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Posted by Betsy Mullen on 9/18/2001 from 24.4.254.64:

In reply to: nodule found posted by Cheri on 9/13/2001 from 204.52.247.58:

Dear Cheri:

I hope that this message finds you well and that the new information is helpful. If you have not done so already, please feel free to contact our office directly at (626) 332-2255 for any additional information, help and support that you might need.

There are many things that can possibly cause a lump, including a cyst, a fibroadenoma and fat necrosis. As 80% of all breast lumps are benign, the odds are in your favor.

I have a saying: "When in doubt, check it out." Everybody is different and every body is different. You know your body well and are your own best advocate. Pursue any concerns with your health care team and remain vigilant.

We are strong proponents of second opinions. I suggest that if you do seek a second opinion, make sure that you have all of your film/images and radiology reports with you to take to the appointment.

If you think that you will have better peace of mind if the lump and a margin of tissue are removed, discuss such feelings with your health care team and arrange a consultation with a board certified breast surgeon if you have not already done so. If the surgeon recommends you "wait and watch", with re-checks over a 3 –6 month period of time, for example, can you deal with that? It is important to keep in mind that in the majority of cases, breast cancer is a slow-growing disease. As a rule, you have time to consider all of your options – although it may feel like it, making treatment decisions, (which includes decisions about a biopsy) is not an emergency. We have a great decision-making checklist right here on this site.

We can help you with suggested questions to ask about breast cancer screening as well as information on risk factors and breast health. Please let us know if you would like such information. We can also send you information on how to choose a well-qualified breast imaging center (you can find great links in the resource section of our site at winabc.org).

Here are some additional specific information/questions you may want to think about and discuss with your doctor(s):

1. Do you have a family of breast cancer?


2. Did you receive a copy of the radiologist’s report/findings from this last mammogram?

3. Did you physician(s) discuss the possibility of a breast ultrasound?

4. Did you physician(s) discuss the possibility of a breast MRI?

5. Do you know how to do a proper breast self-exam (BSE)? You can receive this information and right on our web site (www.winabc.org) and we will also be delighted to send you a booklet that clearly illustrates breast anatomy and how to perform proper BSE’s.

6. Did you receive a copy of the radiologist’s report/findings from your latest and previous mammograms?

7. Are you currently on hormone replacement therapy (HRT)?

One key factor to take into consideration is your age. Premenopausal women particularly women in their 20's and 30's tend to have dense breast tissue which is why traditionally, baseline mammograms begin between the ages of 40-50.

Another key question is whether or not you have breast implants. There are some schools of thought that recommend an occasional breast screening with magnetic resonance imaging (MRI) for women with a breast implant(s). MRI does not involve any exposure to radiation, although it is important to keep in mind that such exposure is minimal with mammograms.

MRI is gaining recognition as a very effective method to detect a ruptured or leaking breast implant and as a breast screening method that may be more effective than mammography for women who have implants. It takes a skilled MRI technician/expert to detect an area of concern in a breast MRI because when a dye is used w/ MRI, (used to help with the reading of tumor tissue) both the breast tissue and the dye appear bright so a trained eye needs to analyze the images. (Source: The Complete Book of Breast Care by Niels H. Lauerson, MD, PhD and Eileen Stukane)


We will be delighted to send you educational materials, free of charge regarding breast self-exam, breast health, understanding breast changes, questions to ask your health plan about exemplary care (found on our web site under help yourself – 10 key questions for women to ask their health plans), breast cancer myths and much more depending upon your needs.

Here is some additional information that I hope you find helpful:

Excerpts from: Breast Imaging Questions

Source: Richard L. Ellis, M.D.


Q: Why is ultrasound performed in addition to mammography?

Ultrasound is an excellent adjunctive examination to mammography, but it cannot be a substitute for the screening mammogram. As noted above, ultrasound is the primary examination in young, pregnant, or lactating women with palpable abnormalities. It is also routinely performed on women with clinical findings whose mammograms are unrevealing and on those whose mammograms show an area that requires further evaluation. Ultrasound is also used to guide interventional procedures, such as needle localization, fine needle aspiration, core biopsy, and percutaneous ductography.

A reliable aid in the diagnoses of most breast cysts, ultrasound can be used to guide benign cyst puncture for those who are symptomatic or do not meet stringent criteria for diagnosis of a benign cyst on ultrasound. In addition, it can provide reassurance that no mass underlies a questionable palpable area. According to recent evidence, ultrasound can aid in the benign-malignant differentiation of solid breast masses and prevent biopsy for many noncancerous masses, such as fibroadenomas.


Q: What other diagnostic procedures are performed in mammography?

Once an abnormality (abnormal mass, calcifications, distortions, etc.) is detected on the screening mammogram, a diagnostic mammographic examination is generally performed in order to obtain special views of the abnormality allowing a more detailed evaluation. This additional mammographic examination may include the use of special X-ray maneuvers and magnification of the abnormality in question as mentioned previously.

Ductography is an examination that allows detailed evaluation of the breast milk duct and is indicated when there is a bloody nipple discharge or persistent discharge from a single duct in the nipple. There are approximately 15 to 20 major milk ducts that converge to the nipple. If the discharge is noted from multiple ducts or from both nipples, a ductogram is not indicated. The cause for multiduct discharge is usually related to a systemic cause (hormonal effect, pituitary disorder, etc.) and is not cancerous. The examination is usually performed by inserting a small cannula (thin tube) directly inside the duct ostium in the nipple and contrast (X-ray dye) is injected to fill the duct. If the cannula cannot be placed through the ostium, the abnormal duct (which is usually enlarged) can frequently be filled percutaneously with ultrasound guidance.

Magnetic resonance imaging is a special radiologic scanning method that is extremely accurate for evaluation of breast implants when there is a suspicion of implant rupture or leakage due to trauma or implant breakdown due to age. In addition, MRI is beginning to show promise as a tool that in the future may allow differentiation of benign and malignant lesions in the breast and provide better demarcation of the size of the lesion to assist surgery. In addition, MRI may help determine recurrence of cancer in the breast after treatment.

Nuclear Medicine Imaging, using sestimibi (Miraluma), is currently available as an additional diagnostic examination for selective patients. We are also using monoclonal antibodies for breast cancer under clinical research trials to evaluate their efficacy in selected patients with the hope of helping to differentiate between benign and malignant breast lesions.



You can be well served in seeking a second opinion and inquiring about an ultrasound and/or MRI of your breast(s).

You are your own best advocate and we are here to help you in any way that we can. If and when you do see another physician(s) for a second opinion, be sure that you have all of your previous films, ultrasound images and radiology/imaging reports.


RECCOMMENDED READING & RESOURCES TO HELP YOU

Some good books that extensively cover breast health, breast cancer and reconstruction are entitled "Dr. Susan Love’s Breast Book" which are also available in our "virtual bookstore" and "Assess Your True Risk of Breast Cancer" by Patricia T. Kelly, Ph.D., copyright 2000. "Assess Your Risk" discusses what statistics really mean, evaluation of heredity and lifestyle risks and What You Need to Know About Genetic Testing (BRCA1 and BRCA2 gene testing).

The Complete Book of Breast Care by Niels H. Lauerson, MD, PhD and Eileen Stukane is also a very good resource with comprehensive and easy to understand information.

Another great resource about breast health is: Diseases of the Breast, Second Edition; Editors: Jay R. Harris, Marc E. Lippman, Monica Morrow, C. Kent Osborne; Publisher: Lippincott Williams & Wilkins; 2000; ISBN #: 0-7817-1839-2. Most medical libraries should carry it; I’m not sure about regular public libraries.

The books can be purchased on line in our virtual bookstore via Amazon.com and should be available in most public libraries.


The following resource looks great (I have provided a link for you below this message), and I know one of the physicians, Richard Edlich, M.D., who created the site. He is a plastic and reconstructive surgeon from the University of Virginia, who happens to know my personal plastic surgeon! This looks like a great site and hopefully a helpful resource to you.

Breast Biopsy.com: http://www.breastbiopsy.com/

"OUR GOAL: Answer questions that arise with discovery of breast abnormality. Explain breast findings, mammography, updated biopsy techniques (stereotactic, ABBI, MIBB, Mammotome).

There is a natural anxiety that occurs in a woman upon finding an abnormality in her breast. From the moment she, her physician, or the radiologist makes the discovery to the time of diagnosis, there is a period of misery.

In an effort to help, this site is intended to provide women with answers to questions that may arise during this interim as well as serve a resource in general because this is an issue that will affect nearly everyone, be it personally or through a loved one.

Throughout this site you will find definitions and simple explanations of breast findings and updated breast biopsy techniques (including stereotactic techniques such as ABBI, MIBB, and Mammotome). We will also discuss breast examination and address mammography. For your convenience, there is an interactive map that will allow you to locate a comprehensive breast care center near you."


Please keep us up-to-date on how you are doing and how we can help.


My warmest personal regards,
Betsy


Elizabeth ("Betsy") Mullen
Founder, President/CEO
WIN Against Breast Cancer
Main Office:
536 S. Second Avenue, Suite K
Covina, California 91723
Phone: 626-332-2255 Fax: 626-332-2585
Web Site: www.winabc.org

• Breast Biopsy.com

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