Before You Donate
Think very seriously before donating to any breastcancer organization, or fundraising program until you read their Annual Report to see who their top contributors are, and if they have a product that appears frequently in the message the organization sends to the public. That would be unethical and its illegal. The same applies to a request that the public buys products, but does not receive a "donor receipt" for tax-deductible purpose. Read any and all food labels that breastcancer "non-profits" are promoting to raise money. Some organizations tell the public to help them raise money by asking you to visit their websites, but that only gives them "hits" to increase their sponsors.
Another tip, "signing" an online Petition is not acceptable, so don't fall for such antics. An ethical non-profit, or professional will not request your visit to their website, nor use "cookies" placed on your computer when you visit their site.
Purchase the Breastcancer Postage Stamp, the Post Office will always give you your charitable deduction receipt. Its a valid form of fund raising.
BIOPSY - What is it? Coping
Biopsy means the removal of some tissue from the area where there is a something viewed as questionable, by mammogram (type of x-ray of the breasts) or other means: physical exam, sonogram, etc. The term itself does not indicate how much tissue. That is one of two primary methods, surgical or needle aspiration (ref: Love, Susan: The Breast Book click here to see this book, and now Mammotome Breast Biopsy (which was finally approved by the FDA 9/99, after being used successfully for several years in Canada, by radiologists.
Throughout this journey, I've noticed that only my oncologist actually told me what was really going to happen to me - how I might feel, how my body or my mind might respond, and what, if anything, I could do about it. So, I'm going to try to share my own experiences with you. Each of us responds in different ways. When I think I've responded in an unusual way, I'll tell you why I think I'm overly sensitive (like recalling my siblings deaths).It will help you down the road if you tell whomever is going to do your biopsy that you unless your mammogram leaves NO question in his/her mind as to the type of biopsy procedure, you want to have a breast surgeon involved (see American Society of Breast Surgeons). Now, remember, at this point, there is NO hurry. . . don't let anyone rush you. Several days thinking, interviewing doctors, etc., will be well worth the time because the physicians you select will all be your team members.
Meet the pathologists who will be involved in determining what the cells are that were removed from your breast (or any place else in the future). Generally, an immediate reading is possible, so you don't have to fret overnight, or even several days, unless the pathologist tells you directly and why. Once you have met these physicians you will all feel more comfortable.
The radiologist who did my fateful biopsy also found the malignancy. He moved swiftly. He was forthright, evidenced integrity, and above all ethically showed allegiance to his patient. I will always be grateful. When we, as the health care consumer (and remember, medical professionals also become patients) received open, thoroughly explanations, and even see their physicians frustrations, fatigue, and efforts to be team members, we are much more at ease in sharing our perceptions, knowledge, concerns, and fears with the physicians - and, vice versa. My one recommendation to others now, is to not have a biopsy until you have taken your mammograms (all of them if you have more than one year's) to a reputable breast surgeon, and discuss the best approach, if any to performing a biopsy.
NOTE: Due to the media, and the incredible number of medical and 'doctor' web sites, lately, we often learn about new treatments and studies before our doctors do. However, be cautious. These sites are advertising, and all materials on those sites have to past 'muster' of the advertisers, and most of the advertisers slip in their product (definitely the situation in our weekly and monthly periodicals, popular magazines, etc), and you'll often notice a subliminal type of advertising on these sites. ALWAYS ask for the credentials of those who are advising you on the medical sites - in a 'chat' or email response. They rarely have any medical training, and these sites are often for-profit corporations, they take advantage of the public's need to "Chat," and many use volunteers! AND, just because a doctor is answering a question does not mean s/he is correct, or is actually actively maintaining a medical practice, such as several of our TV Personality physicians.
If you are asked to go to a location you are unfamiliar with, ask your doctor why that facility is being recommended, over a hospital you know. These questions will float in and out and your coping may not be very solid at this time (mine wasn't) but the questions plague you at the oddest times.
When I heard that my mammogram was highly suspicious for malignancy, I grabbed a notebook and began to write (I still have it, plus others). I felt overwhelming gratitude to the doctor who led me to this radiologist, and for the radiologist's openness and honesty with me in that early morning phone call. That's it! I felt nothing beyond that. I stopped thinking beyond the moment, for a long time to come.
I knew this was a crisis, and needed concentration on what was right in front of me. He said, "biopsy," and I agreed, "Go ahead." Career did slip in there and move me through that day, but . . . I was in a tunnel, except for my work. In fact, on that very day, I career-wise, I sat and heard a colleague absolutely lie to our "CEO," essentially! But it paled by comparison and I just considered the source. "Right now, I have to live," I remember thinking. But, in fact, I was terrified! Nothing else mattered.
I did NOT seek out a breast surgeon and wish that I had (oh, how I wish that I had!). But, I did phone physicians I know to begin a search for the right process, and did phone a dear friend whom I knew was in five-year recovery from breast cancer, and was on Tamoxafin. But, I was 'boxed in' emotionally, not reaching out very far. I was "holding tightly" and felt my grip slipping. As a single person in a new town, I was, in fact, flabbergasted...and yes, I did ask, "Why....why now?" in my spiritual petitions.
The biopsy
At that time, I was not aware that a week, even a month would not make much difference to my outcome. Two or three years, when they missed it on prior mammograms, yes (even though that wouldn't fly in Texas courts...I was alive, not dead!). So take your time, lean on others, cry, see a therapist, but get your ducks lined up before you proceed.A very kind person began accompanying me everywhere, thank God. She had to. I was just going along for the ride it seemed. She even fed me!
Women just have to begin being treated decently in healthcare - we've been talking about changing this model for 30 years now, and it's not happening. Now, with the Patient's Bill of Rights, we'll be swept in to the gin, again! Just treat us the same. There's a distinct difference between facilities for women primarily, and those for the public. They are trite at best, and barbaric in the worst case scenario (the first thing I noticed about the office of the breast surgeon I selected was it's lack of fluff, and advice. It had an orchid plant, and pleasant furniture - comfortably placed. That's all - and I was relieved.)
When we arrived at the place for the biopsy we were shocked: A new, modern women's medical facility that bespoke of anything but serious, professional care. However, we were greeted by pastels, butterflies, stylistic, flighty birds, ribbons, flowers, and desk attendants who didn't know who I was, nor my doctor! We both woke up a bit (note: that facility is now going out of business due to heavy financial losses...they did not ask, nor listen to women, nor, I'll bet, do a strategic plan!!).
No one told me to wear a 2-piece outfit, and they tried to make me wear nothing but a little bolero, "just down the hall to the biopsy room (they had no long gowns!)!" DUH! "No way," I insisted, "go tell Dr. ____, or I'm leaving." I could almost hear, "Bitc_!" under her breath. Finally, they found me some scrub pants - once the doctor became involved.
One type of biopsy: I was having a core needle biopsy, guided by stereotactic images to withdraw tissue - I did ask the radiologist the size of the needle, though (I never thought of investigating other options or methods at that time - nor had I seen a breast surgeon).
When I saw the biopsy table it reminded me of an autopsy table! The radiologist was a wonderfully kind person, and had to tell me the way to get "into" this contraption: I had to lie on my stomach, and get my chest into the basin portion, which had a hole in it. Got it? My breast was to go down through that hole! "My God, help me," I thought, "I bet this is just the beginning!" It was!
Getting Comfortable First: A sinking feeling set in. The radiologist told me that the position hurts women's backs and it often "takes them a long time to be able to get off of the 'table' (his honesty, again)." "Oh, no," I exclaimed, I was in physical therapy for a brachial plexus injury (shoulder/neck) from an auto accident. So, I asked the radiologist and his assistant to give me some towels and time. I felt I could handle my body (spending over thirty years as a childbirth educator, and having attended over 2,000 births, I knew position was critical to relaxation).
The attendant and radiologist gave me some folded towels, and kindly left the room. I placed them in areas where my shoulders were not supported, and made sure that all of my joints were flexed, and or supported by a towel. I had no discomfort following, and could easily get up off the table. So take care of your body's comfort first, and if they seem irritated, just let them know you'll go home and they can get on with their schedules!
Ok, your breast is now hanging down into this hole (it was cold in there, and somehow I thought of ice fishing I'd get dragged along for years ago!!), and the table is then raised up, like for an oil change, so the radiologist can sit underneath and insert needles into the area they believe your mass is in.
First, he injected a local anesthesia, and it wasn't painful - nothing like a dentist's "Novocain." The biopsy consisted of a specially designed "needle" that was inserted and gathered some tissue, and the only pain I had was when they were actually in the tumor sites (I've had this same sensation with another biopsy in 1995 - different organ, however). The kind radiologist quickly gave me more local anesthesia. It was obvious he did NOT want me to feel any pain. After the biopsy he told me a pathologist was standing by and he'd let me know as soon as she had made the determination that day. He later told me that the pathologist needed "overnight," and asked if that was alright with me. It was. He phoned the next morning at the same time as before.
Open Surgical Biopsy: Common until recently, a radiologist placed wires into the breast to 'mark' the area of the breast that evidenced suspicion on the mammogram. A surgeon then removes a large portion of breast tissue, guided by the wires placed into the breast - often referred to as "needle loc (location)." Often a large portions of tissue removed will require a day of recuperation, at least - physically; but more psychologically. This often does not include examination of the woman's lymph nodes under her arm on the affected side, and I would definitely have both sides thoroughly examined by two breast radiologists before having anything whatsoever done!
Mammotome Biopsy Procedure (this hand held instrument was approved by the FDA on September 2, 1999. Full article follows this section): You or someone close to you, first ask your physician for proof of their most recent training to perform this procedure or any other new procedure, such as the Sentinel node dissection, too.
You've heard by now the term "micro-calcifications." These may be the earliest or only sign of cancer, and early detection and accurate diagnosis must occur. In observing a representative of Ethicon/Johnson&Johnson show their film on this instrument, it was obvious that this procedure has the ability to sample these tiny calcifications, and utilizes x-rays from two or more angles and/or ultrasound images to guide the microprobe into the area.
Mammotome causes little trauma, no sutures are required, and it is faster than the other two.
The Mammotome is a probe. Its vacuum system draws tissue into a chamber of the probes and the physician may rotate the devise to obtain the breast sample. The probe may be rotated to another position, until all the suspicious areas have been sampled, then it's removed, and the tissue examined by pathologists.
Bear in mind:
My particular sites of micro-calcifications had gone from being specks (requiring biopsy) one year, to two sites of linear, irregularly placed calcifications the next year, which were over the minimum size cited by the Van Nuys Index, in type of cell, as well. My second surgeon knew this and was up to date and competent.
- Benign means non-cancerous.
- Malignant means cancerous.
- Calcifications are tiny specs or longitudinal lines of calcifications that may indicate cancer - the larger, and more longitudinal the greater the potential that they are malignant sites.
- "Ductal carcinoma in situ (in the site only) " initial diagnosis can no longer be considered 'pre-cancerous,' or 'not spreading, 'unless a Sentinel lymph node dissection (removal and pathology examination using regular and cytokeratin staining to view the node contents more complete). This carcinoma follows along the route of a duct, or several ducts. The type of cell determines the potency of the cell (for example comedo carcinoma is more serious a cell type) (see Breaking News).
CAUTION re Ductal Carcinoma in Situ, and other breast cancers:
1) "Malignant micro-calcifications" brings up the question, in my mind: Variables? Do not leave any variables unanswered. It is now know that women with comedo cell micro-calcifications, may have an equally, or more, malignant site in that same breast that has gone undetected!
2) It is NOT uncommon for malignant cells to be in the opposite breast, as well, breast cancer is multi-centric!
3) There is NO anatomical mapping of the ductal system of the breast, therefore, can one say with any certainty that 'it's only in the duct?" That is an irresponsible scientific observation. NO!
4) If you have a strong immediate (like siblings) family history of breast, ovarian, or thyroid cancer, began menses at before 12 years of age, had your first pregnancy later - mid twenties, are a young woman with dense breast tissues you MUST see a breast surgeon for an initial base line examination, and be watchful. HOWEVER, less than 70% of breast cancer patients have a family history. However, breast cancer is multi-centric, by definition! Your team must acknowledge this!
5) Be certain that you have two separate pathologists ready to read your tissue samples (National Institutes of Health will do one for you at no cost), and realize that in the case of the latter you will need a few days for the final answer. However, you can receive the pathologist's determination of malignant or benign within a few hours. Do NOT go home, when you are sent. Just thank them but say you'll wait, and want to see the pathologist, also. You have A RIGHT to see any doctor who is caring for you and that includes pathologists and radiologists, and know what credentials they possess.
6) Remember - you have choices. Hospitals bring medical groups in to care for us, calling them sub-contractors, and we have no idea who they are or where they received their education, and if they are board-certified in their specialty (that which they are practicing on you - and I used that term literally in many senses which I've personally experienced), and if they are current in their certifications. The first Radiologist who really dropped the ball on my mammogram wasn't even licensed to practice in the state I was in, yet she was lecturing at the medical school, working as a breast radiologist in their mammography department, and sat there and told me all was well (I DID tell her I'd lost my two younger siblings to cancer, and I'd had a thyroidectomy/ parathyroidectomy there a few months before that - which was also "benign," but in 1999 NIH found out it wasn't!!). Did she go back and ask a colleague to "have a look?" NO! She let me walk out of there with cancer! Twice in less than a year I left that medical school with cancer in two different places and was told there was NONE! ANGRY? You bet I am, as I sit here today with no breasts, and a Team of caring, loving physicians who wished to God this never had to happen to anyone much less someone twice! SO, take the time to check your options, and raise your voice if you aren't satisfied. Call me. I'll help you do it! Don't take a chance with your life.
The surgeon who was such a great "neck" surgeon was so sure that my pathology report was correct, pompous arrogance led him to not do a 'scan' after my surgery! Two years later, I was faced with the dilemma...."is all the malignant tissue gone?" And, so was my oncologist! Now, two years later, I'm going through this again, praying that medical science catches up with me. There are indications that there may be thyroid tissue left - MAYBE, not certainly...however, I think we've all had enough of this, especially me!
Question: Do men have to do that for testicular biopsies? NO!
I had only lived in this new town a few months when I received the diagnosis. A busy professional, I had little time for anything but work (bad practice!!). However, I was blessed with the kindness of people I had met, so a small group of individuals were certainly 'there' for me during all of this frightful time. One of these wondrous women took me to her home on Lake Austin, where she had arranged a "pot luck" luncheon after my biopsy. As women arrived, I felt as though this was a rite of passage, each one had been 'here' or knew someone who had, and they helped move me onto the next step. I was still zoned out (I truly never thought I would have an experience with cancer as my siblings did - I was the "caretaker") and I know in shock from the realization that this mammogram had originally been read as "negative for malignancy." Talking about the past two days was therapeutic. I knew these sisters were with me thinking, "what if . . . "