Okay, Within Reason

“You okay, within reason?” the mammogram tech asked me, almost rhetorically, each time before tightening the compressor even more on my right breast and telling me to hold my breath.

She was apparently really focusing on an area they were concerned about.

I was okay (enough) and it still hurt a lot.

Today I had three of the most painful mammogram images that I recall having taken. They typically don’t phase me that much and I’ve often likened them to getting bitewing x-rays of my teeth.

It’s been almost six years since the last time I got called back after a routine annual mammogram screening and yesterday it happened again.

I’ve been called back four times before (2016, 2018, 2019 and 2020). Two of those times led to biopsies (2016 and 2019) and one of those led to surgery (2016).

I was initially told that the breast center staff would contact me to schedule the follow up and thus thought I had to wait overnight before next steps. My gynecologist didn’t seem concerned, which I found reassuring. That said, between my own and others’ experiences with breast care scares, I was feeling anxious.

This morning I ended up getting a “letter” from the Breast Imaging Center telling me to contact them. I was able to schedule a “Mammo Additional Views” follow up mammogram and ultrasound for this afternoon in the NW suburb of Vernon Hills (about 30 minutes from Evanston).

I took a half sick day, since they scheduled 30 minutes for the mammogram at 1:00 p.m. and 30 minutes for the ultrasound at 2:00 p.m. I knew that I would get the results while I waited, which I really appreciate in these situations.

When I flash back to my routine ultrasound yesterday morning, I recall the tech (who was super nice and chatty) taking an additional image of my right breast. I don’t recall the exact reason she gave, however it didn’t concern me in real time. I realize now that she may have noticed something. We were chatting about how I was not feeling great, because I got my second Shingles vaccine on Monday around lunchtime and was experiencing side effects (super sore arm and somewhat sick with flu like symptoms), and when she said she hoped I wouldn’t be back for a year I took that as a good sign. I’d taken a planned sick day off work for appointments, both because of my mammogram and in anticipation that I might feel off after the Shingles vaccine (which I did).

The ultrasound tech today was kind and had big hair sprayed bangs (which fit my childhood stereotype of Vernon Hills — where one of my middle school friends, who liked to style their bangs in the shape of a flower, had moved from in 7th grade). After the tech took those three super painful (within reason) images she checked in with the radiologist about whether any more were needed and confirmed they were not.

Next, I was brought to the ultrasound room and another medical team member got me set up on the exam table. I had to wait for awhile for the radiologist, who apparently does her own ultrasounds there, to make her way to the room. As I layed there, I rested my eyes, did some box breathing and thought about the vast number of ultrasounds I have had in my adult life, mostly related to pregnancies and secondary infertility. Though, at this point I have more than a few related to breast care.

When the radiologist arrived she did a fairly quick ultrasound scan and appeared to be taking some measurements of the “mass in the central outer right breast at middle depth,” which is how it had been described in the “Abnormal Mammo” test results from yesterday.

Then she explained to me that the mass is a slightly concerning (I think she actually said “complex,” but didn’t remember that until I read the report later) cyst in my right breast and they want me to follow up with another mammogram and ultrasound in six months, which I already scheduled for Skokie in September — on my mom’s birthday (which I typically take off as a mental health day, since she died in July 2023). I took the Vernon Hills option today since they had a cancelation and could get me in there.

The official test results and message from my gynecologist said that:

“Everything continues to look stable. For ‘Bi-rads 3’ we repeat every six months for two years and if things continue to look stable, then we can switch back to yearly. For now: The radiologist recommends repeating right breast ultrasound and mammogram in 6 months, to ensure everything continues to be low risk for breast cancer.”

More details include…

IMPRESSION: Complex cyst 9:30 right breast 6 cm from the nipple seen on ultrasound correlating to a new mammographic mass. Six-month follow-up right diagnostic imaging is recommended. The findings, recommendations and imaging were discussed by the doctor.

BI-RADS: 3

FINAL REPORT
Mammography Assessment: 3-Probably benign

Recommendation: Follow-up at short interval

Breast Density: Scattered areas of fibroglandular density.

RIGHT DIGITAL DIAGNOSTIC MAMMOGRAM: A mass is confirmed in the outer/slightly upper right breast.

RIGHT BREAST ULTRASOUND: Targeted right breast ultrasound demonstrates a 6 mm x 4 mm x 7 mm slightly complex cyst with internal septations at 9:30 right breast 6 cm from the nipple.

I have had to follow up like this before (though not every six months for two years) and will review my notes/previous blog posts more thoroughly about how my past experiences played out.

I did see that in 2020 when I got called back the cyst was rated as BI-RADS: 2 – Benign and I didn’t have to return for another year. So, I am noting that this one is BI-RADS: 3 – Probably benign.

I found this explanation about BI-RADS (breast imaging-reporting and data system) on the Cleveland Clinic website informative.

This is what it says about BI-RADS 3 – Probably benign finding:

The findings in this category have a greater than 98% chance of being benign (noncancerous). But as it’s not proven to be benign, the radiologist wants to monitor it to be sure it doesn’t change over time. You’ll likely need additional imaging (like mammogram, ultrasound or MRI) in six months.

So, it’s not the best and not the worst news. I’ll take it!

I recognize that the odds are in my favor and it is still hard to wait. I am also reminding myself how common this is, as my sister told me yesterday I have shared with her in the past when she got called back.

I am choosing to focus on the “probably benign” part and am feeling okay, within reason.

*****

Here’s a list of my previous breast (s)care posts, which I appreciate being able to review as needed and hope they help anyone who might find them useful now or in the future:

Cutting to the Chase (1/11/16)

Biopsy Day (1/16/16)

Benign Phyllodes Tumor (1/18/16)

What Happens Now (1/26/16)

Second Opinion Day (2/15/16)

A Good Problem to Have (2/16/16)

Asymmetry (2/17/16)

Surgery On Monday (3/18/16)

All Clear (3/26/16)

A Questionable Finding (12/15/18)

High Probability of Being Benign (12/20/18)

Expect the Unexpected (8/6/19)