Lumps discovered in both breasts (asking for a friend). Difficulty factor: expat volunteer living in China with limited health insurance.
January 15, 2010 10:20 AM Subscribe
Lumps discovered in both breasts (asking for a friend). Difficulty factor: expat volunteer living in China with limited health insurance. Yeah, YANAD, or at least not her D.
First, the information from my friend:
1. Found lump in left breast about a week ago. Had not done a self exam in a few months.
2. History of cancer on both sides of family, but zero history of breast cancer.
3. 30 years old, in good health otherwise.
4. Had ultrasound on both breasts. Found same lump on the left and size is 12.8 x 9.1 mm. Also found a smaller lump in right breast. They can tell by the shape that the growths are not cancerous. Instead, I have multiple cysts in both right and left. If they continue to grow, there is a slight chance they could become cancerous. They say the other option is to just watch things closely over the next several months. Since they are currently not cancerous, it's not a huge deal having them there. But if they continue to grow or I get a lot more of them, then there's room for concern.
5. Because of the size of the largest one (see #4) they advise removing it and testing it for more information (to find out maybe why they are growing). They didn't say anything about a biopsy. Apparently they are done in China, but it's much more common to just cut the problem area out and then run tests. They also recommended I take some form of Chinese medicine to see if it could shrink the cysts. Both the lump removal and chinese medicine recommendations seem like a bit of an "old school" approach - am thinking this is not the diagnosis I would get in the States.
6. Large hospital in Beijing can do surgery but is quite expensive. Instead, health insurance company would prefer to fly me to Thailand for the surgery. Would pay for both surgery and flight.
7. Planning to get second opinion from another hospital in Beijing.
8. Translated Chinese doctor's report into English and emailed it to doctor colleague in the States. She said the ultrasound could determine the shape/size of the lumps, and she said it's a good sign that they are just cysts. She said that cysts often come and go, and for the most part are totally harmless and more common than you'd think. But she said the one thing to learn is if they are liquid or hard. She said this was important to determine. She recommended seeing another doctor in Beijing for further tests.
Questions: Is surgery really best/standard option or is that a more old-fashioned-developing-country kind of approach? Would a biopsy or other test be better? If surgery turns out to be best, what are logical next steps that I may not have considered when looking at potential surgery overseas? Any experience with Beijing hospitals (or others in the nearby region)?
Throwaway follow up at breastbumpsbeijing@gmail.com
First, the information from my friend:
1. Found lump in left breast about a week ago. Had not done a self exam in a few months.
2. History of cancer on both sides of family, but zero history of breast cancer.
3. 30 years old, in good health otherwise.
4. Had ultrasound on both breasts. Found same lump on the left and size is 12.8 x 9.1 mm. Also found a smaller lump in right breast. They can tell by the shape that the growths are not cancerous. Instead, I have multiple cysts in both right and left. If they continue to grow, there is a slight chance they could become cancerous. They say the other option is to just watch things closely over the next several months. Since they are currently not cancerous, it's not a huge deal having them there. But if they continue to grow or I get a lot more of them, then there's room for concern.
5. Because of the size of the largest one (see #4) they advise removing it and testing it for more information (to find out maybe why they are growing). They didn't say anything about a biopsy. Apparently they are done in China, but it's much more common to just cut the problem area out and then run tests. They also recommended I take some form of Chinese medicine to see if it could shrink the cysts. Both the lump removal and chinese medicine recommendations seem like a bit of an "old school" approach - am thinking this is not the diagnosis I would get in the States.
6. Large hospital in Beijing can do surgery but is quite expensive. Instead, health insurance company would prefer to fly me to Thailand for the surgery. Would pay for both surgery and flight.
7. Planning to get second opinion from another hospital in Beijing.
8. Translated Chinese doctor's report into English and emailed it to doctor colleague in the States. She said the ultrasound could determine the shape/size of the lumps, and she said it's a good sign that they are just cysts. She said that cysts often come and go, and for the most part are totally harmless and more common than you'd think. But she said the one thing to learn is if they are liquid or hard. She said this was important to determine. She recommended seeing another doctor in Beijing for further tests.
Questions: Is surgery really best/standard option or is that a more old-fashioned-developing-country kind of approach? Would a biopsy or other test be better? If surgery turns out to be best, what are logical next steps that I may not have considered when looking at potential surgery overseas? Any experience with Beijing hospitals (or others in the nearby region)?
Throwaway follow up at breastbumpsbeijing@gmail.com
As someone who gets breast cysts often, some that go away and one that has stuck around for years despite draining, it is very old-fashioned to immediately jump to surgery. What she should have done first is the ultrasound, which will give a good idea if it's a cyst. Next (or instead) a fine needle biopsy will determine if it's fluid (and if so, drain it as well), and determine if there are any suspicious cells. If the cysts are easy to reach/feel, the needle can be done painlessly and without need for any anesthesia or ultrasound. If they're more difficult, she would have the area numbed and have the needle done under ultrasound for a better view.
Having cysts should not raise her chance for breast cancer (at least that's what my breast surgeon told me), but it can make it harder to detect b/c you might think "oh, just another cyst" and not get something suspicious checked out.
posted by dayintoday at 10:52 AM on January 15, 2010
Having cysts should not raise her chance for breast cancer (at least that's what my breast surgeon told me), but it can make it harder to detect b/c you might think "oh, just another cyst" and not get something suspicious checked out.
posted by dayintoday at 10:52 AM on January 15, 2010
I have pretty cystic breasts and long before the age of 35 started having annual mammograms, spot compressions, and ultrasounds. I've had two biopsies, both negative. Not once has anyone recommended an operation to remove the cysts, the sizes of which change depending (for me) on weight gain/loss and where I am in my menstrual cycle. They really come and go, and now that I've got 10+ years of mammogram film, the doctors can tell pretty immediately how much has changed in a spot and whether any change is worrisome. I've also never heard that a cyst can "become" cancerous, but I could be wrong about that. So the idea of having an operation to remove a benign cyst sounds pretty extreme to me. To be sure the cysts aren't cancerous your friend would want to get a biopsy, but I wouldn't go further than that without like eight more second opinions. And of course IANAD.
posted by fiery.hogue at 10:56 AM on January 15, 2010
posted by fiery.hogue at 10:56 AM on January 15, 2010
You may just want to fly to Thailand. I know expats in China who go to Bumrungrad for anything potentially serious: It's cheap, they speak better english, they deal with more foreigners, accommodations are resort-like.
posted by FuManchu at 11:06 AM on January 15, 2010 [1 favorite]
posted by FuManchu at 11:06 AM on January 15, 2010 [1 favorite]
I am not a breast cancer expert by any means, but I am a doctor in the US, and I suspect that at least in our healthcare system the standard of care wouldn't necessarily be surgery for a cystic breast mass. Unless things have changed in the last few years (again I'm a pulmonologist, so certainly do not construe this as professional advice), I think the standard approach here often involves trying to aspirate fluid out of the breast and depending on what that fluid looks like, and whether the cyst comes back after a period of time, the next step may either involve a surgical biopsy or just follow-up monitoring over time.
Cysts are exceptionally common and in a 30-year-old without a family history of breast/ovarian cancer, they are benign in the vast majority of cases. You can imagine how many needless surgeries might be performed if every breast cyst were to be managed as you describe. I would get the second opinion.
posted by drpynchon at 11:31 AM on January 15, 2010
Cysts are exceptionally common and in a 30-year-old without a family history of breast/ovarian cancer, they are benign in the vast majority of cases. You can imagine how many needless surgeries might be performed if every breast cyst were to be managed as you describe. I would get the second opinion.
posted by drpynchon at 11:31 AM on January 15, 2010
This thread is closed to new comments.
I didn't have to have a biopsy or any other kind of surgery. An operation does sound like an old-school approach. A biopsy can definitively tell you whether it was a cyst or not -- in fact, sometimes if you do a biopsy on a fluid-filled cyst, that makes it go away, because puncturing the cyst to draw the fluid drains it right then and there.
If they're pretty sure they're cysts, it honestly can't hurt to wait a month or two and see if they go away on their own -- as they most likely will.
posted by EmpressCallipygos at 10:35 AM on January 15, 2010