Understanding Abnormal Mammogram Results: A Comprehensive Guide

Question
Hi,
I have a question regarding abnormal mammograms. I am a 44 year old female, on no medication, not overweight and have no family history of breast disease.  In Jan of 2005 I had a first  mammogram that identified two cysts on right breast. 6 months later I had a small ovoid hard lump that had been detected by my doctor prior to this mammogram,( didn't show up on mammogram) but when he checked it again it had grown and was easier to both find and feel. I was sent to a surgeon for a biopsy in Sept 2005. Biopsy on right breast came back as fibrocystic changes, with  apocrine metaplasia, no evidence of carcinoma. On my yearly follow up mammogram In December of 2005, 11 months after my initial mammogram they detect an asymmetric density in my right breast that did not spread out with compression. additional views were ordered. A steriotactic biopsy was then performed. I was experiencing unilateral spontaneous discharge from my right nipple along with pain in the outer right quadrant of my right breast. This biopsy also came back with no pathologic diagnosis. A 6 month follow up was scheduled which again showed asymmetrical density in the right outer quadrant of my right breast. They have decided to take a watch and see attitude. I also had the right breast nipple discharge checked which came back with mostly foamy macrophages but rare ductal cells are seen. I have had 6 mammograms in the last two years and although I can appreciate them keeping on top of things I am confused by these reports, and why the continuous testing. Also want to know, in your opinion, if I am at a higher rate of developing cancer with this density found and from what is put in these reports. What are foamy macrophages. do these signify inflamation?and what are ductal cells? I was wondering if I need to get another biopsy done of this abnormal density done or just sit tight, waite and worry about this. Thanks for your time and expertise

Answer
Does your dr. not explain these things? Anyway. From what you have described to me you probably have a fibrocystic breast condition which is rather common in young females and not uncommon in somewhat older but still menstruating women. So far your mammograms and biopsies have only produced findings that are consistent with that diagnosis. This is NOT breast cancer, but it makes it somewhat more difficult to find such a cancer should it arise since it may so to speak be hiding among the other non cancerous lesions there. As long as there is no blood in your discharge there is no cause for alarm. Macrophages are normal inlammatory cells but in this case there is no reason to suspect any infection or inflammation. Ductal cells are normal cells from the lining of your milk ducts. As long as no atypical or cancerous cells are reported there is no reason to be alarmed. At the moment I suggest only regular check ups with mammograms, ultrasound scans & breast MRI scans (the two latter scans will make it easier to distinguish between fibrocystic changes and more suspicious lesions should such appear) and if any unclear lesions appear to do (stereotactic) needle biopsies of them and if still unclear after that surgical biopsies. At the moment there is no reason to think that you are at a higher risk, there is only the fact that it is more difficult to examine you due to these other changes. In my opinion this is something your dr. should have explained to you in some detail! Good luck!