If you have a mammogram that indicates the possibility of cancer, you can be better prepared to protect your health if you understand the examinations and treatment that follow that finding.
When you have a mammogram, the radiologist will review your mammogram and assign it a category number of 0 through 5.
• 0 indicates that the mammogram was inconclusive and that you need a follow-up exam with another type of imaging.
• 1 indicates completely normal.
• 2 indicates a benign finding. Radiologists assign this when the mammogram is a follow-up to a mammogram that was category 3.
• 3 indicates that the results probably are benign and that you need a follow-up mammogram, for example, in six months.
• 4 indicates that the results appear suspicious and that a biopsy is recommended.
• 5 indicates that the results appear very suspicious and that a biopsy is strongly recommended.
Remember that results of a category 4 or 5 still are not a diagnosis of cancer. With a category 4 mammogram, one in five women later receives a diagnosis of cancer. With a category 5, 60 to 80 percent of the growths are found to be cancerous.
If you have a category 4 or 5 mammogram, the next step would be to conduct a biopsy. You should bring your mammograms for your doctor to review. He or she also will conduct a thorough medical history and physical examination. This might include an ultrasound-guided biopsy or a mammogram-directed biopsy.
In most cases that biopsy will suffice for a diagnosis of whether the growth is benign or cancerous. While this is rare nowadays, if the ultrasound biopsy results do not conform to the mammogram, a biopsy will be performed in an operating room.
Pre-operatively, a radiologist uses a computer-guided imaging system and precisely locates the lesion. A pathologist then examines this sample to determine whether it is benign or malignant.
If the diagnosis is cancer, doctor and patient consult to determine whether to perform a lumpectomy or mastectomy. Usually I will provide breast-conserving therapy — that is, a lumpectomy. During this procedure, I also need to confirm whether the cancer has spread to the lymph nodes. I examine the sentinel lymph nodes in the armpit area using X-rays and by injecting dye. This involves the first one or two lymph nodes nearest the breast, where the cancer would spread. If this sentinel lymph node examination shows that the cancer has not spread, I can avoid removing the axillary lymph nodes.
If we determine that you need a mastectomy, I will discuss your options for having breast reconstruction. If you desire reconstruction, a plastic surgeon will perform that during the same operation, immediately after the mastectomy or after completing treatment.
After the surgery, I coordinate all of your postsurgical care. You might need adjuvant chemotherapy, which is treatment with chemical substances that kill cancer. Adjuvant means that the chemotherapy is administered after surgery. You also might need radiation treatment.
I will see you for follow-up visits, with the time between visits depending on the amount of time that has passed since the surgery. For example, I might see a patient only annually several years following the surgery.
While this process might seem daunting, the detection and treatment of breast cancer have continued to improve the rates of surviving this disease. About 1 in 6 of my surgical cases involve women who need a breast biopsy and possibly surgery to remove cancer. If you have a category 4 or 5 mammogram, I can provide or coordinate all of the treatment that you will need. Call 352-5300 to schedule an appointment.
Dr. Thomas McCormick joined Northern Nevada Medical Group in April after practicing in Sparks and Fallon for nine years. He is certified by the American Board of Surgery and the American Society of Breast Surgeons. McCormick earned his medical degree from the University of Nevada, Reno, and completed his internship and residency in general surgery at the University of Nevada, Las Vegas, School of Medicine.