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The Mammogram, the Ultrasound, and ‘the Look’

The Mammogram, the Ultrasound, and ‘the Look’

Living with Triple-Negative Breast Cancer
(#3 in a series)

It was a mammogram unlike any I had before. Some women find mammograms painful or embarrassing, but they never really bothered me. However, this was not a routine mammogram. This one was scheduled because I found a large lump in my right breast. This time I knew there was something in particular that needed closer examination, and I was not quite as nonchalant about the whole process.

After changing into the gown, I was ushered into the mammogram room and asked to point out the lump. Other than that, there was no difference in the way the procedure was performed. Then I proceeded to a small waiting area, still in the gown, to await an unseen doctor’s opinion.

Soon a nurse informed me that the doctor requested an ultrasound of the right breast. Her face was difficult to read, giving no hint of urgency. She inquired about my schedule, but by now I was seeing red flags. That schedule suddenly became irrelevant, as the lump in my breast moved to the top of my ‘to do’ list.

A quick call to work to tell them of my delay, plus a phone call to a worried husband, and I found myself in the ultrasound room.

Breast Cancer Fact: Ultrasounds Can Help Distinguish Between Cysts and Solid Masses
From “Ultrasounds produce sharp, high-contrast images. In dense breast tissue, the ultrasound can create an image that often allows a doctor to distinguish between a fluid-filled cyst and a solid mass. Often, breast abnormalities that are suspected to be cancerous after a mammogram can be identified as benign with a follow-up ultrasound examination. Benign breast abnormalities can include cysts and plugged milk ducts. If your doctor sends you for an ultrasound, it doesn’t always mean that you have cancer — just that a clearer picture of your breast is needed.”

The friendly, young technician who performed the ultrasound took time to explain what she was doing and periodically checked on my comfort level. An ultrasound is a noninvasive, painless procedure, and Stephanie chatted animatedly with me and with an observant trainee. She was very thorough, working with precision and confidence, while recording dozens of images.

After completing the task to her satisfaction, Stephanie wanted her trainee to have a turn. As they traded places, they exchanged “the look.” You know the one I mean. It’s never good when other people in the room exchange “the look” with each other, but not with you. I had a feeling the day was about to get more intense.

Then it was off to meet Dr. H in Diagnostic Radiology. The results of my mammogram from 13 months ago, along with the new one, were displayed on the screen. Even a layperson like me could see the obvious changes.

In his best “it’s not good news but I don’t want to scare you” voice, Dr. H informed me that in addition to the large mass I discovered at the 12 o’clock position on the breast, there was another, smaller mass at the 10 o’clock position. By the looks of the mammogram and the ultrasound, he was quite certain they were not cysts or blocked ducts. He was friendly and empathetic, speaking in a soft, calm voice, but something in his manner implied that he knew more than he could say at the moment.

The biopsy was scheduled for the very next day. The fast-track didn’t bode well, but I was determined to remain calm and hopeful.

I hadn’t asked many questions about the biopsy, probably because I didn’t expect things to get that far. I’ve always been told that I have very dense breast tissue, so I was more than willing to believe that would contribute to a false result.

Rather than phone my husband with this bombshell, I skipped work and drove straight home to deliver the news in person, all the while figuring the biopsy would be the end, not the beginning.

After careful consideration, we decided not to tell the family about the situation until we received biopsy results. No sense worrying anybody over nothing.

As I crawled into bed that night, I reminded myself that most breast lumps are noncancerous. I wanted to ease my husband’s level of concern, but knew it was a futile effort. He’d already seen me through so much, and I did not want to believe I was taking him down that road again. If we must travel that road, at least I had the comfort of knowing we would travel it together.

The biopsy would take place exactly one week after I first discovered the lump. Time was beginning to move oh, so slowly. One way or another, that biopsy promised to be a turning point.

Author’s Note: This is article is part of a series chronicling my first-hand patient perspective of life with Triple-Negative Breast Cancer. Without being overly self-indulgent, I hope to convey the raw emotion that comes with such a diagnosis… and the process of living with and beyond it. Entries will appear in Care2 Causes and in Care2 Healthy & Green Living. Follow on Twitter @AnnPietrangelo

Living with Triple-Negative Breast Cancer Series
#1 The Lump in my Breast: Meeting the Enemy
#2 Most Breast Lumps are Non-Cancerous: Would mine be?

Access the up-to-date Living with Triple-Negative Breast Cancer Series

For More Information:
Triple Negative Breast Cancer Foundation
American Cancer Society


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8:10AM PDT on Apr 24, 2013

Thank you for sharing.

9:16AM PDT on Apr 8, 2011

Ann, thanks for sharing your story. I am a radiologist (physician) specializing in breast imaging (mammo, ultrasound, and MRI). I deal with this on a daily basis. To answer a prior question of why not just do an ultrasound: mammography and ultrasound are complementary ways to look at tissue. Mammography gives a global view of the tissue, while ultrasound is used to further define and characterize an area of interest. Mammograms can identify calcifications which are often associated with a mass and can show how large the area of disease is. However, these calcifications are not well-seen on ultrasound. Using both mammo and ultrasound (and sometimes MRI) gives the most complete picture of what is going on, and this allows us to make the most informed decision about how to treat (i.e. lumpectomy vs. mastectomy +/-chemo and radiation).

8:11AM PDT on Apr 6, 2011

Thank you

12:32AM PDT on Apr 6, 2011

Hang in there, Ann; and thank you so much for making us more vigilant in the care of our own bodies! I will keep you in my thoughts and prayers.

4:20PM PDT on Apr 5, 2011

Thank you Ann.

12:39PM PDT on Apr 5, 2011

This past mammogram, they saw a mass that was larger & ordered an ultrasound. I can sympathize with the lady writing this article. It was interesting to watch the photo of the mass on the screen & the contrast ... They decided it was a cyst and wanted to drain it that day - I had to agree to a biopsy if they went in and nothing came out... Thankfully, it was relatively painless and I got to watch as the fluid drained out & where there was a black hole there was now tissue showing.
I was very lucky.
I hadn't felt anything lump or otherwise - but if I did, I would make an appointment right away.

11:58AM PDT on Apr 5, 2011

Grace Adams is correct. Thermograms are the best method for discovering 'very early' lumps that are forming. They work without 'radiation' or squeezing the breast tissue which further spreads cancer if it is there. There must be a REALLY BIG grip by the mammogram industry on the medical profession and medical equipment industry in this country. Physicians KNOW that thermography is BETTER in finding very early changes. Why don't they join together and FORCE changes???

10:18AM PDT on Apr 5, 2011

I was never offered the ultrasound, which had I known, it may have saved me from the irregularities in my diagnosis. I did have pt/ct scans and somewhere in there I had an MRI. However, it wasn't until I had my mastectomy that a biopsy on a questionable lymph node; during my surgery, was taken and it was decided to remove that node. Then, another node was discovered and I was back into the operating room several days later. Again, a third time and a third node removed. That's two additional surgeries and I still question why all of this wasn't immediately discovered along with the original node.
I suffered unmercifully with chemo (note, I live alone and had to take care of myself). Then, along came the radiation treatments.
Finally, I thought I was done, but never did feel well again. I started having a terrible time walking and both legs were in excruciating pain. More pt/ct scans that found both of my femur bones were cancerous; more radiation, but I feared the possibility of more chemo which I made up my mind I would not go through again.
I still have trouble walking and have never felt good again; a period of over three years.
I assume I'm just one of those people that will continue being attacked by this terrible disease; runs in my female family.
I pray for every single person who suffers with cancer and that they will do everything they can to be well.

10:17AM PDT on Apr 5, 2011

Thank you Ann for sharing this, you are brave and strong. You are in my prayers, God bless.

9:59AM PDT on Apr 5, 2011

i have the same question as Grace. Does anyone have an answer to this? A lump was already identified, so why even do the mammogram? Wouldn't it have been better (more efficient, less radiation) to go directly to the breast ultrasound?

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