Cancer Between Appointments

A normal town day with a routine mammogram scheduled.  Nothing out of the ordinary.  The only thing I really remember is that the tech who did my mammogram had family who owns property in our valley, so we had a nice visit.  Also, the receptionist was insistent on trying to get my old mammogram from 11 years ago.  So I called on the spot and gave her the info she needed to attempt to retrieve it.  Then it was off to the rest of my busy town day schedule.  Check one more item off the list.

About 3 or 4 days later, the hospital called back, they were unable to obtain my previous mammogram results.  Mammogram results are only kept 7 years by law.  If you're moving...get a copy and take them with you.  My mammogram show micro calcifications, no big deal, they just needed me to come back in for magnification views.  Fine, my next town day was 10 days away.  I'd put them on my list for that day.  Now back to homeschooling.....

Town Day Again:  A second round of mammograms.  This time the tech told me to wait in the room until the radiologist released me.  As I waited...for the very first time, I had the thought, "what if this is cancer?"  I immediately pushed the thought from my mind.  The Lord's teaching me not to allow my thoughts to wander into "what if" territory.

The tech came back, the radiologist wanted an ultrasound done before I left.  Fine, I had a bit of time before my appointment with my internist.  After completing the initial exam, the tech said he was going to get the radiologist to finish the exam.  When the radiologist came in, he proceeded to re-examine me and then started moving the wand under my left arm.  I'm not medically trained, but I worked in healthcare for 14 years.  I knew instantly he was checking my lymph nodes for signs of cancer.  When he had finished he explained that he was concerned about a pattern of micro calcifications in my left breast, close to the chest wall.  As there was no previous baseline mammogram available to compare, I had two choices, I could wait 6 months and do a follow up mammogram or I could proceed with a biopsy.  He recommended that I proceed with the biopsy.  I told him I'd think about it and talk with my internist who I was seeing in a few minutes.  He said he'd call and talk with her.

30 minutes later, I'm at the internist's office, amazed that the radiologist has already called her.  There was significant concern regarding my left breast and moderate concern with my right breast.  Within 2 days, I was set for a bilateral breast biopsy the following week at the Breast Imaging Center.  My BIRADS score was 4/6.

What does a BIRADS score mean?  It is a scale of 0-6 used by radiologists to indicate the level of certainty they have of a cancer diagnosis on a mammogram.   According to Johns Hopkins website:

BIRADS 4 – Diagnosis: Suspicious Abnormality (S). Next steps: Lesions are present that don't have characteristics of breast cancer, but there is a reasonable probability of malignancy (20% to 35%); a biopsy should be considered.

So why did I chose to do a biopsy instead of waiting 6 months for a second mammogram?  

Three reasons:

1.  I have a young family.  I am responsible to the Lord and my husband to maintain my health, so that I may be active in raising our children for the Lord.

2.  The area of micro calcification that was most concerning was close to the chest wall.  I didn't want to take the risk of anything spreading outside the breast.

3.  If it was cancer, I didn't want to give it another 6 months to spread.
4.  When a radiologist cares enough to pick up the phone and call on the spot, you know he/she has a significant level of concern.

This is not an ethical decision!  You have to weigh your risks and your life situation and make that judgement call for yourself.  I'm just sharing my reasoning and decision making process, based on my current life status and what I knew.  

Why a bilateral biopsy instead of just a biopsy of the one area of greatest concern? 

If the most suspicious area was cancer and the secondary area had not been biopsied, I would be called back for a second biopsy.  This would involve additional cost and delay in moving on to the next stage of treatment.  In addition, there is the risk of "beta error".  That means the first biopsy is negative and the second area of concern was cancerous, but wasn't biopsied.  If that happened, I could go undiagnosed for a year until my next mammogram.  I didn't want to run that risk.  I chose to do the bilateral biopsy upfront and address all known areas of concern.

And then...I was off to the rest of our appointments on another busy town day.

A few days later:  

The Breast Imaging Center is located at the hospital complex in the next town.  K, the nurse navigator for the Center had called previously to review my procedure.  She told me she'd meet me before the biopsy.  I had done some research online and knew what to expect for a stereoscopic biopsy.  Three hours later, I left the center, thankful for the skill of the radiologist, Dr. W, (a breast imaging specialist) and all the staff at the center.  I was told to expect biopsy results in two days.

Call it avoidance, or whatever you will, but until now, I hadn't thought about what kind of cancers could create micro calcifications.  A quick check online revealed that the term to listen for was Ductal Carcinoma in Situ.  This means, cancer of the milk ducts which has not left the milk ducts.  It is usually considered a Stage 0 or Stage 1 cancer.  The micro calcifications are not cancerous themselves, they are markers which may indicate the presence of cancer, particularly in certain patterns.  Here was the part the scared me.  DCIS is often totally symptomless.   Ok, now I knew what the term was and a little bit about it.  Hopefully I could sound intelligent. 

The day before Thanksgiving:  

The entire family, packed, loaded into the truck, with house winterized and out the door at 9:30 am!  That is close to a record when we have to winterize!  We headed to town for lessons and errands before traveling to Grandparents for the holidays.  My internist called just as we were finishing lunch.  She asked where I was.  I told her I was standing outside the truck ready to run the children to music lessons.  Could I stop by to see her?  It was a mixed bag of news and she wanted to talk with me in person.  DH dropped me off at her office on his way to take the kids to lessons.  He desperately wanted to be with me, but he had an intense client conference call scheduled during their lesson time and would pick me up when finished.

My internist took me back to an exam room and came straight to the point.  I had DCIS in my left breast and the right breast biopsy was clean.  She wanted to make sure that I left with hope, 98% of women diagnosed with DCIS, who choose treatment, live at least 10 years.  That was good news, now to process everything else and hold myself together in front of DH and the children.  I was shaken, probably in shock, but not distraught.  I disliked telling DH.  He loves me so much and I knew it would really hit him hard.

DH's conference call ended early (for once) and he returned to pick me up.  He was anxious to know what was going on.  We stood in the parking lot and talked for about 3-5 minutes.  Then we hopped in the truck, picked up the rest of the children and spend the next 6 hours on the road to Grandparents house for Thanksgiving.  

So that's how DH and I learned our lives were taking an unexpected bend in the road.  We've been told the detour will last about 1 year if all goes well.  I personally think the impact will last a lifetime.