The year 2020 affected all of us in ways we could not have imagined. But in February as we were beginning to realize how Covid-19 might alter our lives, I confronted another difficult life event. My annual screening mammogram revealed an abnormality that would require surgery and was likely to be malignant. I feel very fortunate that, in this case, the routine care I recommend to women each day allowed me to receive early treatment. I look forward to continued good health.
Each October, I now experience Breast Cancer Awareness Month as a survivor. Much of my personal experience was the same as it would be for every woman. Then again, understanding the medical process I was about to confront was a great help to me. Most often, a woman has little idea of what to expect after she learns her mammogram is abnormal. So, I thought I might share some insights about the process of moving from an abnormal mammogram to surgery.
The Role of the Radiologist
At Sparks & Favor, our patients are able to have their annual screening mammogram right in our office with up-to-date, advanced 3D technology. The breast images are sent digitally to a team of radiologists experienced in breast cancer diagnosis. Sometimes the radiologist will ask that the patient come back for additional images or other studies (MRI or ultrasound) to look more closely at an area of the breast. A call-back is fairly common, especially when a woman has dense breast tissue. The new 3D technology does provide clearer images. It has reduced the number call-backs. Fewer than 1 in 10 women who are called back for extra tests will actually have a cancer. These extra tests are done downstairs in Brookwood’s Women’s Diagnostic Center.
The radiologist’s goal is to find every single cancer, while avoiding—as much as possible—recommending a biopsy to a woman who turns out not to have cancer. Thinking about this as a doctor and now as a patient, I know a biopsy is uncomfortable and stressful. And once a biopsy is recommended, the family shares the stress and anxiety of waiting. But I don’t view negative biopsies as “unnecessary.” They are a necessary result of trying to find every cancer, and a negative biopsy is always wonderful news! If the mammogram and extra tests find nothing to suggest cancer, your mammogram report will advise you when to schedule your next mammogram.
The Role of the Surgeon
If the radiologist still feels an area of the breast is suspicious, your doctor will help you select a surgeon. The surgeon will advise either a needle biopsy or a surgical biopsy, usually depending on the amount of tissue needed to get an accurate diagnosis. A needle biopsy is performed with a local anesthetic. The doctor uses touch, ultrasound, mammography, or MRI to guide the needle. A surgical biopsy may require general anesthesia. A pathologist (a physician who studies body tissues) will examine the biopsy tissue for the presence of cancer cells.
The results of a biopsy are usually available within a few days to a week. Even before your biopsy, your surgeon will be able to answer some of your questions and address some of the “what ifs.” This is a very difficult time for a woman and her family. Again, most biopsy results are not cancer.
Biopsy Results and Treatment Plan
A biopsy report describes the type of breast cells that are abnormal, how abnormal they appear to be, and whether the abnormal cells have spread into the surrounding breast tissue. Your surgeon will use this information to recommend a treatment plan. If the biopsy shows only non-cancerous cells, the plan may include more frequent mammograms and/or periodic MRIs. When a cancer or pre-cancer is found, surgery is usually recommended. Your surgeon will advise you about the best type of surgery for your situation. At the time of surgery, breast tissue is again examined by the pathologist. The final treatment plan is based on these results. The plan may include no treatment after surgery, local therapy to only the breast area (radiation), hormone therapy, chemotherapy, or occasionally another type of medication.
A Difficult Road
In the stressful days between an abnormal mammogram result and a final diagnosis and treatment plan, I wish, for every woman facing a possible breast cancer, the support of loving family and of caring friends, colleagues, and doctors. In October, the pink ribbons, t-shirts, lights, and awareness events mean a little more to me. I would also like to thank so many of my patients for their kind words and prayers.
Celia Stradtman MD