Q: I recently had a biopsy done on a breast mass and the results came back benign. I was wondering if I still have the option to have the lump removed for peace of mind.
A: Yes, this option is available to you. You have most likely had a needle biopsy. Depending on the type of needle used, the results may vary in accuracy. If you are still concerned about a breast mass, discuss complete excision with your surgeon. Hannah Brooks, MD, FACS
Q: I am 35 and just had a double mastectomy. I was just thinking, do I get a yearly ultrasound now instead of mammogram? I would ask my doc but she is out of town for a week. I could of waited till she got back but figured I would ask here since you have been so much help before. Thanks in advance.
A: A good physical exam and possibly sonograms of the area if something is felt, would be used to screen. Mammograms are not that helpful after mastectomies since most breast tissue is gone. Hannah Brooks, MD, FACS
Q: I just had a breast biopsy, the doctor removed a lump. He said the path report, showed I had a high risk of getting breast cancer. (This lump was ok, no cancer) as I had 9 different things, in my "Make Up" or Genes. Do you know what he means by this, do you know what the odds are , of me getting the cancer?
A: I cannot answer specifically without the pathology report, but if you are not concerned about posting some of the terms on this site, I will be happy to provide you with a brief definition of any term you might find difficult to understand. I can also refer you to websites that will help explain the terminology a bit more clearly. Hannah Brooks, MD, FACS
Q: I am scheduled for a stereo biopsy in 2 weeks, resulting from location of calcification the radiologist felt was suspicious. Meanwhile I have a younger sister who has just undergone a wire biopsy for calcification, performed by a breast surgeon. My sister is convinced that the stereo is not as thorough as the wire. Please advise.
A: The stereotactic biopsy is highly accurate in the right hands. Your sister's calcifications or mass may not have been amenable to the approach that is being offered to you. Each case is different. Hannah Brooks, MD, FACS
Q: I'm 52-years old and had to have surgery to remove a calcium deposit from my right breast. 2 weeks ago I started experiencing a needle like pain in my right breast. I was on estrogen before my surgery but have not been on it since except for an estrogen patch which I wore for 2-4 weeks before discontinuing. Could you tell me what the problem might be?
A: Assuming the biopsy was benign, the pain is likely a postoperative pain. Hannah Brooks, MD, FACS
Q: My Mom (age 60) has just been diagnosed with Stage I breast cancer. It's 0.9mm in diameter, and doesn't seem to have spread. Her gynecologist (also her principal care physician) has referred her to a general surgeon, shouldn't she be seeing an oncology surgeon instead?
A: Any general surgeon experienced with breast cancer can deal with this case. The proper follow up with an Oncologist (cancer specialist) and a Radiation Oncologist (radiation treatment specialist) if she is having only a lumpectomy, is also needed. Her primary physician or her surgeon will provide the proper referrals. Hannah Brooks, MD, FACS
Breast Self-Exam:
Q: I do a BSE right after the end of my period. But my cycles are long, 35 - 40 days, not 28. Should I do a BSE more often than once every 35 - 40 days?
A: It's best to wait until the 5-10th day of your cycle, when breasts are least swollen and lumpy. The 'monthly' exam should be tailored to your own cycle. Hannah Brooks, MD, FACS
Calcification:
Q: I don't understand what a calcification is? Is it calcium based? Same with 'micro' calcification
A: A calcification is a deposit of calcium in the tissues. When we talk about with mammograms, it refers to little white flecks that show up on the image. Depending on the size they will be "macro_" (large) or "micro-" (small) calcifications. Depending on the way they are arranged, the shapes, the number of them, and so on, they may or may not require further testing or even biopsy. Hannah Brooks, MD, FACS
Contraceptive & HRT:
Q: I had a hysterectomy and a bilateral oophorectomy 10 wks. ago. I am on the Vivelle-Dot 0.1mg patch. There isn't any history of breast cancer in my family. Is this a good dose? I have endo, so I would like to try a lower dose. What do you suggest? Thank so much for your time.
A: The information on HRT and risk of breast cancer is very controversial. Since you have undergone TAH/BSO, replacement therapy will be beneficial in preventing osteoporosis, and a number of other physical changes associated with oophorectomy. This is important to discuss with your obgyn--as I cannot comment specifically about the dose you are receiving and what the risks and benefits are to your individual case. Hannah Brooks, MD, FACS
Q: Does anyone know if it's OK to take oral contraceptives after you were Dx with ER/PR negative breast cancer (also called hormone negative breast cancer)?
A: This is a complex question and should be handled by your gynecologist. Theoretically, ER/PR negative breast cancers are believed to be hormone insensitive for the most part. However, if there is a different form of birth control available to you, it should be considered. Hannah Brooks, MD, FACS
Cyst:
Q: I am 41 years old. No family history of breast cancer. My dr. found a small lump 1-2cm. I went for a sonogram and mammogram. The mammogram was clear. The sonogram showed most likely a hemorrhagic cyst the dr. said it could also be a newly appearing solid mass. He was not sure. I have made an appt. with a general surgeon but i am very afraid. What is your opinion.
A: A cyst may sometimes bleed. It doesn't necessarily mean it is cancerous. It can be tested with a sonogram guided needle biopsy to determine what it is before any surgery is done. Alternatively, it can be completely removed with surgery. Hannah Brooks, MD, FACS
Q: I recently had a mammogram and ultrasound which confirmed a cyst in my breast. My doctor aspirated the cyst, but it immediately filled back up. She indicated that it was a hemorrhagic cyst and aspirated it again. It is now 2 days later, and the cyst has filled up again. I am not sure if I should have it reaspirated, removed, or just leave it as it is. Suggestions?
A: Based on your description, it would probably be most prudent to remove the entire cyst and send it for pathology. It is considered minor surgery and will not require general anesthesia. Once it is removed, you will have a complete answer, and it will be gone. Hannah Brooks, MD, FACS
Fibroadenoma:
Q: I just found out that I may have a 2cm fibroadenoma. The radiologist suggested a needle biopsy or complete removal of it. I don't know what I should do. Does anyone have any suggestions or is there anyone out there that has had either of these procedures done? What are some of your experiences and do you regret not choosing the other procedure?
A: A fibroadenoma does not necessarily have to be removed. But you do have to PROVE that that's all it is. A core needle biopsy should suffice. If it turns out to be a benign fibroadenoma, you can leave it alone. The only reason to remove it would be if it continued to grow and was becoming uncomfortable or distorting the breast or creating other problems. Hannah Brooks, MD, FACS
Mastitis:
Q: I am 51 years old. About 30 years ago I was diagnosed with mastitis. I also have fibrocystic disease. Until recently (within the last month) I have had no reoccurrences of either, however for the last couple of weeks I have noticed tenderness in both breasts accompanied by stabbing pain, and burning pain in both nipples. There has been no nipple discharge. I have gone through menopause. I would like to know if in your opinion if the above symptoms are due to the fibrocystic disease, or a reoccurrence of the mastitis, or something else?
A: Some women experience pain simply from the changes in the breast tissue associated with menopause. It sounds as if you have many reasons for the pain. Mastitis, fibrocystic condition, menopause, are all potential causes. See http://www.imaginis.com for additional help and suggestions on breast pain. Hannah Brooks, MD, FACS
Q: I have recently had a breast removed due to granulomous mastitis as there does not seem to be any where I can get information on this subject do you know about this and can you tell me if there have been any reported cases of this ever being bilateral?
A: Try doing a search on "granulomatous mastitis" for additional information. Be sure to stick to "safe" information as is often found at .gov and .edu sites. Basically, it is a benign (non-cancerous) condition of the ducts and lobules of the breast. Surgery is often the last step after a long period of unsuccessful treatment for infections, inflammation, non-healing wounds, and other problems in the breast. Sometimes the underlying cause is never found. Hannah Brooks, MD, FACS
Thermography:
Q: I'm searching for information about Medical Infrared Imaging also known as Thermography? I have heard it is non-invasive and that it is an adjunctive diagnostic tool in the detection of breast disease without harm to the patient. I am looking for a clinic in the Dallas/Ft worth area that might perform this type of screening.
A: You should do a search and locate the centers that use this method, no widely used, through the companies that manufacture the equipment. There are other non-invasive methods that may help with diagnosis of breast cancer that are more widely proven than thermography. Hannah Brooks, MD, FACS
Talking with your physician:
Q: My mother was just diagnosed with breast cancer at age 55. Should I make a point of telling my own GYN about this as it could indicate a higher than average risk for me, or is that only when a first degree relative has it before age 40?
A: Your risk is increased because you have a first degree relative. The risk would be increased even more had she been diagnosed in premenopausal period. You should follow instructions for monthly self exam and yearly mammogram and examinations carefully. Hannah Brooks, MD, FACS
Q: I was wanting to know the normal levels of prolactin, i was told 3 to 30, is this true, mine is 18.
A: Different blood hormone laboratories report prolactin with different units and volumes. You should call the lab where your blood test was processed to get the normals for that laboratory. Hannah Brooks, MD, FACS
Q: Can the antibiotic 'cipro' be used to successfully treat mammary duct ectasia? I'm allergic to most 'oxins and 'illins.
A: Mammary duct ectasia is not an infection of the breast. Using antibiotics, no matter what type, will therefore not 'cure' the situation. If cultures of a breast discharge have been performed and a specific bacteria that is treatable with cipro or any other antibiotic has been identified, and you are having symptoms related to true infection, then antibiotics may help. Speak with your physician regarding this. Hannah Brooks, MD, FACS
Q: Is an OBGYN the best doctor specialty from which to receive breast exams and to have a lump looked at? Is breast care part of the OBGYN specialty or would an internist or other specialty be a better choice?
A: An experienced obgyn or an experienced general/breast surgeon would be of greatest help. Hannah Brooks, MD, FACS
Q: My sister's paraffin block with her tumor tissue / specimen (infiltrating ductal carcinoma) was recently tested for tumor markers (ER, PR, DNA, Her, etc.). I wish to know whether the results could still be accurate, given the fact that the specimen has been in storage for 1 year already.
A: Depending on the type of staining used (eg. immunohistochemical staining), tumor markers can still be tested from older paraffin blocks. The information is often useful to determine what types of treatment options are best suited to an individual. Best of luck to your sister. Hannah Brooks, MD, FACS
Ultrasound:
Q: What does a mass look like on an Ultrasound?
A: The ultrasound will show a black sphere with other, more specific characteristics to indicate a cyst. A solid mass will appear dark or whitish and have other criteria used by the radiologist. You may want to try http://www.imaginis.com for imaging examples. You may have to do some sifting, as it is a very comprehensive site with many links. Hannah Brooks, MD, FACS