Biopsy is only way for de­fin­i­tive di­ag­no­sis

Times Standard (Eureka) - - BOOMERS+BEYOND - By Dr. Eve Glazier Eve Glazier, M.D., MBA, is an in­ternist and as­so­ciate pro­fes­sor of medicine at UCLA Health. Elizabeth Ko, M.D., is an in­ternist and as­sis­tant pro­fes­sor of medicine at UCLA Health.

Dear Doc­tor: I’m 30 years old, and I have a lump in my breast, which imag­ing tests sug­gest is a fi­broade­noma. I’m get­ting mar­ried in six months, and I am lean­ing to­ward hav­ing a biopsy so I won’t worry dur­ing my wedding and hon­ey­moon. With the COVID-19 pan­demic, is it self­ish of me to have the biopsy right now?

Dear Reader: It’s un­der­stand­able that, even with re­as­sur­ing re­sults from a mam­mo­gram and an ul­tra­sound, you want a de­fin­i­tive di­ag­no­sis. As you men­tioned in your let­ter, the only way to achieve that is with a biopsy. How­ever, due to the pan­demic, many hospi­tals have been forced to shift their at­ten­tion and re­sources to deal­ing with COVID-19 pa­tients, and some have put elec­tive surg­eries and rou­tine med­i­cal care on hold. This means that de­ci­sions that in nor­mal times would have been fairly straight­for­ward have now be­come com­plex is­sues.

Let’s start with what we do know. Your ra­di­ol­o­gist has re­ported that the imag­ing tests you’ve un­der­gone sug­gest the mass in your breast is a fi­broade­noma, which is a be­nign tu­mor. It’s made up of both con­nec­tive and glan­du­lar tis­sue, and it typ­i­cally feels hard and smooth to the touch. Fi­broade­no­mas are the most com­mon type of non­cancer­ous growth in young women be­tween the ages of 15 and 35.

Some are so small that they can only be seen in a scan, while larger ones are dis­cov­ered through touch, as dur­ing a monthly breast self­exam. No mat­ter the size, in most cases fi­broade­no­mas don’t play a role in risk for breast cancer.

The good news is that imag­ing tech­niques are quite good at dif­fer­en­ti­at­ing be­tween be­nign masses, such as fi­broade­no­mas and cysts, and those that are ma­lig­nant. When a be­nign growth is dis­cov­ered via imag­ing, it is of­ten rec­om­mended that a fol­low-up scan be per­formed within six months. If the re­sults of the sub­se­quent imag­ing tests raise a red flag, then the next step is a biopsy.

This is a sur­gi­cal pro­ce­dure in which a small sam­ple is re­moved from the sus­pi­cious tis­sue and sent to a pathol­ogy lab to be looked at un­der a mi­cro­scope. It’s only when the tis­sue is ex­am­ined at the cel­lu­lar level that a pathol­o­gist can state con­clu­sively if the mass is be­nign or ma­lig­nant.

A woman’s age adds an­other layer to the de­ci­sion-mak­ing process here. When a woman is in her teens and 20s, be­nign causes for a breast mass are con­sid­ered to be more likely. But that changes for women in their 30s, par­tic­u­larly now, as we are see­ing more young women di­ag­nosed with breast cancer. In your case, it would be wise to seek guid­ance from both the ra­di­ol­o­gist who per­formed and in­ter­preted your scans and your fam­ily doc­tor. This type of biopsy is usu­ally an out­pa­tient pro­ce­dure that can be per­formed in a sur­gi­cal cen­ter rather than in a hos­pi­tal op­er­at­ing room. Wher­ever you go, check that you are com­fort­able with the safety pro­to­cols that are in place. If your par­tic­u­lar re­gion is not hard­hit by the COVID-19 pan­demic, and if your med­i­cal team agrees that a biopsy is a bet­ter choice for you than watch­ful wait­ing, there’s noth­ing self­ish about mov­ing for­ward.

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