After a routine mammogram and sonar, Paula Townsend was incorrectly diagnosed with a ductal carcinoma and almost opted for a double mastectomy. She tells us her story.
In March 2019, I went for my annual mammogram and scan. Admittedly, it was overdue as the previous year I moved from my beloved Jozi to the coast.The mammogram was completed without incident. But, sometime into the sonar, I noticed a level of agitation from the radiographer. In my previous experience, sonars had always been done by a radiologist.
She left the room and returned with a doctor who introduced himself as a radiologist. The two of them focussed on a spot on my left breast. After much subdued discussion between them, I was informed that they had discovered a small lump in one of the ducts. But, “Not to worry, it was still very small, and after all. This is what mammograms were all about.” An appointment for a biopsy was set up.
Needle aspiration instead of core biopsy
On arrival, I found out the radiologist had gone to a neighbouring town, and a replacement radiologist was on his way.
The new doctor, who seemed not to have had the opportunity to review my scans, decided that, to save costs, he would do a needle aspiration, and not a full core biopsy, and hopefully a sufficient sample would be collected.
During my consult with my GP, I learnt the biopsy results indicated a ductal carcinoma; it needed to come out as soon as possible. A consult was set up with a surgeon.
The surgeon opened the consult with “So, you’ve been diagnosed with breast cancer!” He then explained the various options, ranging from the removal of the lump, “which would have to be followed by 42 consecutive days of radiation”, or the removal of the whole breast “which would probably remove the problem, without the likelihood of a reccurrence, or the need for chemotherapy”, to the possibility of a double mastectomy.
He also indicated that he would need to trace and remove the first lymph gland under my arm, to ensure that the cancer hadn’t spread. I was told to read up as much as I could to help me come to a decision.
The physical examination got a whole lot worse! While standing naked from the waist up and vulnerable, he said, “Breasts are wonderful things on a 21-year-old, but at your age, they’re really of no value, and can be easily dispensed with.”
The consultation came to an end, and, totally demoralised, anxious, and on the verge of tears, I was told that if I let him know by tomorrow, he could have me in theatre the next week.
Fortunately, I have good friends who advised me to go for a second opinion, preferably from an oncologist. The oncologist told me that current practice tended towards the preservation of breasts where possible, and in my case (with the lump being so small), the first option would be the removal of the lump, for proper pathology, and if necessary four weeks of radiation.
It was then that I remembered attending, many years ago, a talk by a specialist breast surgeon, on the wonderful work she and her team were doing in overcoming pro-mastectomy prejudice on the part of many surgeons; the progress made on the removal and treatment of lumps; and breast reconstruction.
On the strength of this, I opted for a lumpectomy. The operation was carried out, pathology done, and it was found that although there was a small papilloma (a small wart-like growth), it was not malignant, and unlikely to develop into cancer. So, I was incorrectly diagnosed!
I was referred to a dedicated breast centre. My six-monthly check-up showed the development of another papilloma which a proper biopsy has shown to be benign. By the way, a full core biopsy is not nearly as unpleasant as a needle aspiration.
The way forward
So, in my case, the recurrent papillomas are like “Granny warts” and can be managed through regular screening. I consider myself fortunate, despite having being incorrectly diagnosed and undergone surgery, which should never have been necessary. I’m still under the care of the specialised breast clinic, and am confident that I’m getting the best care possible.
Lessons to be learnt
- Don’t be intimidated by healthcare professionals.
- It’s your body. Take ownership of it and what is happening to it.
- You have a right to know and to be informed.
- Don’t allow healthcare professionals to take short cuts.
- You have a right to a second opinion.
- Don’t allow yourself to be hustled into quick decisions, simply to fill up the surgeon’s diary.
- You don’t need to put up with patronising comments.
- It’s okay to be scared.