start at the beginning

Four years ago, in the spring of 2007, my mother was diagnosed with breast cancer, a form known as Inflammatory Breast Cancer (IBC). What followed was a grueling time for all of us close to her, and most especially for her and her partner - first waiting for test results, and then the enduring of intense chemotherapy, then surgery, then radiation, and recovery. My mother did recover, thankfully - it was a hard hard road to walk, but she made it through.

On Saturday, April 16, 2011, an obvious palpable lump suddenly appeared in my left breast - I'd swear it hadn't been there the night before. It was large (I guesstimated just over 2 cm) felt hot and heavy at first, though not painful; rounded but with an almost webbed texture - and I was terrified. 

First thing Monday morning, I called and got an appointment at my primary care clinic, was examined there, and was informed that, given my presenting symptoms, it was most likely a cyst that would resolve itself, and was referred to the local breast care center for mammogram and ultrasound. 

My appointment was for Friday the 22nd at 10:30. By that point, the lump was decidedly uncomfortable... achy and prickly feeling, all of which supported the possibility of a cyst. Soon after the mammogram was completed, I was told that the mass was highly suspicious; the ultrasound confirmed that it was not a cyst, but a highly irregular tumor consisting of two joined sections, one deeper in the tissue with the other easily palpable mass blooming forth from the lower mass. The radiologist informed me that he was 'leaning heavily" towards the mass being malignant and advised performing a needle biopsy, which was done that same afternoon.

I left at 4:30 - this is the report:

"Left breast findings: A triangle marker was placed over the newly palpable lump at about 9 oclock. Standard views are augmented with spot compression magnification images of the area of palpable concern demonstrating an area of vague architectural distortion without a discrete definable mass. The architectural distortion is located at the site of a solitary coarse chunky calcification which has been present for several years. The architectural distortion is seen to better advantage on the spot magnified images. Additionally, there are some new slightly amorphous and slightly heterogeneous calcifications projecting over the area of architectural distortion on the CC view. These are located about 3 to 4 cm above the palpable mass on the ML view. On the prior mammogram, there are some scattered calcifications in this region. The calcifications have somewhat increased in number since the 2009 exam. There is no rod or branching morphology however. The remainder of the left breast is unremarkable. No mammographically evident enlarged axillary lymph nodes are seen. There is no evidence of skin thickening or retraction overlying the palpable lump.

Left breast ultrasound was performed demonstrating an approximately 19 x 15 x 20 mm hypoechoic trilobed malignant appearing mass at 9:30 to 10:00, 1 cm from the nipple. The coarse chunky calcification seen in association with this mass on the mammogram can also be seen byultrasound. The mass appears to be somewhat lobulated and macronodular. It is highly concerning and likely represents an invasive breast cancer. The remainder of the left breast was evaluated and is overall unremarkable. Left axillary lymph nodes are identified and have a normal internal architecture by ultrasound. Heterogeneous and amorphous calcifications noted superior to the palpable mass on the mammogram could be identified with ultrasound. These are randomly scattered and located at about 11:00, 3 cm out from the nipple. They are associated with minimally dilated ducts which are embedded in dense echogenic fibroglandular tissue by sonogram. These calcifications and the appearance of the surrounding parenchyma would be more consistent benign fibrocystic changes than DCIS.


Impression left breast: BI-RADS category 5, highly suggestive of malignancy.


Recommendation left breast: As discussed with the patient after reviewing the imaging findings, she will undergo ultrasound-guided core biopsy with clip placement later this afternoon. The biopsy will be reported separately.


Right breast ultrasound findings: Given the highly suspicious findings in the left breast, a right breast ultrasound was also performed demonstrating dense parenchyma throughout and scattered subcentimeter cysts and fibrocystic nodules, none of which is viewed with concern. There are no suspicious solid masses in the right breast. The right axilla has a normal appearance."


Three days later, Wednesday the 27th, the biopsy results came back. I have invasive ductal cancer with lobular features. The tumor is both ER positive (60%) and PR positive(40%), with cell nuclei rating of 2. Given the visible rate of growth, the proximity of the tumor to the nipple, and that mastectomy (single and bilateral) has already been mentioned  repeatedly,  I expect rather radical and unwanted body modification in my near future.