Annual Checkup Tests

Posted by mjay @mjay, Dec 8, 2020

I had an estrogen receptor breast tumor removed last year followed by radiation. I am on an aromatase inhibitor for a little over a year now. My six month checkup found a questionable lump which, after biopsy, was found to be scar tissue. My annual checkup was just completed and consisted of MRI and mammogram, which were clear, but I had no ultrasound, which I've always had prior to cancer diagnosis due to dense breasts. They said the U/S is more if they found something on MRI or mammo, but I thought I read all three tests (MRI/Mammo/US) can reveal different things so I question why an U/S wouldn't be done given my history. Secondly, I had an annual physical with my GP who did a complete blood panel, but I've never had my hormone levels checked, yet I'm on an AI and had an estrogen based tumor. Is this consistent with others' experience? TIA.

Your experience for monitoring is similar to mine. I have very dense breast and was diagnosed with ER+ breast cancer. Treatment was a lumpectomy, chemo and radiation. I took AI for awhile and stopped due to side effects. I have only had ultrasounds to check suspicious areas or biopsy. Every 6 months I have a mammograms and MRI. I do not have ultrasound as part of ongoing monitoring. I would think an ultra sound of both breast would take hours. I have never had my estrogen level checked in blood test, and no dr has suggested.

At first the dr was just going to do routine mammograms and I asked to also do MRI due to dense breast.

I am comfortable with this monitoring plan.

Laurie

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@mjay
To add to Laurie's very complete response, the reason why most oncologists don't test for estrogen levels (and other biomarkers like testosterone, leptin, and inflammatory proteins) is that they change from day to day, even without our ovaries. Apparently, the aromatase enzyme is produced in our extra fat cells, and it converts to estradiol (estrogen). The AI (aromatase inhibitor) which you are taking is designed to block that conversion. These extra (total body fat) fat cells also are responsible for long-term, low grade inflammation in our bodies, and that, too, is linked to a higher risk for breast cancer.

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mjay
This was my experience: I also have very dense breasts. I had a 3D mammogram and was told that everything was normal. Two months later I felt what was determined to be a 2 cm nodule in my breast. I was told that I had scar tissue from a previous benign tumor surgery. I did not believe it since my surgery was over 20 years prior. I got a hold of my primary care doctor and relayed my concerns and luckily she approved my getting an ultrasound. I had a rare low grade adeno squamous metaplastic carcinoma tumor that was difficult to identify on mammograms and was only viewed on an ultrasound. Even my local hospital had trouble identifying the tumor and had to send the tumor specimen to Stanford.

Do you think maybe you should insist on an ultrasound?
katrina123

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@katrina123

mjay
This was my experience: I also have very dense breasts. I had a 3D mammogram and was told that everything was normal. Two months later I felt what was determined to be a 2 cm nodule in my breast. I was told that I had scar tissue from a previous benign tumor surgery. I did not believe it since my surgery was over 20 years prior. I got a hold of my primary care doctor and relayed my concerns and luckily she approved my getting an ultrasound. I had a rare low grade adeno squamous metaplastic carcinoma tumor that was difficult to identify on mammograms and was only viewed on an ultrasound. Even my local hospital had trouble identifying the tumor and had to send the tumor specimen to Stanford.

Do you think maybe you should insist on an ultrasound?
katrina123

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Thanks for your input. I will request at my next checkup.

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Same story I am 6 months post surgery and 2 months post radiation my oncologist said med dr don’t do estrogen levels
Maybe a naturopath might but self pay

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@elizm

@mjay
To add to Laurie's very complete response, the reason why most oncologists don't test for estrogen levels (and other biomarkers like testosterone, leptin, and inflammatory proteins) is that they change from day to day, even without our ovaries. Apparently, the aromatase enzyme is produced in our extra fat cells, and it converts to estradiol (estrogen). The AI (aromatase inhibitor) which you are taking is designed to block that conversion. These extra (total body fat) fat cells also are responsible for long-term, low grade inflammation in our bodies, and that, too, is linked to a higher risk for breast cancer.

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That makes sense, although I'm very underweight and was for a couple years prior to finding the lump so not sure what that means for my "fat cells"! -:)

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I had breast cancer in 2017, I had a lumpectomy and radiation. No chemo. I had my yearly mammogram last week, and I've been called back for further imaging. Here is part of the test result. "indeterminate microcalcifications, B-RAD-0, Scattered areas of fibroglandular density." Does anyone have any information about what these findings might indicate? I'm very nervous.

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@sparklegram
B-rad or Bi-RAD is the staging of mammograms. Your Bi-RAD-0 is a good sign meaning they did not find actual cancer, but there is an area they want to look at again, it wasn't clear enough. It was explained to me that after breast surgery or radiation, it is common to have "fat necrosis" where the fatty breast tissue is damaged, but it is not cancerous. I have had to have extra mammograms due to that. So please don't get too worried, but be vigilant. Sometimes the radiologist will follow up with an ultrasound. My radiologist took me aside to go explain all of this and helped me through it. And if you did not have that opportunity, please talk with your oncologist who an explain it better.

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@trixie1313

@sparklegram
B-rad or Bi-RAD is the staging of mammograms. Your Bi-RAD-0 is a good sign meaning they did not find actual cancer, but there is an area they want to look at again, it wasn't clear enough. It was explained to me that after breast surgery or radiation, it is common to have "fat necrosis" where the fatty breast tissue is damaged, but it is not cancerous. I have had to have extra mammograms due to that. So please don't get too worried, but be vigilant. Sometimes the radiologist will follow up with an ultrasound. My radiologist took me aside to go explain all of this and helped me through it. And if you did not have that opportunity, please talk with your oncologist who an explain it better.

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THANK YOU, TRIXIE!!!!

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I had my annual yesterday and it was not clear. I have to go back for an ultrasound…. scared, but hoping for scar tissue. I cant do this all again.

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🙏🏽🙏🏽 Mine is coming up and I think we all get anxious when it does🙏🏽🙏🏽

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@jeaniebean

I had my annual yesterday and it was not clear. I have to go back for an ultrasound…. scared, but hoping for scar tissue. I cant do this all again.

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Oh Jeaniebean! I’m so sorry! You must be so worried and nervous. Please keep us posted here, we’ll all be sending you our love and prayers.

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@jeaniebean

I had my annual yesterday and it was not clear. I have to go back for an ultrasound…. scared, but hoping for scar tissue. I cant do this all again.

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@jeaniebean
I sympathize with you, Jeanie. I have numerous benign calcifications which the radiologists watch like a hawk, and I often get called back for ultrasounds. On the one hand, it's anxiety-producing. On the other hand, I'm grateful that they are doing their best to detect something early.

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@jeaniebean

I had my annual yesterday and it was not clear. I have to go back for an ultrasound…. scared, but hoping for scar tissue. I cant do this all again.

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@jeaniebean When I had my ultrasound recently they came back in and asked if I was having any pain. They did the ultrasound on one breast again and determined it was scar tissue. I know how you feel I was nervous until I was given the all clear. Sending positive thoughts to you that it's just something similar.

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@sparklegram

THANK YOU, TRIXIE!!!!

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So, I went for the further imaging and sonogram on Thursday, and now I have to go back on February 1st for a biopsy. Still nervous!

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