I was lucky and there was a cancellation yesterday so I had my biopsy – although the appointment was for 2 they ask you to be there 30 minutes early so I got there before 1:30 and then they were running an hour behind so it was around 3 when I finally changed into a gown and was wishing I had eaten more for lunch. Based on the ultrasound findings the mass has a very low risk of malignancy (BI RADS category 4a – the lowest rating at which they do a biopsy) and based on what they have said if I didn’t have the mastectomy scheduled they likely would have kept an eye on it and not bothered with a biopsy. The Dr. doing the biopsy was surprised they found it as it was so small. But it’s done and now I just wait a week for results.
If anyone is interested it was an ultrasound guided core needle biopsy. The ultrasound tech first found the lesion and then the Dr. came in to confirm that was the area of concern. They wipe your chest area with some kind of cleaning agent and place a drape over you to keep the area as sterile as possible and then they numb the area. This is the part the part that stung for me. The Dr. then prods around to be sure you are nicely frozen. Once they are sure you wont feel any pain the actual biopsy starts. A small cut is made in the skin of the breast near the location of the mass and the needle is put inside the breast tissue – if you are properly frozen you don’t feel any pain but it certainly feels strange. I’m not sure the exact needle/procedure she used but when she depressed the plunger there was a loud noise and lots of pressure – again very strange. They usually do at least 5 separate passes but my mass was so small that after three samples there wasn’t really enough left for another pass. Another they might do, and did so in my case, is insert a tag in the area of concern so if more imaging and/or removal of the mass is needed it is easy to locate. After the placement of the clip I had a mammogram to ensure the chip was properly placed and then I was done. The entire procedure was less than an hour. The after care is pretty simple – no strenuous activity for a day or two, expect more (minor) bleeding for a few days until the area scabs over, I could shower the next day (and was encouraged to to keep the area clean) and cover the area with a regular bandaid. I think that is about it. For me the procedure itself wasn’t bad – but waiting for the biopsy and results is nerve racking.
I leave you with a picture of a toad outside my parent’s house. We thought it was a rock until M reached for it and it moved – it was a bit of a surprise.
I’m writing this morning with only my little girl for company – my husband is still in bed and our little guy is at a sleepover with Grandma and Pepe. He really likes it there and we realized two things – it had been awhile since he had stayed over and he needed to move out of the crib at their place. With the surgery scheduled he will probably be spending a few nights with Grandma. The next step is trying to get E to sleep over as well – we haven’t been away from her overnight yet and she isn’t as easygoing as M so it’ll be interesting to see what she thinks. I’m trying to spend more time at my parents with the kids – since they are retired and I don’t work it hasn’t been too bad to find time – and hopefully E will get used to their place. Unfortunately, she is in her stranger danger phase and for some reason really doesn’t like most men – including my dad (although she always lights up when she sees her Daddy – she’s probably going to be a Daddy’s girl and I think we have a Mommy’s boy). She seems to be getting over it and fingers crossed she will soon let my dad hold her / be around her alone without screaming.
So I got a date and time for the biopsy and I guess the good news is that they can’t be too worried as it was three weeks away but it meant it was scheduled for only 8 days before my surgery. The guy booking it seemed surprised when I mentioned that I had a prophylactic mastectomy scheduled – shows how all these Dr. communicate – but he asked someone and they said it should be ok and they would put me on the waiting list. Honestly, although I’m worried about cancer (apparently even when a biopsy is recommended it’s only cancer about 30% of the time), I was more worried about the possible effects on my surgery. We have planned our lives around this date – a change would be very disruptive and I’m not sure what we would do.
Since I was starting to panic a bit and needed reassurance I called my breast surgeon and of course she’s out of the office this week and you can’t even leave a message. So I tried the breast clinic – this was just before lunch – and the receptionist sent me to a message box. I got a call back the next morning and the nurse was reassuring – she told me that the most it would likely change is the addition of lymph node removal as the surgeons don’t like to change the dates either. She also contacted the booking office and about 5 minutes (maybe a bit longer – but considering most medical times it was really quick) I got a call about changing the biopsy date to Sept 14th, so 2 weeks before the surgery, which I feel SO much better about, considering they told me at the ultrasound that it is usually a week for biopsy results, so 8 days seemed like they were cutting it close.
Diagram from American Cancer Society: https://www.cancer.org/cancer/breast-cancer/screening-tests-and-early-detection/breast-biopsy/core-needle-biopsy-of-the-breast.html
So today I had a breast ultrasound in preparation for my mastectomy and they found one suspicious mass. I guess this is why we have screening but I could do without the worry.
I was off to a great start when the technician asked when I had weaned, I replied that it had been over a month and she said she needed to talk to the radiologist as they suggest you be dry for 6 months – this is after the high risk Dr., from this clinic, said that a month would be sufficient. Fortunately, it didn’t take long to determine that was ok – but now the question was why I wasn’t having an MRI, I didn’t know as this was the test that was scheduled. So back to the radiologist my technician went – they decided to go ahead with the ultrasound as it was likely a time constraint (surgery is in a MONTH). I was happy that it wasn’t a wasted trip – but she noted some cysts (not a problem) and one suspicious mass. I’m hoping the technician is right – she told me she has never had a case of breast cancer for just a screening ultrasound. But now I have to wait for a call back for a biopsy – which better happen quickly as it apparently takes a week for results and I have surgery in a month (plus I could do without the worry). This is a prophylactic surgery so the procedure will likely change if cancer is present and we are keeping our fingers crossed that if nothing else the date of the surgery will not be changed as we have already made plans based on that date.
So this past week we had M’s 3 year and E’s 9 month check ups. M. is growing in leaps and bounds he’s in the 90th percentile for weight and 70th for height – so he’s a stocky little guy, or I guess not so little at almost 40 pounds – no wonder he seems so hard to lift. E is in the 50th for weight, 70th for height and 90th for head size. It’s funny my husband and I never thought her head was that big – M also had a large head – but it’s obvious when she is beside other kids and when I try to put on a hat or headband, they are too small for head.
- Of developing breast cancer by age 70 if you have a BRCA-1 mutation in greater than 1 in 2 (55-65%) (1)
- Of developing breast cancer by age 80 in the general (female) population 1 in 8 (12%) (1)
- Having a BRCA mutation is about 1 in 400 to 800 (0.25%) for the general population (excluding those of Jewish Ashkenazim descent) (2)
- Of drowning 1 in 1,188 (3)
- Having a trisomy 18 baby 1 in 2,500 (4)
- Of dying in a cataclysmic storm 1 in 66,350 (3)
I have never drowned nor been a cataclysmic storm but I’ve been that 1 in a large number. In fact the odds of having a BRCA mutation and a baby with trisomy 18 is 0.0001% – lucky me. Odds mean nothing when you are that ‘1’, your head knows that usually those are great odds but your heart hurts knowing that if it happens once why won’t it happen again (and why YOU had to be that one). The roll of the dice wasn’t lucky for me – I had a 50% chance of inheriting the BRCA mutation from my dad. When I first heard about Ava’s diagnosis all I could think was that I have awful genetics. But I’m hoping that my children will have better luck and neither will have inherited my ‘bad’ genes.
Well it boils down to having an increased risk of cancer – specifically breast and ovarian, although research continues to work to determine the mutation effects on other cancers. There are two BRCA genes (1 & 2) and they are tumor suppressing genes. So when you have a mutation in one of these genes your ability to repair your DNA is diminished. Also, there are MANY different BRCA mutations – some are deleterious and some appear to have no increased cancer risks. If you have a deleterious mutation (which I do have) your risk of breast cancer is about 5 times the national average and your risk of ovarian cancer is about 20 times the national average (1). If you have a mutation you have a 50% chance of passing it on to your children, girls and boys can inherit the mutation.
Having a mutation doesn’t mean you will GET cancer it just means you are increased risk. The good news is that once you are identified as having a mutation you are considered high risk which opens the door to increased surveillance, medication and/or prophylactic surgery – and I guess do nothing but I don’t think you would get tested for a mutation if this was your choice. The decision is highly personal and likely to change with time – ie surveillance for a number of years and then surgery. Which has been my choice – more to follow in another blog.
Graph from: https://myriad.com/patients-families/disease-info/breast-cancer/