Birard Code WHAT?

Kaiser finally released the results from the mammogram + sonogram that I had Wednesday. I understood most of it, but had to learn something new.

For those of you who may have seen this term on your reports, and not understood what it meant, the BIRAD code is the 'diagnosis' result on your mammogram. I'll provide the scale here:

Category	Definition
0 - Incomplete	Additional imaging evaluation and/or comparison to prior mammograms (or other imaging tests) is needed.
1 - Negative	This is a normal test result.
2 - Benign (non-cancerous) finding	This is also a negative test result (there’s no sign of cancer), but the radiologist chooses to describe a finding that is not cancer, such as benign calcifications, masses, or lymph nodes in the breast. This can also be used to describe changes from a prior procedure (such as a biopsy) in the breast.
3 - Probably benign finding	A finding in this category has a very low (no more than 2%) chance of being cancer, but hasn't been proven benign.
4 - Suspicious abnormality	These findings do not definitely look like cancer but could be cancer. The radiologist is concerned enough to recommend a biopsy. The findings in this category can have a wide range of suspicion levels. For this reason, this category is often divided further: 4A: Finding with a low likelihood of being cancer (more than 2% but no more than 10%) 4B: Finding with a moderate likelihood of being cancer (more than 10% but no more than 50%) 4C: Finding with a high likelihood of being cancer (more than 50% but less than 95%), but not as high as Category 5
5 - Highly suggestive of malignancy	The findings look like cancer and have a high chance (at least 95%) of being cancer. Biopsy is very strongly recommended.
6 - Known biopsy-proven malignancy	This category is only used for findings on a mammogram (or ultrasound or MRI) that have already been shown to be cancer by a previous biopsy. Imaging may be used in this way to see how well the cancer is responding to treatment.

I've paraphrased or reduced length on a lot of this. You can find the original source for the above table on the American Cancer Society's website here.

The TLDR of everything is they rated the masses in my right breast as a BIRARD Code 5. That means there's a 95% chance it's malignant.

Now I understand why they were aggressive about getting the biopsy sooner rather than later. 

Trying not to have a meltdown. Maybe they're wrong. Maybe I'm in the 5%.

Unlikely.

I'm not freaking out. If I say it enough, I might not freak out.

I may have cancer.

Making Lemonade?

I made the decision today that when I have the results, one way or the other, I'll be putting a PSA into our Women's ERG at work. I worry it'll bite me in the ass at some point later in life, but I'm not at all worried about losing my job over this. I know people will be supportive at work, it's just the type of culture we have.

I have it all written out, sitting in notepad. I'm hoping this is just a really bad scare.

Punched In The Booby

I had the biopsy this morning. Found out there's not one mass, but two masses. One in my breast, and the other in one of my lymph nodes.

When the Doctor came in, he discussed the procedure with me. It didn't help much with the fear, I wasn't worried about the procedure itself, I'm terrified-bordering-on-panic about the results.

He numbed up my right boob really good, all I felt was tugging. That needle was HUGE. It reminded me of the IV needle they used when I had my hyperparathyroidectomy. He took 7 core samples total. After that, he put little metal 'clips' in my boob which are supposed to mark both lumps, so that in the future, anyone doing a mammogram will know that those two lumps were already biopsied.

The Doctor was very clear that he would call me as soon as the results were in, one way or another, but it might take up to 5 days.

I am thankful for several things during this procedure:

• The nurse who held my hand (I'm sorry if I bruised it!)
• The nurse who held a fan in front of my face (That was brilliant!)
• The doctor who give me the time I needed to push past the panic attacks that kept threatening to break fee

There's a 3x4 bandage with steristrips covering the biopsy site, which seems a bit extreme for needle sticks (granted, those needles were BIG).  I feel like I've been punched in the side-boob. I really should have taken some one with me on this one.

I Have a Bad Feeling About This

I had the follow-up mammogram today, it was also 3D. I also had a sonogram they had scheduled me for, but didn't tell me about, that was a surprise!

I saw the monitor as they were doing the sonogram. There were some impressively large black spots showing up. I really hope that's a case of magnification. I'm pretty sure I know what those black things mean - a tumor. I just don't know whether it's benign or cancer.

Right after they finished the sonogram, they sent in a doctor and a nurse to discuss having a biopsy. My choises were tomorrow or next week. Of course, I immediately pulled out my calendar to figure out when I could fit it in between my meetings. As soon as I opened my mouth to begin appointment negotiations, I knew I was wrong. I corrected myself and told her I'd take the soonest available tomorrow.

I know something suspicious is there. I'm scared.

The IVF Verdict

I met with the fertility clinic's doctor today about IVF. While I was hoping we'd be able to use my own eggs, the numbers look pretty bad. I went in expecting this given my age (44) and history, but it still hurt. Managed not to cry until we were done talking. I started looking at an egg bank for potential donors. That made me cry.

Part of me feels like there's no use crying over spilt milk. The time was never right, the money was never right. Now that it is, it's too late for my own. It doesn't mean everything is over, but it's still a type of mourning.

The Mammogram Follow-up Call

 Kaiser called me today to schedule the follow up from my annual. I told them I already had it scheduled, and asked what the report meant by "right breast asymmetry". They said it's just a part they couldn't make out and doing a second mammogram is "routine" and it's "probably nothing"

Alarm bells?  Kinda? It always bothers me when medical people are vague like that, then tell me it's routine and probably nothing. I know the medical people don't want to cause alarm in patients, but I'd rather hear it from them than asking Doctor Google.

They're probably right, and I'm being a little alarmist.