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Diagnostic mammogram's and other breast imaging questions.
|Asked||Publicly Submitted Question|
|5/6/2012||Hi, I was diagnosed about 10 months ago with IDC, 1.8cm, grade 3, triple negative, no node involvement. I'm 33. I had a lumpectomy and a SNB, chemo, and just finished radiation. I felt a lump on my 'good' breast so got referred for an ultrasound. The radiologist said it was a lymph node, but they found another mass that I wasn't aware of. It's not fluid filled, so I'm going back for a core needle biopsy. I had an MRI last year and I remember a comment that I had a couple of bilateral benign cysts, but I've no idea if this could be what they saw.|
I was wondering if a tumour can look benign on an MRI when it's not? Which imaging tool is most effective at identifying a malignant tumour? What percentage of women who have a core needle biopsy are found to have cancer? Am I at more risk of getting another cancer (new primary I mean, and not a recurrence) than a woman that hasn't ever had cancer. And if I have cancer again, can I have radiation again, or have I had enough (I had 52 gray all up).
Sorry this is so long.
|Replied||JHU's Breast Center Reply|
|5/6/2012||Am hoping that genetic counseling and possibly testing as also happened for you already so that you have information from a genetics perspective about risk going forward. women who carry a BRCA gene are the group at greatest risk of breast cancer happening in both breasts at some point. that said, let's address your questions:|
1. usually tumors seen on MRI either appear suspicious or don't but there are unusual circumstances with a mass looking benign can end up being otherwise.
2. most effective?? hhmmm. the most sensitive one is MRI. no one imaging technology however is 100%. so using a combination of them is common for young women with dense breasts.
3. correct. you are due to having had breast cancer already and as mentioned above if you carry a gene then that risk goes up much more.
4. when lumpectomy with radiation are performed the breast cannot be radiated again. if breast cancer happens in the opposite breast, it can receive radiation however.
We hope you get good news on your next biopsy. if not, then genetics is very important to discuss at length. we know of several genes however there are other genes for which there is not a blood test for yet too. so counseling to determine your actual risk of having a gene followed by testing is useful. women who do carry a gene usually do bilateral mastectomies with reconstruction too due to increased risk of local recurrence as well. Once a breast has been radiated however, implants don't work too well. 35-40% will develop capsulitis from previous radiation effects. So DIEP flap or S-GAP are usually better options as they are not effected by previous radiation. Steer clear of bilateral TRAM flap that requires you to sacrifice your abdominal muscles. if you want to come to us, do. just call 443-287-2778. We see and treat a LOT of young women.
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