- Question from Grannie: Hi, I am a 4-year breast cancer survivor. On my last mammogram I was called back for an ultrasound and was told that they had found new breast tissue that was not there last year. Also, I am postmenopausal, and have lost a lot of weight since the mammogram a year ago. I had never heard of having new breast tissue at my age.
- Answers - Cecilia M. Brennecke, M.D. I would be suspicious of that as well. I don't know how old you are, but if you take estrogen, new tissue can appear on a mammogram. If you are not undergoing hormone replacement therapy, then a new area of tissue should be regarded with suspicion. I would ask for a biopsy. When you lose weight, the breast may be smaller and look more condensed on a mammogram, but a new area of tissue should not develop. What I do when there's an area of abnormality on a mammogram is solve it on the mammogram by doing additional views. I then go to ultrasound to see if I can tell if the area of concern is normal breast tissue or a cyst or a mass.
- Marisa Weiss, M.D. Tonight we have talked a lot about tests—tests performed within the hospital as well as your own breast exams and your doctor's exams. If you find a lump in your breast that persists, even if the mammogram and ultrasound are read as normal, it's important to follow and evaluate the lump. We do have a tendency to favor technology over something as simple as your own breast examination. Of course, you want to be completely reassured by the normal test report, but again, about 20 percent of women are diagnosed with breast cancer based on a palpable or visible abnormality that is not seen by mammography. It's important to take this a step further with ultrasound or the other tests described above by Dr. Brennecke.
- Cecilia M. Brennecke, M.D. The other issue is that biopsy of the breast is a very simple tool. We don't want to do unnecessary biopsies, but if you or your doctor has a concern, and the imaging is negative, and the concern is real, you can't stop there—you have to obtain tissue. I do biopsies using imaging guidance. It's quick and painless, and gives you a diagnosis: normal, abnormal or needs to be evaluated by a surgeon. Trust your own instincts, and do not be swayed by a negative test.
- Marisa Weiss, M.D. You make an important point with regard to the advances in, and the ease and accuracy of, biopsy techniques today. When the biopsy procedure is guided by high quality imaging, you are likely to obtain a good sample that accurately represents the area of concern. Also, the core biopsy can be done through a very small incision. The scars that biopsies caused in the past can usually be avoided today.
On Wednesday, July 16, 2003, our Ask-the-Expert Online Conference was called Breast Cancer Screening. Cecilia M. Brennecke, M.D. and Marisa Weiss, M.D. answered your questions about mammograms, ultrasound, MRI, breast self-exams, physical exams by a doctor, and other topics related to breast cancer screening.
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