This is 40…

Well, the time has come…I am officially 40!  Leading up to this big milestone, I really didn’t think it was going to bother me.  Honestly, I thought 50 was going to be the number for me, but man, did that quickly change!  The last few months I’ve been dealing with an issue (and it’s still ongoing), and it definitely changed my perspective about this whole 4-0 thing.  I wasn’t even sure I was going to share this story, but it’s a story, and if this story inspires one person to take action, then it’s worth the share!  So, let me rewind time for ya…

December 23, 2022

It’s a few days before Christmas and I was at home spending time with the family.  In fact, we were gearing up for what they said was going to be a pretty big winter storm.  I remember I was sitting in the chair and started to feel a pain in my left breast.  It progressively got worse over the day, and I honestly figured it was just hormonal pain and that it would go away.  A day later and the pain was not getting any better, but instead it was getting worse.  If any of you Mamas ever experienced mastitis when you were breastfeeding, that’s where this was headed.  I had very intense focal pain, followed with swelling, redness, warmth to the touch, and a generalized ill feeling.  I actually thought to myself, “This is bizarre! I haven’t breastfed in 12 years, but suddenly I feel like I’m right back at it.”  The pain was not getting any better, and I was trying anything I could to get some relief, including sleeping with ice packs.  Christmas Day came and went and the ice and ibuprofen had seemed to help ease the pain a bit, so I was less alarmed than I had been a few days prior to.  However, that changed when I noticed bruising on my breast.  Yep, that was the kicker for me…it was time to schedule an appointment with my nurse practitioner.

December 27, 2022

I met with my nurse practitioner and explained the symptoms I was having.  She didn’t seem overly concerned, as she thought it was perhaps a clogged duct.  She called in an antibiotic to use if the symptoms didn’t improve, and suggested that “Since you’re turning 40 anyways, let’s just go ahead and get that mammogram now.”

January 23, 2023

One month after having the pain, I walked into Upper Valley Medical Center for my scheduled mammogram, with no worries about what was soon to happen.  Let me note for the record…work was extremely busy at that time, and since the pain had eased, I actually considered cancelling the mammogram and rescheduling for later (after I turned 40).

I go through the first round of images and the tech comes back stating the doctor wanted additional images.  Was I concerned? Nope, because I had heard ladies with dense breast tissue require additional imaging.  So, round two of images is complete and the tech comes back stating the doctor wanted an ultrasound.  Was I concerned? Nope, because I actually figured I would end up with an ultrasound because of the dense breast tissue.  In fact, you can see, I was enjoying my “spa like” experience. 😉

I lay down on the gurney and I’m completely relaxed during the ultrasound.  The tech scanned my right breast first and then moved to my left breast.  This is when I became slightly concerned…the scanning of the left breast ended with “I’m just going to take a few pictures under your arm.”  I knew exactly what that meant….they were checking my lymph nodes…they found something.

The ultrasound tech left the room to go speak with the radiologist and I began to prepare myself for what was about to come.  I remember sitting there thinking “They are going to tell you they found a mass.  You need to prepare yourself for this journey.  Be strong.  You’ve got this.”  This is the point where I knew I was outside of the normal “dense breast tissue” screening.  The radiologist came into the room and wanted to scan the left breast herself.  It’s then that she delivered the news…”We’ve found something on your images…”.  Now, being a healthcare provider myself, I’m pretty in tune with tones during patient communication, and I knew this radiologist was 1) very alarmed by the information she gathered and 2) very upset that she had to deliver this information to me.

The ultrasound/mammogram reports indicated I did indeed have a mass in the exact spot where I had the focal pain days before Christmas.  The mammogram identified an “architectural distortion” and the ultrasound deemed the lesion to be an irregular, hypoechoic mass with angulated margins and internal vascularity.  When you have a mammogram, they label the findings using a system known as BIRADS, which basically correlates to how likely the lesion is to be malignant.  The scores range from 0-6, with 0 being the need for additional imaging up to 6 being known-biopsy proven cancer.  Where did mine fall?   4C, which meant “high suspicion for malignancy (>50% to <95%).  It all began to make sense why the radiologist was so alarmed.  She had to deliver news to a 39 year old (at the time) that she might indeed have breast cancer.  That day was the first day I realized birthdays/age…they are just a number.  My only thought after being scheduled for a biopsy and walking out of Upper Valley Medical Center that day….”Please dear God, just let me see my baby girl grow up.”

February 2, 2023

I headed back to Upper Valley Medical Center for an ultrasound guided breast biopsy.  They also had me scheduled for a stereotactic breast biopsy that same day (in the event they couldn’t get to the mass with the ultrasound).  The radiologist came in (not the same one) and began looking at the images on the screen.  I remember him saying “That’s it? (asking the ultrasound tech)  That’s not what I was just looking at on the films.”  So he took control of the ultrasound and began searching for the appropriate area.  He finally landed on a spot, but I got the sense he wasn’t completely sure but rather settling on this area.  The biopsy was conducted and the tissue marker was placed.  You then go back to the mammogram to ensure the tissue marker correlates with the area on the mammogram (aka to ensure they hit the right spot).  I asked the radiologist “What do you think?”  He said “Are you asking if we got the right area or is it cancer?”  I told him “both”.   He said “I’m confident we got the right spot and as to whether it’s cancer…it’s really a toss up, 50/50.  It could be one of these pre-cancerous types of things.  If I was a betting man, I’d go to Vegas and bet no.”  That felt pretty convincing, right? I soon learned, not so much…

February 8, 2023

I had gotten my results back in the online patient portal but didn’t get to see my nurse practitioner until a few days later.  We had a conversation about how it was benign and that we would do another mammogram in six months just to follow up on it.  I walked out of the office finally able to “relax and breathe”.  That only lasted a few hours though.

I was sitting at my desk at work and my nurse practitioner called.  She informed me that the radiologist had called her not too long after I left her office and informed her that he had some follow up recommendations.  The pathology report from the initial biopsy was “discordant” with the initial imaging findings.  Basically, the pathology report didn’t align with what they typically see from architectural distortions, so the radiologist didn’t believe he got the right spot.  (Side note:  None of this was really explained to me, but rather what I learned by reading scientific journal articles.  Thank God that’s something I do on a regular basis.  It was presented to me as there might be two areas of concern.)  So, initially I was really emotional and frustrated.  I was not confident in the team at Upper Valley Medical Center and really questioning where to go from there.  Once I read an article from a radiology scientific journal, I quickly realized this was actually normal procedure (healthcare providers…talk to your patients, please).

So, because the biopsy results didn’t align with the initial imaging findings, I was scheduled for that stereotactic biopsy the following week.  This is basically a mammogram guided biopsy where you lay on a table in the most uncomfortable position with your breast poking through a hole. (Yea, sounds delightful, doesn’t it?) That was done on February 16th and that basically brings us up to where we are today.

Now what…

So I got my results back and everything was benign but I was diagnosed with a Radial Scar/Complex Sclerosing Lesion.  While I was ecstatic to see the word benign, the journey isn’t quite over.  A radial scar is basically an area of hardened tissue as a result of proliferative changes (cells are multiplying and spreading) and looks like a scar under the microscope (it’s not a scar as we know scars).  While radial scars are benign lesions, they are alarming due to the fact that cancer cells can hide within it or around it.  Now, the chances of the radial scar being upgraded to cancer (especially since I didn’t show any atypia cells) is very low!  However, the chance of the radial scar being upgraded to a high risk lesion (with atypia cells) is much higher.  So, because of the radial scar diagnosis, I have been referred to a breast surgical oncologist at the James Cancer Center at OSU.  I will be seen on April 12th to determine what the next steps are.  The research is controversial on what to do with radial scars, with some research stating to leave them and monitor, while other research says with the upgrade potential being there, excise them for a full pathology report.

So, I do believe it’s likely that I will be undergoing a lumpectomy in the near future, where they will remove the radial scar and the surrounding tissue to do a final pathology report.  If it comes back benign, then I can finally say the journey will have come to an end.  The other potentials are:  upgrade to a high risk lesion with atypia cells and could require the addition of a chemoprevention drug or upgrade to a malignant lesion (which is often a very early and less invasive form).

So, while I am feeling MUCH better about where I am today, as compared to January 23rd, when the first radiologist delivered the initial news, I’m not letting my guard down until after I discuss everything with the surgical oncologist.

This journey has really shown me that we often take years for granted.  Here I was thinking I was getting “old” at the age of 40, but really, I’m “blessed” to be 40.  No one is guaranteed this time on Earth, and I’m forever thankful that God has given me a wonderful 40 years of life and for every other year after that in which he blesses me with.

Ladies, do me a favor and schedule your mammogram.  Remember I said that I almost cancelled mine.  Yea, don’t be like me.  Get your yearly screenings and don’t put them off.  They are extremely important and I hope my story pushes you to make that appointment.

God Bless,

Kalette