birad 3 again?

Posted by andreag @andreag, Feb 12 12:01pm

I'll try to be as brief as possible - anyway June of 2023 i was referred by my family doctor for a mammogram and ultrasound of left breast due to some weird breast sensations..kind of like this weird internal itching feeling, and i had a rash on my left armpit. Never did figure out the rash and i still have it, but it's not getting worse. - anyway, that work up revealed an indeterminant lesion, given a birad 0 and was referred to a local cancer centre for a full work up - july of 2023 i was seen at the cancer centre, did tomosynthesis and ultrasound of left breast with radiologist present, mass they were concerned about turned out to be glandular tissue but they did find another mass, not seen on other ultrasound and was determined to be isoechoic, was given a birad of 3, told to come back in 6 months. So i had that follow up appt - did another mammogram and ultrasound, i didn't personally see the radiologist this time but radiologist said in her report the mass is stable and i was given another birad 3 - it is slightly larger but not significantly larger, only my 1 mm or but morphology is the same and it hasn't changed shape. i do have access to my scans and it actually looks more hypoechoic than isoechoic but hey, i'm not a radiologist but it does look noticeably different. I have an appt with the oncologist to discuss these results on Feb 23. I should also add my birth mom (i was adopted) was diagnosed with a stage 1 BC in her left breast around the time i was waiting for my first appt and DCIS in her right breast. I guess my question is, if it's stable, why is it still a BIRAD 3? I realize the chance that it's cancer is low but to me this doesn't mean that there is a 0% chance it's cancer, otherwise it would have been downgraded. I do plan on asking the oncologist this but i also want to push for a biopsy but i'm so worried as being seen as "that patient." does it make sense to at least ask for a biopsy, even if just for piece of mind? and i still have the weird breast sensation/itchy feeling for which i've never been given any explanation for. I'd rather not wait another 6 months. also i don't know if it's relevant but i have a TIRAD 4 nodule on my thyroid that is being biopsied on March 6 - i say i don't know if it's relevant because i don't know that there is a correlation between breast and thyroid cancer - i do plan on asking the oncologist this when i see but thought i'd ask - thank you

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I hope you can get a biopsy. I can't imagine why not. The issue has not gotten worse but it hasn't resolved and may even look different, as you say. That is a long time to be anxious or concerned. Keep us posted!

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I had itching too. It started itching intermittently. It was on and off about 2 years or so before I thought to say something. The NP that I was seeing ordered a mammogram along with the ultrasound because she thought she felt something and because of the unexplained itching. I was told nothing to worry about. But about 18 months later I have a 16 mm lump. I had Stage one no lymph nodes involved. I’ve had a lumpectomy and 19 treatments of radiation. No chemo. I have no itching now. I know the itching was the cancer. So keep pushing. Keep asking questions. So what if you’re That patient. Who cares. You have advocate for yourself!!! I have had to. We all have to. Still do.
God Bless you.
Glenda.

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You seem to have a good understanding of your medical situation. The part of your comment that popped out at me was " i also want to push for a biopsy but i'm so worried as being seen as "that patient." does it make sense to at least ask for a biopsy, even if just for piece of mind?"
I'm also often worried that I'll be perceived as a difficult patient. I'm not even sure where this fear comes from, as I'm usually on congenial terms with my doctors. But I do have it. I'm guessing that if you use your question as a way to open communication, and even test out how well you and the doctor can communicate, things will go smoothly. The doctor is there in part to address your concerns. Plus, you can always get a second opinion. How are you feeling going forward?

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@mir123

You seem to have a good understanding of your medical situation. The part of your comment that popped out at me was " i also want to push for a biopsy but i'm so worried as being seen as "that patient." does it make sense to at least ask for a biopsy, even if just for piece of mind?"
I'm also often worried that I'll be perceived as a difficult patient. I'm not even sure where this fear comes from, as I'm usually on congenial terms with my doctors. But I do have it. I'm guessing that if you use your question as a way to open communication, and even test out how well you and the doctor can communicate, things will go smoothly. The doctor is there in part to address your concerns. Plus, you can always get a second opinion. How are you feeling going forward?

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I'm feeling more confident that i can push for at least a second opinion - i'm hoping for a biopsy but i will settle for if they can even have a different radiologist take a look. I have a history of being dismissed by doctors, has happened most of my life. A few years ago i had weird symptoms like being tired all the time, having to pee a lot, i asked my family doctor for bloodwork to check for type 2 diabetes as i have a strong genetic tie to that - he dismissed me..told me "you're just a busy mom with 3 kids." I had to push flor bloodwork, finally he agreed and what do you now, i was diagnosed with Type 2 diabetes. i need to worry less about being seen as "that patient." it's funny because i work at a family health team (i'm a social worker) and i work with doctors who often complain about patients who want one more test, or want this or that and how they sometimes feel personally offended. I met this oncologist 6 months ago after my first appt at the cancer centre - she seemed nice enough i suppose but was pretty dismissive. i'm going in "armed" with questions and valid reasons why this needs to be looked at further - i'm also bringing a friend with me, who used to be a nurse at the clinic where i work, just for support and maybe articulating the medical side of it if i am struggling to do that.

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You were so right to get tested for type 2 diabetes. I'm glad you got the correct diagnosis. Great to bring a friend. I did learn that early in my cancer process--my husband comes to everything and even his quiet presence is a support. Very interesting what you have learned from working with doctors. (I've heard something similar from doctors I know.) Because of the hierarchy of the situation doctors have the information, and I need to remind myself that I'm the ultimate authority--on myself, that is. Wishing you all the best.

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Hello @andreag sadly I think a lot of us fear being “that patient” , I also had kind of a weird sensation like an internal itch, for about 6 months before I noticed the lump of invasive ductal cancer.
I believe that as long as we are respectful, we should be included in our health decisions. I also have been dismissed only to find out there was a real problem later, statistics show that this is definitely more common with women.
Ask for your biopsy, this might be one of your reasons already, but here was mine. If it turns out to be something we caught it early on and I have less treatments to fix it, it it turns out to be nothing, I don’t have to have to live in fear for the next 6 months or year.
Insurance may create another hurdle, hopefully not but you may need to be prepared to have the same conversation with them. Sigh.
Will you come back and let us know how your appointment goes tomorrow?

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@auntieoakley

Hello @andreag sadly I think a lot of us fear being “that patient” , I also had kind of a weird sensation like an internal itch, for about 6 months before I noticed the lump of invasive ductal cancer.
I believe that as long as we are respectful, we should be included in our health decisions. I also have been dismissed only to find out there was a real problem later, statistics show that this is definitely more common with women.
Ask for your biopsy, this might be one of your reasons already, but here was mine. If it turns out to be something we caught it early on and I have less treatments to fix it, it it turns out to be nothing, I don’t have to have to live in fear for the next 6 months or year.
Insurance may create another hurdle, hopefully not but you may need to be prepared to have the same conversation with them. Sigh.
Will you come back and let us know how your appointment goes tomorrow?

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Thank you for your response! i think how you phrased it is a good way for me to explain it to the oncologist. I'm so anxious, i feel sick to my stomach and i'm not anxious about if it's benign or malignant - i'm already anticipating being dismissed and how she will respond. I am bringing a friend with me - she's a nurse that i used to work with and she "speaks doctor" so i think it will help me to have her there. i will certainly come back tomorrow and let everyone know how it goes. I'm on canada so we have OHIP (provincial health coverage) most things are covered as long as the doctor orders whatever test, etc.

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Hello @andreag. Hope you can get the biopsy soon. I think you should ask for an MRI.
Wishing you all the best!!

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Thank you for all the support! Unfortunately the appointment with the oncologist went as i expected it to go. She was pretty dismissive, but was polite about it. She kept saying "I trust the expertise of our radiologists." I showed her the scans that i screen shotted and even she agreed it looked different but because it's not her area of expertise, she couldn't comment one way or the other (which is fair i suppose). She flat out said they never ever biopsy birad 3, even though i found articles that support doing a biopsy with changes (that don't include it getting much larger) but have other symptoms (like the itching) and risk factors. I asked her if she could at least recommend a different radiologist to look at the scans for a second opinion and she said no and again kept saying "i trust their expertise." I pointed out that even good doctors make mistakes. She told me i could call the radiology department and ask for a second opinion, but they will likely say no. Or i can go back to my family doctor and ask him for a referral to a different radiology clinic. Otherwise, it's just "come back in 6 months for another scan." I'm not sure what i will do yet. i'll probably call the radiology department on monday to at least ask. I'm also pissed because i have access to my "after visit summary" and she didn't note any of my concerns (the intermittent itching ) and said "Patient did not express any health concerns." At the very least i'm contacting the hosptial to complain about that - her visit notes should at least be accurate. i don't know why she would do that. maybe some sort of liability thing - i also want it documented that i asked for a biopsy and want her to include her reasoning of why that would not happen - she did say only the radiologist can recommend a biopsy and they won't for birad 3 but i want her to document that. I'm wondering if, by the very small chance, i come back in July and it is actually cancer, then they are "covered" with their inaccurate reporting. so i'm disappointed but not surprised. thanks again

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@andreag

Thank you for all the support! Unfortunately the appointment with the oncologist went as i expected it to go. She was pretty dismissive, but was polite about it. She kept saying "I trust the expertise of our radiologists." I showed her the scans that i screen shotted and even she agreed it looked different but because it's not her area of expertise, she couldn't comment one way or the other (which is fair i suppose). She flat out said they never ever biopsy birad 3, even though i found articles that support doing a biopsy with changes (that don't include it getting much larger) but have other symptoms (like the itching) and risk factors. I asked her if she could at least recommend a different radiologist to look at the scans for a second opinion and she said no and again kept saying "i trust their expertise." I pointed out that even good doctors make mistakes. She told me i could call the radiology department and ask for a second opinion, but they will likely say no. Or i can go back to my family doctor and ask him for a referral to a different radiology clinic. Otherwise, it's just "come back in 6 months for another scan." I'm not sure what i will do yet. i'll probably call the radiology department on monday to at least ask. I'm also pissed because i have access to my "after visit summary" and she didn't note any of my concerns (the intermittent itching ) and said "Patient did not express any health concerns." At the very least i'm contacting the hosptial to complain about that - her visit notes should at least be accurate. i don't know why she would do that. maybe some sort of liability thing - i also want it documented that i asked for a biopsy and want her to include her reasoning of why that would not happen - she did say only the radiologist can recommend a biopsy and they won't for birad 3 but i want her to document that. I'm wondering if, by the very small chance, i come back in July and it is actually cancer, then they are "covered" with their inaccurate reporting. so i'm disappointed but not surprised. thanks again

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I got 4 opinions when I had cancer. The 4th doctor listened to every concern and addressed each with new testing, most of it repeat testing. The other three were dismissive (but nice about it). I hope you find an oncologist who listens to your concerns and addresses them to your satisfaction.

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