Scar Tissue or Cancer?

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QUESTION: I was diagnosed with low-grade infiltrating ductal carcinoma with two out of 14 nodes positive. I had two more lumpectomies before I got clean margins. I chose not to have a mastectomy after many opinions and much info. From there, I had four treatments of cytoxin, adriamycin, four treatments of Taxol, 33 radiation treatments, then tamoxifen. My question: Nine months later, follow-up mammography report says "Bi-rads category 4: suspicious abnormality—biopsy should be considered." (This is at the site of the last surgery.) How can this be happening in just nine months? I find it hard to believe that scar tissue could be confused with carcinoma. How often IS it scar tissue? It just seems that no one wants to tell me that PROBABLY the cancer is back. I would really like your HONEST impression. Thank you in advance.

ANSWER: Sounds like you are riding the roller coaster of fear. It is very common for radiologists to describe findings on mammography after lumpectomy, re-excision, and radiation that could be consistent with both scar tissue and persistent/recurrent breast cancer. So soon after your surgery that eventually obtained clear margins, plus chemo, radiation, and tamoxifen—the findings in your situation are most likely scar tissue, not cancer. What the radiologist is probably saying is that your breast does not look normal. But we expect it to look abnormal. That poor breast of yours has had a VERY HARD YEAR!

Of course, we can't give personal advice. The best advice will come from your doctors after a careful review of your mammograms, correlating that with your surgery and related treatment. It's common for the radiologist to recommend every-six-month follow-up mammogram on the treated side, and yearly for the other breast.

The uncertainty of breast cancer stinks! You gotta prepare for these occasional roller coaster rides.

—Marisa Weiss, M.D.

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