Breast care after the age of forty is mandatory, but for a woman with diabetes, breast care is a bit of a wild ride. In 1991, I had my first biopsy for a lump I found in my breast. At age 34, I had a baseline mammogram, and at age 39 had my second biopsy on the other breast. It wasn't until 2008 that a radiologist looked at my history and said, "I think you are classic diabetic mastopathy." I've had 6 biopsies and lots of tissue samples removed for study.
Diabetic Mastopathy Review
Diabetic Mastopathy is a condition that occurs in about 13% of type1 women between the ages of 20-40, and who have had long-term diabetes (15 yrs. or more). It is considered an uncommon complication of type1, and physicians who do not specialize in diabetes are not always aware of it, so it goes unreported.
Diabetic Mastopathy is a form of fibrous breast tissue that is hard, irregular in shape, easily movable and painless and often bilateral (63% reported). By mammography and ultrasound, diabetes mastopathy looks just like breast cancer tumors, but a needle biopsy helps to differentiate cancer from DMP. Tissue samples usually yield a granular dense tissue, or the lump contains little cellular material for a cytological diagnosis (I've had both forms in separate biopsies).
**Surgical Biopsy vs. Interventional Radiolog **
My first and second biopsy were surgical and the problem with surgery is that is creates more scar tissue and in some cases the surgery can encourage more masses, involving more of the breast tissue.
Subsequent biopsies have been using ultrasound-guided needle that offer minimally invasive image-guided procedures. Procedures that use MRI, Ultrasound, CT scan or x-rays are known as Interventional Radiology.
In my years at the clinic, I have had 4 ultrasound guided biopsies, which have saved me from having to take a ton of time off from work and then not having to deal with the healed incision, which usually leaves a dimple where the tissue was removed.
However in 2013, my breast team started talking with me about switching to an MRI for tracking changes in my DMP. The team thought that an MRI might define the masses better to know that they are not cancer, but the drawback was that an MRI could open up Pandora's box.
In late December, I had the MRI and the images showed all was good with the exception of one small 1.8mm lump. Unlike the past lumps, this was one is closer to the inside of the breast, versus all the others that have been on the outside of the breasts. And this time, they wanted to do an MRI-guided biopsy, instead of the ultrasound-guided biopsy.
The drawback is that the MRI machine is noisier and an MRI is a more intense experience due to the narrow tunnel and, for some, the feeling of claustrophobia. But the benefits were more accuracy and more precise pictures for the radiologists to work from.
Procedures like MRI-guided biopsies will make this process more precise and less invasive, and in my book that's a win/win. The doctors get a chance to look more closely at an unknown, and for me, it's less of a time suck and invasion to my body.
Living with DPM is all about patience, persistence and education.