Biopsy Results

 Well, there it is.  It's cancer.  

• Invasive ductal carcinoma (IDC) of no special type, Nottingham grade 2-3.  
• Focal ductal carcinoma in situ (DCIS), intermediate nuclear grade, with associated focal necrosis.
• Breast biomarker studies:
• Estrogen receptor: Positive (moderate staining, >90%).
• Progesterone receptor: Positive (strong staining, >90%)
• HER2/neu: Negative (score 1+)

Finding was malignant, concordant.

The hospital sends lab results to you in the patient portal as soon as they are available. While I waited for the follow-up call I spent a lot of time googling the terminologies in the lab results. None of it sounded good.

Here is what I have learned (keep in mind I'm no doctor):

• IDC is the most common type of breast cancer, originating in the milk ducts.
• "Grade" determines aggressive potential of cancer. It's rated on scale of 1-3 with 3 being the worst.
• DCIS is a non-invasive form of early stage breast cancer known as stage 0. It is common for IDC to have an accompanying DCIS component.
• Estrogen and Progesterone receptor positive (HR+) means my cancer feeds on these hormones. Majority of the breast cancer cases are HR+. Women with this type of cancer cannot take birth control pills or get hormone replacement therapy (HRT) when they reach menopause.
• Since I am HER2 negative, I don't know much about this indicator. It seems HER2 positive cancers are more aggresive.

Next step: Surgical referral.

Biopsy

The ultrasound guided biopsy was under local anesthesia.  The anesthetic injection was the most painful part.  The needle they use to collect the samples can be felt as a tug occasionally.  Not very comfortable.  I felt upset that I had to go through something I felt was invasive.  I cried a little.  

During the biopsy the doctor places a titanium clip in the location of the biopsy.  The reason for this is two fold.  First, if biopsy results showed the tumor to be benign, doctors reviewing future mammograms will know the mass has already been tested.  Second, if biosy results showed malignancy, thus requiring surgery, the surgeon would be able to find the mass more easily with the clip.

The unforunate part of biopsies is that it takes like a week to get biopsy results since they have to see in the lab how fast the cells grow/split over time.

Additional Imaging

I went in for additional mammogram and ultrasound images today.  One thing I noticed is that they squeeze my breasts a lot harder during mammograms here than they did at the VA.  The first mammo and this one was painful.  I hated it.  I swear society likes to torture women in many ways.  

After the imaging the radiologist came and talked to me.  He gave me some bad news.  I had a highly suspicious mass that would require a biopsy.  I asked many questions, one of them being how likely it is to be cancer in his opinion.  His response was "I would be very surprised if it was nothing."

The mass was 1.4cm in my right breast.  There was also a probable satellite mass of 0.4 cm approximately 1.7 cm away from the dominant lesion.  I was told that the satellite mass would not be biopsied but treated the same way the larger mass would be.  

The radiologist went on further to say that it looks like we caught it early, and I should be just fine.  He told me of many women in his family who went through breast cancer and is fine.  While the thought of having cancer was scary, his words were reassuring and appreciated.

From what I understand, they move pretty quickly at the breast center.  From time of abnormal mammography to surgery is typically less than two months.  As much as I appreciated the VA, somehow I couldn't see them moving as quickly.  As wonderful as government provided healthcare is for those who have no alternatives, the system may not always be able to handle the volume of patients in a timely manner.  I was glad to have gotten my screening in private sector this year.

Abnormal Results

The next day I got a message from the breast center that my mammogram results came back abnormal.  I needed to go in for additional imaging.  Some how I got the impression that it was something they usually do for women who get their images done for the first time at the center.  I also have dense breasts, which could also explain the additional imaging.  My view on corporate greed in America was also such that I wondered if they were just trying to make more money off of additional imaging by keeping thresholds low.  After all, my mammogram the previous year was normal, and I was fairly healthy.  At this point I was like, "No way.  I don't have cancer."  But, somewhere in the back of my mind I knew something was wrong.  1.2 cm potentially spiculated mass right breast.  I didn't like the sound of that.

Mammogram

I had my annual mammogram today.  I am 50 and have been getting my mammogram almost every year since turning 40.  I had one almost exactly one year ago which was normal.  

This year I decided to do my mammogram at a nearby cancer center five minutes down the road for me.  The last couple of screenings, however, were done at the Veterans Affairs (VA) hospital in Hampton, Virginia.  I couldn't get a Primary Care Physician (PCP) in the private sector when I first moved to Virginia Beach, so I drove the 30-minutes across the Hampton Roads Bridget Tunnel (HRBT) to the VA hospital.  The HRBT is notorious for its traffic, and during rush hours, the drive across can be an hour or more.  I usually took time off of work to go to my appoints in middle of the day.  Driving to the VA hospital for visits was not fun, and I was happy to be doing this year's mammogram closer to home.  Little did I know how much time I would be spending in that building over the next several months.