Friday, April 28, 2017

40,000 deaths from breast cancer in 2012

Here are the statistics on breast cancer and biopsy in 2012, as found in BasicMedicalKey.com by Darryl Carter, 5th ed.:

In 2012 in the United States, there were 230,000 new cases of breast cancer, 99% of them in women, with nearly 40,000 disease-specific deaths (1). A much larger number of lesions were detected on clinical and radiographic breast examinations, and many of these were sufficiently suspicious of cancer to result in a biopsy. Ultimately, it is the responsibility of the pathologist to distinguish those of the biopsied lesions, which require additional attention or treatment from those which do not. In addition, the pathologist must integrate and disseminate an increasingly complex set of pathology-derived data to radiologists, surgeons, and medical and radiation oncologists to achieve optimal clinical results.

Apparently, calcifications are often seen in mammograms and are often an indicator of cancer cells. This paragraph describes core needle biopsy and fine needle biopsy.

  NEEDLE BIOPSY
Core needle biopsy (CNB) has the advantage over fine-needle aspiration (FNA) of allowing identification of benign entities and localization of calcium deposits with the result that the proportion of indeterminate and inadequate specimens is far less. Distinction between in situ and invasive carcinoma may also be more readily accomplished, and predictive markers (estrogen receptor [ER], progesterone receptor [PR], HER2/neu, etc.) can be better evaluated. However, FNA may be done more quickly with a diagnosis of malignancy at the time of outpatient visit. In the evaluation of CNB, problems are encountered because of the limited size of the specimens and, not infrequently, the presence of crush artifact. Other problems include potential destruction of lesional tissue by hemorrhage or infarction and displacement of benign epithelium to simulate invasive carcinoma (3), although displacement of epithelium has also been reported following localization by guide-wire for excision of a mammographic abnormality (4). CNB of nonpalpable lesions requires radiographic guidance by either ultrasonography or stereotactic mammography. In CNB performed to evaluate microcalcification, it is important that the calcifications be identified on specimen radiographs (5) and confirmed in the histologic sections, even though calcifications imaged on radiographs are often larger than those seen histologically. Calcification is rarely seen in FNA. Uncertainty in the interpretation of a CNB or the finding of significant atypia should lead to open biopsy. In patients receiving neoadjuvant therapy, CNB specimens may be the only histologic evidence of cancer if there is a complete response.

And much more... to keep reading, go to the site: http://basicmedicalkey.com/breast-4/

Biopsy Result: No Cancer

It's all part of the cancer dance: biopsies that are positive for cancer cells and biopsies that are negative.

I got a call from my doctor this morning: "Good news: there was no cancer found in your biopsy.  The calcifications we saw in your mammogram were caused by columnar cell change and fibrosis."

I thanked her, and she told me to come back in six months, not a year, for another mammogram of the right breast only.

We pause here for a moment of gratitude dedicated to the Creator and to the incredibly complex universe of atoms, molecules, cells, and organisms that She caused to be.

I'm a free person again: no lumpectomy, no change in my status as a survivor.  I still have a 1-in-10 chance of the cancer found three years ago metastasizing.  If this biopsy had found cancer, I think my odds for long-term survival would have gone down.

The next step, of course, was an internet search:  what is columnar cell change?  And what is fibrosis in a breast?

And of course, columnar cell lesions of the breast can later develop into cancer.

Here's a discussion of columnar cell lesions from breast-cancer.ca :


Columnar cells are epithelial cells which have an elongated shape with a height about 4 times the width. Columnar cells are a normal part of functional breast ducts and TDLU’s, but sometimes they develop in unusual ways, or grow more rapidly than one would expect.
But if a women and a physician are talking about columnar cell lesions at all, in all likelihood following a breast cancer screening mammogram and subsequent microscopic analysis of a fine needle aspiration tissue sample, it means that there is either absolutely nothing to worry about, or if there is anything potentially worrisome, it has been identified at the earliest possible stage, in fact, too early to even warrant further investigation let alone treatment.
And, if by chance a columnar cell lesion were after some time to develop into something resembling ductal carcinoma in situ, it would be picked up and treated before developing into anything serious.
What I had before, in the left breast, was invasive ductal carcinoma (cancer of a milk duct that has grown a little beyond the duct).  In situ means still in place, inside the duct.

columnar cell co·lum·nar cell (kə-lŭm'nər) 
n. 
A cell, usually epithelial, that is tall, narrow, and somewhat cylindrical.
The American Heritage® Stedman's Medical Dictionary
  • Epithelial tissue is composed of cells laid together in sheets with the cells tightly connected to one another. Epithelial layers are avascular, but innervated.
  • Epithelial cells have two surfaces that differ in both structure and function.
  • Glands, such as exocrine and endocrine, are composed of epithelial tissue and classified based on how their secretions are released.

... an epithelial cell that is shaped like a column; some have cilia. Synonyms: columnar epithelial cell Types: spongioblast. any of various columnar epithelial cells in the central nervous system that develop into neuroglia. ... one of the closely packed cells forming the epithelium.

columnar cell - Dictionary Definition : Vocabulary.com

https://www.vocabulary.com/dictionary/columnar%20cell

Fibrosis and Simple Cysts in the Breast

Many breast lumps turn out to be caused by fibrosis and/or cysts, which are non-cancerous (benign) changes in breast tissue that happen in many women at some time in their lives. These changes are sometimes called fibrocystic changes, and used to be called fibrocystic disease. 

Fibrosis and/or cysts are most common in women of childbearing age, but they can affect women of any age. They may be found in different parts of the breast and in both breasts at the same time.

Inside your breast...

Here's everything you ever wanted to know about the structures inside your breasts and the various types of lesions (from benign to cancer) that can develop in them.

http://basicmedicalkey.com/breast-4/

This website has photos of cells and their changes, as well as diagrams of the ducts and how they change during lactation.

Wednesday, April 26, 2017

My Stereotactic Needle Biopsy


I walked out of the medical office and into the bright sunlight under a blue sky, glad to escape from the radiology equipment, computer screens, and radiologic technicians that had surrounded me for the previous two hours.  

I walked self-consciously, grateful for mobility and my strong legs.  Eighteen days earlier I'd been sitting by the bedside of Kathleen Mirante, no longer able to walk, dying of uterine cancer that had moved to her lungs.  

She has passed on to another state of being.  I am still here, emerging into the bright sunlight after a stereotactic needle biopsy with post clip.  Grateful.  

In my mammograms last Friday, three years after cancer was discovered in my left breast, there were spots of calcium in my right breast.  They are very small, seven specks in a cluster, looking like the Pleiades, fleeing Orion in the night sky. 

"These could be the sign of a tumor," Dr. Geeta Iyengar told me last Friday, recommending a biopsy.

Three years ago I lay on a table as she found the right spot, numbed the area, and shot the thin needle in, sucking out a bit of tissue from the tumor.

This time I was sitting up with my right breast squeezed flat by a mammogram machine that enabled her to pinpoint the spot on a computer screen before a needle stabbed in and sucked.  Above me hung one of the crystal chandeliers that give patients something to see while looking up.  There's one in every room. 

Actually the name of the machine is Selenia Dimensions, and it is accredited by a college:


This equipment has been accredited by the
American College of Radiology
while in service at

As my breast was being pushed into place and my arm lifted away, I realized, "I'm being woman-handled."  The doctor and her two radiologic techs are women.  I felt safe and secure during it all, grateful that no men were involved.

This procedure costs $2,200 -- but I think Medicare will pay for it.

Dr. Iyengar told me to return Friday for the report after the tissue is analyzed.  I wonder why she didn't just handle it by a phone call.  Does the appointment mean that there's at least a 50% chance that it is another cancer?

Waiting to see... like three years ago.    

[Note on Friday: I received a call from Dr. Iyengar at 9:30 am telling me that the biopsy was negative for cancer.  So now I know: 
1) She tells patients to make an appointment to hear the results if there's a reasonable chance it's cancer. 
2) She calls before the appointment if the result is no cancer.]

X-ray of fluid removed from my breast today including this little patch of 7 specks of calcium

I'm very grateful for all this loving attention.  These women made me feel important.  Karen, one of the radiologic techs, showed me the removed tissue on a screen, including the seven specks of calcium.  

I think of all the women in the world who are 40 years old but don't have the opportunity to get mammograms every year and who won't receive the lumpectomies they may need.  

I think of my three paternal aunts who had breast cancer in the 1930s, 1940s, and early 1950s.  Aunt Mildred died because her cancer metastasized to her neck and the rest of her body.  Her two sisters survived into old age after surgery, but one died of ovarian cancer.

My husband's Aunt Con had the best medical care then available in New York City for her breast cancer, but it metastacized to her bones and she died in 1984.  http://www.nytimes.com/1984/07/24/obituaries/constance-hoguet-president-of-the-philharmonic-society.html

Thanks to Dr. Geeta, Karen, and Donna, aided by Selenia, I'm confident that the worst possible outcome is another lumpectomy, not a terminal illness.





Friday, April 21, 2017

Another biopsy, 3 yrs. later

Women's Imaging: orchids at the doorway, orchids inside... 

It's always a surprise.  

We show up for our annual mammogram, and the doctor sees something.

(Actually, not all of us show up.  Women who do not have health insurance or who live far from a clinic may not have that surprise until they feel a lump--much later in the growth of a tumor.)

Today after the usual two x-rays per breast, my radiologist asked for three more of my right breast, including a close-up of the lower breast.  Ten minutes later she asked for a closer close-up.

Then came the news: a patch of eight or so tiny specks of calcification.  They looked like the cluster of stars we call the Pleiades.

"Calcification is sometimes a sign of cancer, sometimes not," Dr. Iyengar said.  "We won't know until we do a core needle biopsy."

Vocabulary Lesson One for breast cancer patients: needle biopsy.

Cancerquest.org defines needle biopsy:

A needle biopsy is rarely used to obtain skin tissue; it is usually used to remove a sample from internal organs, lymph nodes, or deep skin areas. These techniques involve the use of a small, hollow needle and is sometimes aided by an imaging technique such as x-ray.  There are two types of needle biopsy, fine needle aspiration (FNA) and core needle biopsy.  They differ in the amount of tissue removed. Core needle biopsies remove a larger tissue sample than FNA.1More about these are in the sections that follow.
See also:
I had plenty of time to think about it between x-rays: the right breast, not the left, site of my lumpectomy three years ago.
Does that mean all the cells of my body are vulnerable to going haywire at this point in my life--coming up on 69 years?
Or is it just the cells of my breast?  Why didn't I have a double mastectomy last time?  Go for it now.
I'm so grateful for the expertise of Dr. Geeta Iyengar.  She's kind and she recommended the ultrasound three years ago that revealed my stage 2 tumor.  I think ethnically she may be from India.  I trust her completely.
It was also great to see Winona, the radiology technician who did my ultrasound three years ago and showed the tumor to me and Dr.Iyengar.  She knows me by face and welcomes me each time I show up a year later.  She's African-American and very warm-hearted.
Anyway, I'm strapping my seat belt for another ride--whether a short trip or the beginning of a roller coaster, I don't know.



Monday, March 27, 2017

That scary door...



As I rushed to my doctor's appointment today, I wasn't thinking about exactly which doctor I was going to see: internist, cardiologist, dermatologist...

The sign on the door was a shock as I arrived:  UCLA Oncology.

Yes, I regularly visit an oncologist.  Ugly and scary word.

But I am a three-year survivor of breast cancer, so that's good.

Sunday, March 12, 2017

In Memory of Melinda Sue Casey

Melinda Sue Casey survived for 16 years after she was diagnosed with metastatic breast cancer.

Born in 1955, she died on February 20, 2017.

For many years she taught the children of migrant workers in Oxnard, California.  She retired for health reasons at age 45 and took up volunteer work.

She was a member of St. Aidan's Episcopal Church in Malibu.

Her survival for 16 years rather than the predicted 4 years was the result of "one-part medicine, but the lion's share was heart and spirit," her obituary reports.

http://www.legacy.com/obituaries/name/melinda-casey-obituary?pid=1000000184443335

My heart aches for her, just 61 years old at her passing, because I too received the CA diagnosis.

Mine was stage 2, not stage 3 or 4.

Mine was three years ago this coming April.  

We cannot know the length of our days, but we can remember that "Dust we are, and to dust we shall return" (Genesis 3:19).

I also like this verse:

"Remember now your Creator in the days of your youth, before the days of trouble come, and the years draw near when you will say, 'I have no pleasure in them"... before the silver cord is snapped, and the golden bowl is broken, and the wheel broken at the cistern, and the dust returns to the earth as it was, and the breath returns to God who gave it" (Ecclesiastes 12:1-8).