Anxious - can a 0.9cm spiculated nodule be benign?

[momonono]

Hi everyone, I’m new here. Can I start off by saying I’m quite anxious and waiting on my biopsy result, my appointment is tomorrow. I may not be the most coherent at this moment and I don’t exactly know what I’m seeking here, but I haven’t had the courage to share this with family and friends (apart from my husband of course) and some advice might help. My breast surgeon tells me I’m too anxious, and recommends that I see a psychologist, but I don’t think it is unusual to be afraid and scared.

A health screening with breast ultrasound discovered a 0.8 X 0.9 X 0.8cm nodule in my right breast, appearing spiculated. The same report listed it as suspicious and recommended a consult with a breast surgeon for histological sampling. I have had physical exams by 3 different doctors/nurses (during various screenings) in the last year and nobody felt any abnormalities, and neither did I. The anxiety started the (Saturday) night I received the report, and going down the rabbit hole of Googling the findings didn’t help at all. After all, the whole internet tells me spiculated appearance is highly indicative (like 90%) of malignancy.

Background: I’m 31 this year, with no children of my own. I’ve been putting off having kids due to financial and career commitment circumstances within the marriage for a couple of years, and have just convinced myself after multiple conversations with my husband about trying for a child right before this episode happened - so it definitely adds to the sadness. While I’ve always lived a fulfilled life, 31 is too young, no? My mum had stage 1 breast cancer in her late 40s and is now in remission and well for over a decade. My dad, on the other hand, was diagnosed with advanced metastatic prostate cancer 2 years ago and is currently under control of meds. He tested negative for BRCA1 and 2, while my mum has refused genetic testing.

So after receiving the report in my email inbox on Saturday night, I contacted multiple breast clinics in my area and managed to secure a walk-in appointment on Monday morning (with a number of other clinics only available in the following weeks) and the doctor has been very nice and supportive. She thinks I’m overly anxious. While she tries to tell me that most growths at my age are normal, she then went on to tell me that there is a 80% chance of a spiculated mass being cancer. She also said because the growth is still small, we can also monitor and come back in 3 months. Her reasoning is that even if it doubles in size, it will still be <2cm and classified as stage one. This would save me unnecessary biopsy assuming it is benign, but also would mean we miss out on 3 months of treatment opportunities. However, looking at how anxious I was, she recommended to proceed with a core needle biopsy in clinic, which I proceeded with. She also gave me a Lorazepam pill before the procedure and recommended I take home a couple more doses. I took one before the procedure per her advice and I really hated how groggy, floaty, and out of control I felt while on it.

That’s where we are at now, 2 days since I saw her, 1 day from my next appointment, and I’ve broken down a couple times despite trying pretty hard to stay positive. My husband has been so supportive, but I also live with my parents, whom I’ve not told about the current situation because I don’t want them to worry unnecessarily.

I’m praying hard that the result comes back with the mass being a benign growth, but I can’t stop my mind wandering. I have random thoughts like “if its benign I think they will call me ahead of my appointment to tell me so I won’t worry, but I haven’t heard from them”, “could this spiculated mass be fat necrosis from a fall from my recent snowboarding lesson?”, “they haven’t called me regarding needing to pay for stain, does it mean its not cancer because I read online that special stains are also used to identify specific markers on the cancer cells?”, “what if this isn’t the primary tumour and it has already metastasised and thats why I have random tingling in my limbs and jaw at times?”, etc . The random constant voices in my mind really aren’t helping. It might also be my (undiagnosed but very apparent) ADHD brain. I have so many concerns about the impact and consequences a breast cancer diagnosis can bring me at 31.

Does anyone have any experience with a spiculated growth coming back benign? Should I not keep my hopes up? I know its a “pray for the best, be prepared for the worst” type of approach I ought to take, but its TRIFFICULT (as Bingo from Bluey would say).

[Tigress]

Hi @momonono I’m so sorry that you are here but you will find a lot of support, whatever the outcome of your results. I should say that I do not have personal experience of a spiculated nodule but I would like to recommend that you give our nurses a call on 0808 800 6000 from 9am Monday to Saturday (until 4pm M-F and to 1pm on Sat) as they’ve “seen” everything. I am sure that you will get a lot of benefit being able to ask these questions to the lovely, kind, professional women that they are or just to download your concerns and fears to them. They won’t rush you. You have mentioned that you work but perhaps you could book a meeting room or find a quiet space and call them during your lunch hour? I guarantee that you’ ll feel better for having done so.

I had to have Lorazapam on Christmas Eve before having an MRI due to my claustrophobia, it worked but I felt much the same as you did - ghastly isn’t it?

Good luck with the results, let us know what the next steps are. I’ll keep everything crossed for you.

[momonono]

Thanks @Tigress. Unfortunately I’m not from the UK nor the Western part of the globe, so dialling in isn’t really an option. I’m trying to keep as calm as I possibly can while I wait for the results tomorrow. Hoping that I’ll have good news to share.

[entropy]

Hi, its good that you came across what sounds like an empathetic Dr who listened to you, gave you options and found a way for you to manage your anxiety.
I think she steered you to the right choice of getting the biopsy sooner rather than later. Though it was a reasonable option, you would of had 3 months of anxiety on top of potentially waiting for biopsy results, and that probably would not have done your mental health any good.
I don’t know the ins and outs of the meanings of scan pictures, but guessing spiculated sounds like a pattern of calcification that could indicate something.
Focusing on the good side, is it’s very small. I think part of your distressed state might be as a result of you flipping your mind between all ok - good, and cancerous- disaster. These are 2 extremes and fluctuating between them leads to instability and confusion. Trying to focus on best case scenario while doom-scrolling google is not helpful.
There are positives. Even if it turns out to be cancerous, its far from disaster.
I dealt with the time between results by focusing on the size as a positive. Whatever it is, at worst its stage1, unlikely at that size to be in the lymph nodes, so hopefully no need for chemo.
At your age and with your family aspirations, chemo or no chemo is a big deal, and right now, it’s looking most likely, whatever the outcome, you won’t need that. That is such a big plus to focus on. Hopefully, your results will offer backup to that.
Usually when they USS breasts they check the lymph nodes out too, so you would of been told if they looked suspicious, so that is a positive.
If it does turn out that you need treatment- maybe surgery- I recommend you discuss it with a therapist to help you through the journey. Tell yourself that whatever it is, small is good.

[Tigress]

Ah, I see. Well the fact remains that there is support for you here. The best of luck tomorrow, let us know how things turn out if you can.

[momonono]

thank you for the insight @entropy, I didn’t know that chemo would be unlikely as my mum went through chemo and a unilateral mastectomy when she was initially diagnosed with stage 1/2 breast cancer. They weren’t sure until they tested her lymph nodes during surgery, which luckily weren’t affected. They also found more stage 0 removed during the mastectomy. So far my ultrasound report states no enlarged axillary nodes detected but I also read that lack of lymph node involvement doesn’t always mean that the cancer has not metastasised - which worries me too. Would you be able to share more about why you say at my age and family aspiration, chemo or no chemo would be a big deal? This is something that never crossed my mind.

I never really thought of my anxiety as a problem until this doctor pointed it out. My distress is from the unknown and innate fear I guess. Because I have so much planned out and I have a lot of considerations and things to think about, with many trips booked for the rest of the year (China next week, Korea start of Sept, London and Iceland in Oct, Europe in Dec for Christmas market and snowboard classes, a sport my husband and I just picked up together), a diagnosis will definitely knock all my plans messy.

On top of that there are insurance considerations (where I am once you’re diagnosed with cancer, you pretty much cannot purchase anymore insurance, and I have exclusion clauses on my private insurance, which also means once I am diagnosed, there is zero chances of appealing to have my other exclusion clauses removed even if they’re unrelated to this diagnosis). To add on the fact that if I’m diagnosed at 31, I would reconsider my plans for a kid, which took me really long time to convince myself that we’re financially ok to have one (my husband really wanted one, and we didn’t try for one earlier because of commitments and I didn’t want to bring a kid into this world knowing I’ll shortchange him/her). The health screening which picked this up was also in preparation to try for a baby. If I know that I have a chance to pass a defective gene to the next generation, I wouldn’t want to do it. Whats more, given the age of onset (which I’m really hoping it is not malignant) insurers would likely put exclusion clauses on my child when he/she purchases any health insurance during medical underwriting, which is a risk to him/her having no coverage and extremely unfair for me to want to bring a kid to this world knowing all of these. Lastly, the impact of this on my work will also be huge.

Thanks for being here - while I type these all out its also helping me sort out my thoughts better. I’m even considering the next step such as a PET scan and how I can balance these happenings on my calendar for minimal disruptions to my existing plans while expediting any treatment timelines as much as possible.

[momonono]

It is really reassuring to know that there’s support here, @Tigress. Beats going down the google rabbit hole. I’ll definitely update once I know the results. For now I’m trying very hard to remain positive, and not break down emotionally.

[entropy]

As your mother probably experienced, the type of surgery is often dictated by size of the area, and also how many areas. Some can have multiple areas, resulting in a mastectomy required. Some can have DCIS, which in cancer terms is stage zero, not needing chemo, but still might require a mastectomy. Your mother probably had chemo either because of size (1 is different to 2, so which your mother had in the end is important) or grade and receptor type of the cells. This is important information you don’t know yet for the full picture.

If you were to need chemo, and still wanted children, there are fertility considerations to navigate. Hopefully, you won’t have to deal with that.

Do you know why your mother said no to genetic testing? Is it because she feared the outcome or that she feared you worrying about it? Sometimes anxiety can be hereditary or learnt from parents. Or parents wrongly try to protect their anxious child , even if the knowledge is useful for their future.

[momonono]

My mum’s explanation was that her oncologist said it isn’t necessary, but this was over a decade ago when technology and cost for genetic testing differed a lot from today. My take is that she doesn’t dare face the truth of potentially carrying this gene that she may have passed down to us unknowingly.

Anyway a quick update on my results, my diagnosis is fibroadenomatoid hyperplasia, benign cyst and fibrocystic change. In short, there is no evidence of malignancy found in my sample. Thanks be to God. I can finally sleep well and eat well. I am sooooo lucky, and I’m so thankful for the support found here.

My next follow up scan with her is in 6 months and hopefully that goes well too.

[Tigress]

I’m so pleased for you @momonono. I hope you get the sleep you need and can turn your attention to any treatment needed knowing that there is no cancer involved. I also hope that all of your plans with your husband can be readdressed with confidence and your travel plans go ahead and are full of fun.

[entropy]

Fantastic news, enjoy your travels. Consider though that the single biggest cause of breast cancer is getting older, so it may be wise not to put off starting a family too much longer.
My mother also had breast cancer over 18 years ago when 63. I thought I might get it around her age, maybe a few years earlier. She wasn’t tested as it wasn’t routine then, and still isn’t- depends on type and family history. I was 11 years younger than my mother - she’s a bit sketchy on the type but both ER+, though I was Her2 also. My mother was the only person known to get a cancer of any sort in her family for generations, and none on my fathers side either, so its doubtful that its genetic, just bad luck or share the same environmental factors and both late with menopause.
Don’t judge your mum on it, it may not have been advised as they look for specific indicators before suggesting a test, so it may well not have been offered as she says, its not something that is routine. In time there may be new genetic connections that aren’t known about yet.

[mjm]

Dear Momomnono,
I too am waiting for the results of my biopsy for my 1.9 spiculated mass. I too was read that a spiculated mass has a 95% chance of being malignant. I am older than you are and I realize that makes a big difference.
I believe that being told you have breast cancer is not a death sentence. Your mass is small, like mine. I am trusting that could mean that if it is malignant the process to treat it might be less complicated in what others experience.
The other thing to remember is that God is not limited to statistics. He doesn’t need a 5% chance to cure anything. Either way, you will be in His hands and He knows your life and what you need and He will supply. Try your best to relax as much as you can so that if you do have cancer you will say to your oncologist, “So what do we do now?” It’s okay to be afraid, it’s ok to cry, but try to be kind to yourself so that you can heal your emotions as much as possible before you go on. Remember, a cancer diagnosis can be so varied, most of the time it is not a death sentence but rather a hurdle in the middle of the road. You can climb this hurdle and be ok.

[momonono]

I will keep you in my prayers and I hope your biopsy will come back all clear as well. While age definitely plays a part (the breast surgeon I saw - her first recommendation was to wait 6 months and review it as according to her, most growths at my age are fibrocystic changes and while she was spot on, she also mentioned 80% chance for it to be malignant as it appeared spiculated. Even if it double in size, she said, it will still be stage 1, which would be similar to your case, which is still very treatable).

Early today I just had a review with my health screening provider and the GP who saw me was so concerned about the spiculated mass found in the ultrasound. That is, until I showed him the biopsy report and letter from my breast surgeon. He thought I moved really fast with the specialist. So yes, in general, spiculated masses are supicious BiRADS 4/5. I’m not afraid of death, and to a certain extent, cancer as I see my parents both living with it. What threw me off is the time that it hit me (nobody is too young for cancer) and all the plans it would have knocked out order. The plans to starting a family, now that husband’s career (he did a career switch) and our finances finally stabilising, all the big travel plans we have for the rest of this year (I’m writing this while waiting to get to the airport in a bit), and the fear of ‘what’s next?’

I guess my doctor is right that I have some kind of medical anxiety, which I’m sure many has. Add that to the fact that I react very swiftly and plan a lot. I was already thinking about how to slot my PET scan, surgery etc into the next couple weeks of my schedule (with minimal disruption to my immediate plans) while waiting for the biopsy result, reading medical journals etc. My doctor, however, mentioned that these shouldn’t be my worries as I’ll need to trust her to manage all of that, and life must still go on. I think God gave me the wisdom to look at the right places for support (this forum especially), and for medical advise/treatment options, and I found a great doctor who looks at me holistically and proposes the most suitable path for me.

I’m lucky my growth turned out to be benign, and I’m going on all my life plans and trips as @Tigress advised, and YES I’M FINALLY SLEEPING & EATING WELL. Even if it turned out otherwise, the initial phase would be the toughest but I’ll learn to cope and live with it.

I’ll still have to follow up with my surgeon in 6 months just to ensure that all is well, as per her recommendation, instead of going with an excision biopsy and removing the growth entirely as that would be more invasive. I still haven’t found a right way to tell my parents about this episode though. @entropy how did you do it?

[beyond]

I feel your anxiety and get almost angry. That they want to send you. Two I knew this morning psychiatrist. Let me tell you. It has been over 2 years since I had a lump. Ectomy and nine nodes removed for stage three countries, the other countries invasive carcinoma. I would make a guess to say they must be men. I hate to tell you this, but for me, I am no less anxious. Then I was two years ago, every ache and pain I have, I attribute to it being cancer. Right now, I am going through some intense shoulder pain on the same side that I had the notes in cancer removed, however, no stranger to shoulder surgery as I had nine on my right for osteo problems. I can say that it kind of feels the same like my rotated cuff problems. But I am also thinking that, because the cancer was in those nodes, then it may have spread to the bone. Nobody can tell me not to be anxious.That is actually my right and it is your right as well. The only advice I could give you if you allow me that is to try to stay in the moment and say to yourself right at this moment, everything is okay. If you have faith that lead you to prey, I would encourage that as well. Anybody on this forum, who reads this? We’ll definitely keep you in our prayers. Let us know, and we will be here for you.