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/

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

Medical Imaging Center of Southern California

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.