An anxious week

Last week was a very busy and emotional week for me. Someone close to me discovered a small lump in her breast and I accompanied her to the hospital to have a mammogram done.

She went into the mammography room by herself - I did not go into the room with her. While doing the mammogram, the person-in-charge of handling the machine sort of mentioned that the lump couldn't be seen clearly and that the doctor may ask for an ultrasound to be done. We then waited. Before the doctor could see us to explain about the results of the mammogram, one of the nurse asked us to go and have the breast ultrasound done. At that time, we were kind of in a daze so we went to queue up to have the breast ultrasound done.

After waiting for some time, we were called into the ultrasound room. This time I stayed with her. The radiologist could see the lump which was about 1.2cm by 0.7cm clearly through the ultrasound image. She then mentioned that a biopsy need to be done to test whether it is cancerous or not and it could be done immediately by her.

As we were still in a daze, we agreed and signed the necessary forms in the ultrasound room. I sat there watching the whole core needle biopsy procedure. It was not a pretty sight. First the radiologist disinfect and numb the area to be cut. Then she made a small cut on the breast near the lump and then poke the core needle inside. With one hand on the ultrasound scanner scanning the breast to provide her with the image of the position of the lump to guide her needle and one hand on the core needle, the radiologist dug around inside the breast and tried her best to get 4 samples from the lump.

At last it was done. A small plaster was placed on the small wound and a huge plaster was wrapped around half the upper torso to prevent bleeding. We were advised to remove the huge plaster after 9 hours and the small plaster after 2 days. If there were signs of bleeding we would need to go to the ER.

The biopsy result would be out in about 2 days. I thought a breast surgeon would talk to us about the result of the mammogram but no, we were not seen by a breast surgeon and at that time, we did not ask to see one as we were tired and would just want to go home. As it was a Thursday, we were told that we could leave and were asked to call the hospital next Tuesday for the result and to collect all the images and result reports if they were ready by then.

For a digital mammogram, ultrasound, core needle biopsy procedure, biopsy lab test, and misc medication and about 4 hours spent in the private hospital, the total cost was RM1388. A small price to pay to get the result.

On Saturday, the hospital called me and told me that the result was out. The lump was not cancerous. On Monday, we went to collect the reports and images and were advised to consult a breast surgeon on follow-up actions for the lump.

We were glad to hear the result but there are some questions remaining such as since the lump was small, it was quite difficult to collect tissue samples from it via core needle procedure so were the 4 tissue samples collected for the biopsy came totally from the lump or some were from the tissues around the lump?

Everything happened so fast on that day that we did not have time to think much before doing the core needle biopsy. Somehow I felt that everything was rushed and to me, the core needle biopsy was an invasive procedure which we need more time to think and to decide on whether to have it done or not and where to have it done. There could have been another biopsy procedure which we could have opted to do.

On hindsight, there were risks on what was done. First, something could have gone wrong during the core needle biopsy as the general health of the person was not known - her blood pressure was not taken to check her health situation before the biopsy was done. Second, there is always a risk of infection for the small cut that was done for the biopsy.

A better way of handling this situation would have been:

1. Perform the mammogram.
2. Wait for the result of the mammogram and consult with a breast surgeon about the result.
3. Go home, read up on mammograms and breast lumps and think.
4. Go back to do an ultrasound.
5. Consult a breast surgeon on the result of the ultrasound.
6. Go home, read up on core needle biopsy and other procedures of doing biopsy.
7. Talk to people to find a doctor who is very skillful in doing biopsy.
8. Consult with that doctor and perform a full check up to ascertain the general health/well being of the person.
9. Find out which biopsy procedure is recommended to be done.
10. Decide on whether to do the biopsy or not based on information gathered.
11. Schedule for the biopsy.
12. Then only have the biopsy done.

So now we are monitoring the lump in the breast and will not act so hastily as before.

In general, for women above 20, it is recommended that breast self examination to be done every month. For women above 40, it is recommended that they undergo mammography once a year.