6/20/19: Mammogram and Ultrasound - Inconclusive + NP Appointment

Today's appointment was scheduled because the MRI showed "something" in the left breast.

I thought they were going to do an ultrasound of my right breast, too, but they didn't. Maybe there's no need to look any further now that it's clear the right breast will be removed anyway.

In the waiting room, I was asked to fill out the standard mammogram paperwork again. This time, my answers included my recent MRI, biopsy, and breast cancer diagnosis. My NP popped in and said I could ask to speak with her at any time during my visit.

First, I got a diagnostic mammogram of my left breast.

Next, the ultrasound of my left breast. When the ultrasound technician left to show the images to the radiologist, the nurse who was at my biopsy came in. She was so comforting, I couldn't help a few tears from slipping out.

The technician and the radiologist returned. The radiologist was the same doctor who performed my biopsy. She said the technician didn't see anything in the ultrasound. She repeated the ultrasound herself to confirm the same.

So, neither the mammogram nor the ultrasound could explain what the MRI showed. The radiologist recommended an MRI-guided biopsy for my left breast, and also genetic testing. Before leaving, she gave me a kind, sympathetic, "I'm sorry you're going through this" kind of look.

At this point, my appointment was technically over, but I asked if I could speak with my NP.

I held it together until my NP walked into the examining room. She handed me some tissues and reassured me my reaction was normal. 

She said she is still in the process of making the appointment with the plastic surgeon.

She will make my appointment for the MRI with biopsy. That appointment would have to take place in the city. These appointments are typically made about 2 weeks in advance.

She will put in a referral for urgent genetic testing. They will call me to set up an appointment. 

She said genetic testing results typically take about a week. Even if the results aren't available in time for next Friday's appointment with the breast surgeon, we should still keep that appointment. 

We will proceed assuming both the biopsy and genetic testing are negative.

If the biopsy comes back as cancer, or if the genetic testing shows I carry genes linked to breast cancer, the surgeon would likely recommend bilateral surgery - a double mastectomy.

The NP said that even if both tests are negative, I should still think about whether or not I want to get both breasts removed. For some women, preserving natural breast tissue is very important. For others, reducing the anxiety of cancer recurrence is more important. If I decide to get a double mastectomy for preventative reasons, she would cancel the MRI biopsy, as the results would be irrelevant if the left breast is going to removed anyway.

I asked if there is any chance of recurrence if both breasts are removed? She said the goal is to remove all the breast tissue, but sometimes it's not possible, so there is a small 1-3% chance of recurrence even after a double mastectomy.

And how would I be screened for cancer, if there are no breasts to image? She said I would have regular clinical visits with her, the NP, and she would perform physical exams to feel for lumps. (I didn't think to ask, but will add to my list: Would breast reconstruction surgery affect the ability to palpably detect new lumps?)

Regarding breast reconstruction surgery, she said I don't need to decide that now. I can always choose to have it done at a later date. It was something of a relief to have one less thing to worry about right now.

To aid her in setting up my appointments, I had previously given her my summer vacation schedule. I told her to disregard them. I don't want to delay treatment.

6/17/19: (Diagnosis) My NP Called Me with Biopsy Results - I Have Breast Cancer

My posts are now caught up to real time. I'll post new information as I receive it.

My NP called me on the 2nd business day after my biopsy. "The two lesions both show breast cancer."

I have to say, I did not expect this.

Both diagnostic mammograms of my right breast showed "no evidence of cancer."

After two ultrasounds on my first lump, two different radiologists identified it as a sebaceous cyst, and were unconcerned. (I am not clear on this, but is the first lump itself still a sebaceous cyst, and the cancer cells are underneath it?)

It was only because of the appearance of the second lump, which did not show up on the second ultrasound, that the MRI was ordered, which led to the biopsy, which led to this diagnosis.

Anyway. The NP called the cancer "grade 2". She said there are 3 grades. According to this site, "grade 2" means the cancer "looks less like normal cells and is growing faster".

She said the testing on the "receptors" takes more time, and we still need more information on those. Depending on the receptor testing results, the cancer may respond to hormone medication. She said a particular protein called "HER2" can help indicate how aggressive the cancer is. None of this made much sense to me on the phone, but later I read up on breast cancer hormone receptors and HER2.

The NP confirmed my upcoming ultrasound appointment, then said she wanted to add a diagnostic mammogram of my left breast to that appointment, so we have all possible testing done for both breasts.

The next step after that is to have an appointment with a breast surgeon. But I guess some things still need to happen behind the scenes, because she said she can't set up that appointment yet. Maybe the receptor testing results will dictate what kind of appointment I need with the breast surgeon.

My NP said she will call me again on Wednesday to check in, to see if I have any questions. Hopefully by then she'll have an appointment with the breast surgeon for me.

After I hung up with the NP, I thought of a question. I called her right back, and luckily she was still available to talk. I asked her if, now that I had been diagnosed with breast cancer, should I stop taking my birth control pill? She said yes, once a person is diagnosed, they do recommend stopping any hormone medication. It's not imperative to stop immediately, but as soon as I'm able to stop, I should stop. (I stopped immediately.)

6/13/19: Biopsy

I arrived early for my appointment, and had a pleasant exchange with another woman entering the Breast Center.

After changing into a hospital gown from the waist up, the first step was the ultrasound. I lay on my back with my right arm positioned over my head. The ultrasound technician looked at both locations without saying much. I asked her if she was able to get a look at the second lump. She said it was difficult to distinguish between the lump and the nipple, but she was able to see it.

We waited for a nurse to arrive. To my surprise, the nurse was the woman I had met walking in. She stayed with me for the rest of my appointment, her supportive bedside manner keeping me calm.

Meanwhile, the ultrasound technician had left, presumably to confer with the radiologist. When they returned, I was relieved to hear the radiologist say she would attempt to biopsy both locations. She said she wasn't sure if she could get samples from the second location, but she would try. (I have to say, this radiologist was so much more personable than the other two I had seen previously.)

As the radiologist came and went to prepare for the biopsy, the nurse explained that after the tissue samples were taken, the radiologist would insert a tiny titanium "clip" into each site, so each location would be easily identifiable for future reference.

The radiologist explained the biopsy procedure. A shot of Novocaine would provide local anesthesia. After that, I should only be able to feel slight pressure, no pain. The ultrasound would help guide the position of a "core needle," which would extract the breast tissue. I didn't dare look at the instrument for fear of getting queasy. Each extraction would be accompanied by a loud "click" sound, which the radiologist demonstrated so I would know what to expect. Finally, she told me that I should expect bruising afterwards.

The ceiling above me was designed and lit to look like a skylight through which I could see blue skies, wisps of white clouds, and colorful tree tops. I kept my eyes on this calming image while the ultrasound technician and the radiologist got to work on the first location, with the nurse standing by. The Novocaine shot pinched a bit, but then I didn't feel a thing when the radiologist extracted 5 samples.

The second location near the nipple was more difficult, and the radiologist had said she would try to get at least 2 samples. With the "click" of the first extraction, I flinched. I could actually feel it. It wasn't painful, but also not painless like the extractions from the first location. The radiologist checked with me to make sure I was okay, and then continued. She was able to get I think 4 or 5 samples from the second location as well.

Just as the radiologist finished with the second location, I felt a flow of blood run from the middle of my right breast down the outside of my torso. Yikes. The radiologist quickly put pressure on the area, then the nurse took over. I lay with the nurse putting pressure on the second location for quite a while before the location was covered with steri-strips and a band-aid.

With the biopsy finished, and the titanium clips inserted, the ultrasound technician took some more ultrasound pictures. As a final step, I would also need to get a "soft" mammogram of my right breast, meaning a mammogram in which the breast is gently positioned, but not squeezed.

Before taking her leave, the radiologist mentioned that I should come back for another ultrasound for my left breast, because the MRI showed "something" in the left breast, too. (To date, all diagnostic mammograms and ultrasounds were only on my right breast, where the two lumps are located.) This was the first time I had heard anything about my left breast, and to be honest, the idea that I had to come back yet again for yet another test was overwhelming.

The nurse had me sit up slowly in stages, first with my feet still on the table, and then with my feet hanging over the side. Just as the nurse asked me if I was ready for the mammogram, I started to feel queasy. Then I felt very warm, and a little foggy. The nurse had the mammogram technician get me some water and Teddy Grahams, then some ginger ale and saltines. After a while, the feeling passed. The nurse said "hot flashes" are a common reaction to Novocaine, and apparently I got a lot of Novocaine.

Once I was feeling better, the nurse gave me written instructions for how to handle the biopsy recovery. She said she would call me the next day to check in, and she would call again in 3-5 days with the biopsy results.

Then I went with the mammogram technician to get the "soft" mammogram.

Lastly, the mammogram technician left me briefly, and then came back with my appointment date and time for another ultrasound. They would look at both breasts, presumably just a follow-up for the right breast. She mentioned the idea of doing the ultrasound the same day, but then said everybody thought I had been through enough, and it would be better to come back another day.

5/13/19: Mammogram and Ultrasound - Inconclusive

At the Breast Imaging location, even though I had been told on the phone that a mammogram wouldn't be necessary (because one had already been performed on that breast within the last 3 months), while sitting in the waiting room, I was told that the radiologist wanted a diagnostic mammogram after all. This time, I definitely remember little stickers being placed on both the lumps.

Since my appointment had been scheduled as an ultrasound only, I guess having the mammogram first disrupted their schedule, because I had to wait a bit longer than usual for my ultrasound. 

The ultrasound technician (not the same person I saw at my first visit) looked at the first lump first, then looked around for the second lump. Curiously, she couldn't see the second lump on the ultrasound machine. She asked me to show her exactly where it was, and she spent quite a bit of timing looking for it, but she just couldn't see it on the machine. Eventually she gave up and left the room to confer with the radiologist. 

The technician and the radiologist (also not the same person I saw at my first visit) returned together. The radiologist, too, spent quite a bit of time looking for the second lump on the ultrasound, but couldn't see it. I really don't know how ultrasound technology works, but it seemed weird - and a little alarming - that the machine couldn't detect a mass that obviously existed and was easily palpable.

Anyway. The radiologist confirmed that the first lump was a sebaceous cyst, and she recommended I see a dermatologist, who might advise me on whether to leave it alone or get it removed. 

Regarding the second lump, the radiologist simply said that she was unable to see it. She said maybe the dermatologist could advise me on both lumps. I have to admit, this lack of information was troubling, and internally I was glad to know I had an NP appointment at the Breast Center coming up.

3/16/19: No Change, and I Got Billed

I used a warm compress for a few weeks, and though the cyst seemed to get smaller after each use, it would always return to its usual size between warm compresses, and it didn't seem to get any closer to draining. I gradually just stopped with the warm compresses.

Knowing that the lump was "only" a sebaceous cyst, I really wasn't worried about it anymore, even if it wasn't draining or getting smaller.

Meanwhile, I received my bills for the PCP appointment, the diagnostic mammogram, and the ultrasound. For the mammogram and ultrasound, I got one bill from the radiologist, and a separate bill from the Breast Imaging location's affiliated hospital. (My PCP and the Breast Imaging location belong to the same hospital network.)

2/19/19: PCP Appointment: $230
With insurance, I paid only the co-pay: $20

2/21/19: Mammogram & Ultrasound Radiologist: $246
With insurance, I paid: $83.15

2/21/19: Mammogram & Ultrasound Hospital: $857
With insurance, I paid: $216.85

Total cost: $1,333
With insurance, cost to me: $320

2/21/19: Mammogram and Ultrasound - It's a Sebaceous Cyst

At the Breast Imaging location, I needed to fill out all the same paperwork that is required for routine mammograms.

The diagnostic mammogram was pretty much the same as a routine mammogram - my breast was firmly squeezed while I stood in various awkward positions! - except they only looked at my right breast with the lump. I'm writing this months later, so my memory is a little foggy, but I think they also put a little sticker on the lump, like a marker to show where it is.

I returned to the waiting room until I was called for the ultrasound.

In the ultrasound room, I laid on my back with my right arm over my head. The technician squirted a warm gel on my right breast, and then went to work with the transducer. I could see the images on the screen, but of course I couldn't make any sense of them.

When the ultrasound was complete, the technician left the room to show the images to the radiologist. They both returned together, and the radiologist told me my lump was a sebaceous cyst. She explained that the cyst was in my skin layer, not actually in my breast, and it was not concerning. Phew! (I didn't know the word "sebaceous" at the time and had to Google it afterwards. Sebaceous cysts are basically non-cancerous cysts in the skin.)

The radiologist said sebaceous cysts sometimes will drain on their own - gross! - but that's a good thing. To promote the likelihood of draining, she suggested I use a warm compress on it a couple times a day, for a couple weeks. (Just wet a towel with hot water, squeeze out the excess water, and hold it on the lump until the towel cools. Repeat once or twice.)

She also said it's possible the cyst might get infected. In that case, it would be red and painful, and I should let my PCP know.

Finally, she recommended a 3-month follow-up ultrasound. I made that appointment at the front desk before leaving.