not clear. He does believe they are in the breast. This same group was evident on my mammogram in 1997, although no one told me about them until now. He said they haven't changed much, and in fact could be due to better imaging since 1997. I know the medical community likes to put the best spin on things, but I'd like to know if this is really a possibility. I do intend to proceed with a biopsy.
		A:	When calcifications are seen and are followed over time and found to be stable-- unchanged--- this is a good sign that they are probably just calcium deposits. -- a common finding in breast tissue. From 1997 to 2003 is a long time and this raises the confidence even higher that they are benign in nature if unchanged or even diminished.
Question:  #1604 01/13/2003		Q:	Could you explain the BI-RADS categories for mammograms. What does each category tell the Doctor.
		A:	if you visit this website address you will see the information listed by category for you. http://www.ehendrick.org/healthy/00055990.html
Question:  #1605 01/07/2003		Q:	My sister had her first mammogram, which came back suspicious. She was then sent for a sonogram. Today she received a letter stating that the results of the sonogram showed positive abnormalties, and she should make an appointment with her doctor at her earliest convenience, to discuss the results. She will be 40 yrs old next month. Our mother died of breast cancer 11 years ago this month. What does positive abnormalties mean? Is this a polite way to say breast cancer in a letter? We are all very scared.
		A:	it probably means that her xrays looked suspicious enough that she needs follow up and probable biopsy. A definitive diagnosis of any kind can't be made without tissue being sampled and evaluated by a pathologist. If it is cancer hopefully it has been caught early and she won't follow in her mother's footsteps but instead become a long term survivor..
Question:  #1606 01/07/2003		Q:	I'm 25 years old, a couple of years a go while exercising with a 45 pound weight I felt like I injured mysefl. Next day I had a big lump. I check it every day and actually instead of growing It got smaller. But now I fownd another lump (now I have two). I went to the doctor and had a mamogram. The technitian that helped me called a doctor to see the result of my mamogram. The doctor told me after seeing the screen thath I have to se a surjeon. Does that mean that I have to have surjery or that something is really wrong? Thanks
		A:	It doesn't necesarily mean surgery but does mean that the doctor wants you evaluated by a surgeon to see if it would be wise to surgically remove the lump(s) or to leave them there. Hopefully a full diagnostic mammogram including an ultrasound was done to provide the doctors all the information they will need in making this decision.
Question:  #1607 01/07/2003		Q:	I stopped breast feeding 4 months ago, I started to have a pressure feeling in one breast then a week later noticed small spots of clear fluid on my t-shirt A week later the other breast started to leak during the night. The discomfort is increasing, I saw my doctor, he said I may still be lactating but my prolactin levels are normal. Should I request an ultra sound? "Also on exam the breast tissue felt normal, with increased tissue under my arm" Could this be cancer?
		A:	even with normal prolactin levels your breasts cancer still be producing milk. For some women, it can take as long as 9 months for the milk to dry up.Avoid stimulating the breasts (squeezing the nipple or expressing milk) as this will only keep the milk flowing. Give it more time and if not resolved in another 3 months then request a diagnostic evaluation in breast imaging. (congrats on the baby too!)
Question:  #1608 01/07/2003		Q:	I had my first baseline mammogram at age 37. I returned at ages 38 and 39 for screening mammograms because I was told my breasts were cystic and dense. I am now age 40 and in this particular year I had to undergo a diagnostic mammogram of my right breast in October due to pain, my yearly screening mammogram of both breasts at age 40 (alot of views were taken because my breasts are very large) and for a spot compression of my left breast in December because a small well defined 3mm nodule was found on the left breast. This turned out to be a skin tag. My concern now is how much radiation have I been exposed to in such a short period of time? I've read that having yearly screening mammograms prior to age 50 are more dangerous and your risks of getting cancer from the radiation are increased. Have I gotten too many mammograms this far and are they safe? Your prompt reply is greatly appreciated.
		A:	you are fine. rest easy. You actually get more radiation driving around in your car each day than you have gotten getting mammograms. your mammograms were done for a good reason. you are not increasing your risk of breast cancer having had these films now taken. continue with annual mammograms and feel confident you have done the right thing
Question:  #1609 01/01/2003		Q:	Is pain killer given for the stereotactic breast xray?
		A:	yes, for stereotactic BIOPSY (you typed xray)usually local anesthetic in the form of lidocaine. For a standard mammogram xray though, the answer is no. If breasts are especially sensitive then women usually take tylenol an hour before their appointment time.
Question:  #1610 01/01/2003		Q:	I had my mammography in November 2002. Three days later, I had a letter from the facility to come back for another viewing which I did.. The result was I had calcifications on my left breast but they were found benign and asked for me to come back in 6 months. My gynecologist read the results and recommend for me to go to a surgeon. Do I really have to see a surgeon and what is he going to do? Pls help because this is kind of worrying me too much.
		A:	Seeing a surgeon isn't necessarily the answer-- getting your films read by another mammographer who specializes in breast imaging would be wise though. The purpose is to get 2 opinions that these calcs appear benign. A surgeon would feel obligated to operate on you which may be unnecessary.. if they look suspicious, pursue a stereotactic biopsy in a breast imaging setting that gives you the answer without an incision or operation.
Question:  #1611 12/30/2002		Q:	After a second mammogram I was told that I would have to have a steriotactic biopsy. On the mamogram it showed a cluster of sharp white spots, maybe 4 or 5. I am told that I need to be referred to a surgeon before having the procedure done. Is this routine, and does this sound like it is cancerous?
		A:	usually the "routine" is to have a stereotactic biopsy done in a breast imaging setting by a radiologist who specializes in breast imaging. Then based on the pathology results a decision is made it you need a surgeon or not after that (ie, evidence of cancer).
Question:  #1612 12/26/2002		Q:	I am 49, and had my normal gynecological exam in November, including breast exam. My gynecologist told me it was time for my annual mammogram, but when I tried to make an appointment was told the wait time was 3 months for screening; only 1 month for diagnostic. The nurse was able to call in and request diagnostic, so I had the mammogram in early December. It did not show anything, nor were there changes from the prior year...but because I'd been sent for a diagnostic mammogram, they decided to use sonography and found an ovoid, isodense mass just under 1 cm in all dimensions, with sharply-defined edges. Not irregular in any sonogram view. The radiologist put it in category 4 and recommended needle aspiration (which did not show fluid) or biopsy. The surgeon I was referred to recommends (and would only do) excisional biopsy, but I would prefer a less invasive procedure given the odds of malignancy are small. I assume it's time for a second opinion by a qualified radiologist and/or surgeon. Your opinion?
		A:	yep you are right. you need those films re-reviewed by a radiologist who specializes in breast imaging. A stereotactic biopsy should be doable, leaving no incision and virtually no scarring inside the breast so check in your area for mammographers who provide this expertise.
Question:  #1613 12/23/2002		Q:	i was sent for a mammogram, then sent for an ultra sound as a couple of things showed on the x-ray, the ultrasound indicated a larger dark mask, with couple smaller ones, the doctor says they are cysts but wants me to have another ultrasound in the next couple of weeks. Why would a 2nd ultrasound be required.
		A:	hhmm. not sure. Another option is to have the cysts aspirated in ultrasound-- then the worry with them is gone because they are gone! The give you local anesthetic then insert a needle and pull back on the plunger to evacuate the cyst-- you can watch it yourself on the computer screen as it literally empties and seals closed on itself.
Question:  #1614 12/16/2002		Q:	About six months ago I had two complex cysts removed from my right breast. Since then I've had one problem after another. I've had clogged ducts that present themselves around the outer edge of the nipple. As soon as my doctor removes one, another will appear in the same location. At this time I have three knots. One that is very painful and very red. I was already taking medication for infection when this one came up a few days ago. While the doctor was examing me he found one I hadn't even noticed. He has recommened removing all the ducts in my right breast or just keep coming back to him everytime one appears. Which is about every two weeks. He has sent me for another mammogram and ultasound. It's almost as if my breast won't heal from the first surgery. I would like to know what you think and what all is involved with having all ducts removed. Thank you.
		A:	you need a second opinion-- a formal one where the doctor who specializes in breast disorders can physically examine you and determine the best course of action. to remove all the ducts frankly would mean a mastectomy. so seek a second opinion at a large teaching hospital that has a breast center as one of its components.
Question:  #1615 04/04/2003		Q:	Several times at my mammogram facility, the tech has retaken images during a screening mammogram due to having my eyeglasses or hair on the head (short hair style) included in the image. Is it normal to get the head involved in the image? Can the radiation in a mammogram be injurious to the eye?
		A:	Frequently when patients are tall or very petite, positioning the patients can be somewhat complicated. In attempts to displace the fatty breast tissue away from the anterior chest wall, a patient’s height which does not fall within the population norm may be forced to stand with her chest forward in attempts to place her breast at the level of the compression table. This requires the patient to bend at the waist projecting her butt out in an exaggerated fashion. Depending upon the patients height she may even be asked to keep her knees bent. This highly awkward position naturally results in flexion of the cervical spine placing the patients head directly within the field of view. In my experience this occurs most commonly on attempting to obtain adequate separation from the chest wall on cranial-caudal projections. Although the patient is instructed to attempt maximum extension of her cervical spine, some patients are unable to maintain this posture without excessive motion. Another quite common scenario is the arthritic patient or frail/weak patient who does not possess the range of motion within the cervical spine required to extend the neck far enough to get their head out of the beam path. Given this is obviously a persistent and thus annual problem for patients of heights not within the population norm and the more frail patient, may I suggest these patients inquire of their prospective mammography site if they have wheelchair accessible mammographic equipment. This will allow a tall woman to sit and have her mammogram performed. This same equipment may be adapted for a petite woman. Alternatively a petite woman should request a stepping stool to achieve a more comfortable position on a standard height mammographic camera.
Question:  #1616 11/28/2002		Q:	I am 39 and recently found a lump in my breast. My doctor examined me and suggested I wait an entire cycle to see if it was hormone related. The lump did go down quite a bit but not completely gone. I was sent for a sonogram exam. The sonogram showed nothing. I am not being sent to a surgeon. I am wondering why the sonogram didn't see anything and what could that mean. What kind of exam should I expect from the surgeon?
		A:	Ultraound and mammograms are not 100% guaranteed to see what if going on inside the breast... If a mammogram wasn't done it should be (you only mentioned ultrasound). A surgeon should do a clinical breast exam and talk with you about what changes you felt in the lump as you went through your full cycle as hormonal changes can cause changes in the breast tissue. He may also order an MRI to evaluate the lump and if he can feel it possibly do a fine needle aspiration of it to take a few cells to see what it is.
Question:  #1617 11/26/2002		Q:	What is MIRA LUMA imaging? How does it differ diagnostically from MRI, MRI with contrast, and US?
		A:	Mira Luma is also known as mammoscintigraphy. It is another method of lookng at breast tissue but has lost its popularity in the last few years, now that breast MR is available. It doesn't identify tumors as clearly as MR does. MRI can be done with contrast dye or without it, depending on the doctor's preference. US is merely ultrasounding the breast to look at objects and differentiate solid from liquid masses.
Question:  #1618 11/24/2002		Q:	I have microcalcification in both breast. I was told that this could be normal for me.I'm due to have another mammogram next week but was wondering if it does turn out to be normal for me ,what would cause all these spots?They thought I was wearing powder there were so many.
		A:	the body naturally has calcium in it-- everywhere--- including in breast tissue. About 80% of women will have some degree of calcs like this show up on mammograms at some point in time. the key is to watch to see if they change in shape, size, or start clustering together.
Question:  #1619 11/17/2002		Q:	I went to my Dr. because of discomfort and discolored left breast nipple. My mammogram came back abnormal so now I have to get a mammogram. This is the same breast I had aspirated about two years ago. My breast nipple feels like it is constantly burning. What might this be?
		A:	not sure... you need a good clinical breast examination and a diagnostic evaluation including mammogram, spot films in mammography and ultrasound to answer this question.
Question:  #1620 11/17/2002		Q:	My yearly mammogram report impression was "new right breast calcifications. Recommend additional views". The impression on the additional views was "benign calcifications. Six month follow-up is recommended". The finding mentioned probable layering of milk of calcium on the 90 degree lateral view. What does all of this mean?
		A:	calcifications can either be calcium deposits, as they believe yours are, or early stage cancer. they determine this by looking at their shape, pattern, location and history of others seen on previous mammograms. It is good news for you!