First Mammogram Post-Lumpectomy

January 13, 14, and 16, 2012

So, on Friday I returned to the scene of the mammogram which catapulted me on an unexpected journey last year.   Last year’s mammogram – the one with the “suspicious abnormalities” – took me on my journey to a DCIS (ductal carcinoma in situ) diagnosis and lumpectomy.  This was to be my first follow-up mammogram – almost five months after my bilateral surgery on August 22^nd of last year.

I went there feeling calm.  I was not future-thinking or worrying and stressing.  But truthfully, that was probably because I was multi-tasking big time – trying to communicate and coordinate with a sister, a niece, and another caregiver about a doctor appointment for my mother that morning which had been scheduled just the night before.  I wasn’t thinking about the mammogram; I was just concerned with getting there on time while simultaneously making about five phone calls.

Anyway, long story short, the (really wonderful) technician took two x-rays of each breast and showed them to the radiologist who then ordered close-up shots of the surgery site.  The upshot is he found “one calcification”  – right next to the place where tissue had been removed during the lumpectomy.  We’re not quite sure what to make of it.  Does that mean they didn’t get it all after all?  Even though the pathology report said that the margins were clear last August?  Or is this something that happened as a result of surgery?  Apparently calcifications can form after cell injury.  Apparently it’s not unusual to have some appear after surgery and radiation.

This particular  radiologist hadn’t seen me since May 31, 2011.  He hadn’t known until he saw my surgeon’s order for this mammogram that I’d been diagnosed with DCIS and had had surgery on each breast.  He also didn’t have access to my pathology report, so he didn’t seem to have a clear idea of what that “one calcification” meant.  (Or if he did, he wasn’t letting on.)  He said he would call my surgeon to talk with her.

I kind of thought I might have heard from her by now, but alas, no such luck.

I guess I was a bit surprised by what they found but I don’t think any shock or panic showed on my face.  Instead I continued to smile, be polite, ask a question or two.  (Feels kind of strange admitting that, but smiling is usually fairly second nature for me.)  He did ask me a few questions about whether I’d had radiation therapy (RT) or not.  I’m not positive why he was asking.  It could be he was surprised I didn’t get RT (which is how I took it at the time) or it could be because apparently RT can result in some calcifications. (I found this out during later research.)   I suspect he was trying to get a feel for how “suspicious” this one lonely calcification was.  I kind of feel sorry for him having to do a report on this.  How is he going to rate this one little calcification?  How will he determine how “concerning” it is?  (To use a term mentioned in my radiology report last June.)

Mammograms are rated using the BI-RADS system (Breast Imaging and Reporting Data System.)  Radiologists rate their findings 0 through 5. You may recall that my mammograms and ultrasounds last year “earned” a 4.

The wonderful chart explaining these ratings would not copy to this blog.  However here is the verbal description of how a radiologist determines a rating:

“A negative diagnostic examination is one that is negative, with a benign or probably benign finding (BI-RADS 1, 2 or 3).
In BI-RADS 3 the radiologist prefers to establish the stability of a lesion by short term follow-up.
In the evaluation of your BI-RADS 3 lesions the malignancy rate should be < 2%.
A positive diagnostic examination is one that requires a tissue diagnosis (BI-RADS 4 and 5).
In BI-RADS 4 the radiologist has sufficient concern to urge a biopsy (2-95% chance of malignancy).
In BI-RADS 5 the chance of malignancy should be > 95%.” http://www.radiologyassistant.nl/en/4349108442109

The radiologist seemed to be unsure what to make of this one microcalcification, so I’m going to guess he’ll rate it a 3 or 4 based on what my surgeon tells him.  I imagine they won’t be able to say it’s definitively benign, so I’m guessing it won’t be a 2.

By the way, macrocalcifications are not concerning.  It’s only the microcalcifications which are.  For those late to this party, here is a brief summary on breast calcifications:

“On a mammogram, breast calcifications can appear as large white dots or dashes (macrocalcifications) or fine, white specks, similar to grains of salt (microcalcifications). Macrocalcifications are almost always noncancerous and require no further testing or follow-up. Microcalcifications are usually noncancerous, but certain patterns can be a sign of cancer. If calcifications are suspicious, further testing may be necessary, including additional mammograms with magnification views or a breast biopsy.”  http://www.mayoclinic.com/health/breast-calcifications/MY00101

How do I feel about all this?  Well, on the one hand, ONE calcification can’t be too scary.   First of all, there’s a great possibility it is a byproduct of the surgery itself and therefore completely benign.  And if it is cancerous, it’s only one little spot of it.  But to be honest, one of the things I started to do after listening to the radiologist was second-guess my decision not to do radiation therapy.  RT is supposed to get whatever stray cells weren’t removed during surgery.   It is usually considered “standard  operating  procedure”  to get radiation therapy following a lumpectomy.  Perhaps I was hasty in my decision to not go that route.  Perhaps I should have considered it after all.

I have discovered that microcalcifications often form at the lumpectomy “bed.”  In a study of 402 patients who had a lumpectomy followed by radiation therapy, 68 developed new calcifications.

The results of the study were: “In 63 cases (93%), the new calcifications developed in the same quadrant as the primary tumor. None of the calcifications initially interpreted as BI-RADS category 2 (n = 40/68; 59%) and category 3 (n = 19/68; 28%) represented recurrent disease. Nine (13%) of 68 calcifications were initially classified as BI-RADS category 4 or 5; six (67%) of the nine were malignant and three (33%) were benign at biopsy.”  http://www.ajronline.org/content/188/2/393.full

You realize, of course, that I am no expert AT ALL on any of this stuff.  The purpose of this blog is to share my experiences, my thoughts, my emotions, and the research I do.  I imagine in a few months or years some of my thoughts and conclusions will seem incredibly naive or even ridiculous, but you are getting a view of what it’s like for a woman as this stuff happens.

Anyway, after worrying a bit, I decided to pull a couple cards from some oracle decks.  The card that resonated with me the most spoke about the power of the words we use and suggested it was a good time for affirmations.  “Say it is so – and it will be so,” the author declared.  SO!  I declare that I am healthy!  (And I do feel healthy!)  I do believe that if I continue to be vigilant with my diet, I will be healthier than I’ve been for many years.  (In fact,  already I have lost weight  and have much more energy.)

Perhaps the whole reason for this one little calcification is to remind me to continue to be vigilant.  I can’t afford to get complacent.  I have to be very conscious of my choices.  My health absolutely depends upon what I feed my body and how I care for my physical, emotional, and spiritual self.

I do want to conclude by reminding myself that even though I can let myself get a bit worried, what I am experiencing is NOTHING compared to what many people on the planet are experiencing.  I am supremely conscious of my friend who only a short month or so ago discovered that her excruciating back pain was the result of cancer which had, unbeknownst to her, formed in multiple places throughout her body.  I think of her often.  It certainly helps me keep my tiny little health issue in perspective.

However, even though my health issue may be minor compared to others’ issues, I know it’s important for me to document this process so that women who go through a similar journey can learn and/or perhaps not feel so alone in their process.  Also, when I write, it helps me to process things.  Also, it’s much easier to write this blog post than to tell every friend and acquaintance the details of what happened!

Thanks for rooting for me, everyone!

May you be blessed.