My 7mm, palpable, solid breast mass was confirmed on Tuesday, and I was scheduled to have an ultrasound-guided core needle biopsy on Friday. On Wednesday, I had to fly to St. Louis, MO on business, so I was too busy to reflect on my health. Typically, I am a relentless researcher, wanting to understand every detail of a situation. But it wasn’t until I was tucked into my Holiday Inn bed Wednesday night that I had a chance to think for two seconds, and my thoughts went something like this…
OK, so I have a breast lump. And it’s 7mm, which is no big deal. Typically, 1cm or larger is when things start to get sticky. I hate needles. Let’s get some more details about the procedure. I googled “ultrasound-guided core needle biopsy,” and I read LOTS of articles and discussion threads about the process.
The Mayo Clinic defines it this way: “A radiologist or surgeon uses a thin, hollow needle to remove tissue samples from the breast mass, most often using ultrasound guidance. Several samples, each about the size of a grain of rice, are collected and analyzed to identify features indicating the presence of disease.”
I thought about the size of a grain of rice. Just for perspective, here is an image I created that shows the size of 7mm against a 1-inch line. If a core needle biopsy needs to pull a sample the size of a grain of rice from THAT, this sucker is going to be obliterated. So, this makes no sense to me. Why not just remove it?
So, I went out to some breast cancer discussion boards and started asking questions. Even at 10:00 pm, I got answers. Most of them went like this: “It is standard of care to biopsy all solid masses first. An excisional biopsy is different from a lumpectomy; they are not interchangeable procedures. If there is no needle biopsy first, you run the risk of having two separate surgeries to treat one lump. Breast surgeons like to avoid that.”
Standard of care…all solid masses…I thought back to the sea of women in robes. I get it. There is no time to discuss individual approaches when faced with so many lumps. These doctors don’t care that I have no attachment to this breast and would rather have the whole thing removed than deal with it. They have a procedure that works for the masses (no pun intended).
I told myself to go to sleep. As I was drifting off, I thought about the needle again. Once that needle punctures that mass, won’t the materials (liquid, cells, whatever) inside that mass go spewing out? I mean, right now, it’s one solid mass. But at that point, it’s going to be a hot mess, and the doctors have no intention of eradicating it for days (or, more likely, weeks). I was too tired to do more research. I slept.
On Thursday morning, as I was walking into my client’s office in Missouri, the nurse called to confirm my Friday biopsy. She asked if I had any questions. I said, “Actually, yes.” And I posited my concerns about potential cancer cells leaking out of my nicely contained lump. She hesitated, stammered, and answered, “You don’t understand how cancer works. It works at the cellular level, so you don’t need to worry about that.” As I hung up, I had the uneasy feeling that she lied to me. I walked into my client’s lobby and tackled the day.
Late Thursday afternoon, I headed to the St. Louis airport and called my sister. I told her my thoughts, and her reaction was unexpected. “Oh, I understand your concerns. That’s exactly what happened to my father-in-law. His lung cancer was contained. Within a week of doing the biopsy, it had spread. The doctors denied it, but you’ll never be able to convince us otherwise.” Hmmm. I got to the airport and started to scour for information.
And then I found them: “Risk of Tumor Cell Seeding Through Biopsy and Aspiration Cytology“, “Prevention of Tumor Seeding During Needle Biopsy by Chemotherapeutic-releasing Gelatin Sticks“, “Core‐needle Biopsy of Breast cancer is Associated with a higher rate of distant metastases 5 to 15 years after diagnosis than FNA biopsy“, etc.
The official name for the cancer cells establishing themselves elsewhere is “seeding.” The results of the first article above? “In our review, 94% of breast cancers and 4% of liver malignancies showed risk of seeding of tumor cells following biopsy or FNAC.” FNAC stands for “Fine-needle aspiration cytology,” and I was scheduled for the procedure with the thicker needle!
I jumped out to the cancer discussion boards. Now that I knew the term seeding, I started to dig. Story after story immerged from women who were perfectly fine one day (besides having a lump), had a biopsy, and then everything spiraled out of control. And, regardless of what the medical community told them, they couldn’t be convinced that the biopsy hadn’t set off a horrific chain of events.
The worst part for me? My cancer nurse lied to me. And, she played the “you’re not capable of understanding the complexity of what we experts know to be true” card. Crap. When someone does that to me, they throw down a gauntlet. The game is on.