ROJoson PEP Talk: MAR: The Disappearing Breast Mass

ROJoson PEP Talk: MAR: The Disappearing Breast Mass

1. September 14, 2024 1400H - 1500H Via Zoom Med Anecdotal Report - The Disappearing Breast Mass Empowerment objective - for laypeople to have an essential  understanding on “The Disappearing Breast Mass” as part of their health management.

2. September 14, 2024 1400H - 1500H Via Zoom Med Anecdotal Report - The Disappearing Breast Mass Empowerment objective - for laypeople to have an essential  understanding on “The Disappearing Breast Mass” as part of their health management. Welcome all! MUTE yourself but always show your video picture. Sign in your name, FB account, or email address in the Chat Box! Include names of companions attending. Use the Chat Box to ask questions and make comments while the PEP TALK is on. There will be group pictures at start and end of PEP TALK – show your face in video.

3. t Reminder after the PEP Talk: Take the Online Learning cum Evaluation Test Exercise (OLETE) for mastery of learning and have a perfect score to get a Certificate. Link is in Chat Box.

4. Reminder: 25 OLETE Certificates = 1 Voucher for ROJoson Medical Consultation either Face-to-Face or Telemedical.

5. Med Anecdotal Report - The Disappearing Breast Mass Empowerment objective - for laypeople to have an essential  understanding on “The Disappearing Breast Mass” as part of their health management. ROJOSON’S REQUEST: FEEDBACK TO THIS PEP TALK! Pls. type in your feedback in the chat box during the open forum and before we adjourn! Thank you!

6. Med Anecdotal Report - The Disappearing Breast Mass Empowerment objective - for laypeople to have an essential  understanding on “The Disappearing Breast Mass” as part of their health management. LET’S NOW HAVE A GROUP PICTURE TAKING BEFORE WE START PEP TALK PROPER IN 2 MINUTES! Pls. turn on your video! Show your face!

7. Med Anecdotal Report - The Disappearing Breast Mass Empowerment objective - for laypeople to have an essential  understanding on “The Disappearing Breast Mass” as part of their health management. ROJoson PEP Talk I have a Patient Empowerment Program in which I like to empower the lay people or patients to take control in the management of their health.

8. I started the PEP Talk on May 15, 2021 during the COVID19 Pandemic. There are 3 courses in the PEP Talk. I completed the Core Course on October 9, 2021.

9. From October 23, 2021 onwards, I have been tackling Health Disorder and Health Issue Courses. May 18, 2024 marks the start of YEAR 4 of ROJoson PEP Talk. How long the PEP Talk will last will depend on our enthusiasm , discipline and perseverance .

10. Med Anecdotal Report - The Disappearing Breast Mass Empowerment objective - for laypeople to have an essential  understanding on “The Disappearing Breast Mass” as part of their health management. My PEP TALK today is entitled: Med Anecdotal Report - The Disappearing Breast Mass

11. Contents What is a medical anecdotal report or MAR? Narration Insight / Reflection MAR Title: The Disappearing Breast Mass Reporter: Dr. Reynaldo O. Joson Date of Medical Observation: 2024 Med Anecdotal Report - The Disappearing Breast Mass Disclaimer: ROJoson PEP Talk contains ROJoson’s Thoughts, Perceptions, Opinions and Recommendations (TPORs) culled from experiences of ROJoson and writings of other health professionals .

12. Med Anecdotal Report - The Disappearing Breast Mass Empowerment objective - for laypeople to have an essential  understanding on “The Disappearing Breast Mass” as part of their health management.

13. MAR: The Disappearing Breast Mass GIST of MAR A 41-year-old Filipina with history of fibrocystic changes and macrocysts of the breast who developed a “big” solid non-tender dominant mass in which a breast cancer was suspected and created an alarm to all concerned. With mere observation, the big mass disappeared spontaneously. Med Anecdotal Report - The Disappearing Breast Mass

14. MAR: The Disappearing Breast Mass Some reflection and learning points and issues: Can breast masses disappear on their own? If yes, what kind of breast masses? Can they recur after they disappear? If a hormonally related breast mass spontaneously disappears, if it recurs, is it always the same diagnosis? Can it be a cancer appearing this time? Can breast cancers disappear on their own? How long can you observe breast masses hoping for disappearance? ROJoson’s tips on management of similar situation Med Anecdotal Report - The Disappearing Breast Mass

15. What is a medical anecdotal report or MAR? MAR is operationally defined by ROJoson as a brief written report on an actual medical event that involves an actual patient. The medical observation must have an impact on the reporter in terms of insight gained and which the reporter thinks is worth sharing with other people, usually for learning purpose. Med Anecdotal Report - The Disappearing Breast Mass The MAR will have 2 parts: Narration Insight or Reflection

16. NARRATION I had a patient, MDJC, 47-year-old female who on June 25, 2024, consulted for a right breast mass noted 2 weeks prior. On physical exam, there was a 4.5 to 5 cm dominant solid firm right breast mass at the right upper outer quadrant, with ill-defined border, non-tender with no associated palpable right armpit mass or lymph node. Med Anecdotal Report - The Disappearing Breast Mass

17. NARRATION She has seen me before for her breast concerns. ( 2018, -2020 ) In 2018, she had a 2.5-cm macrocyst on the outer upper quadrant of the left breast which I aspirated 6 cc of serous fluid with resultant disappearance of the dominant mass. The macrocyst disappeared thereafter. Med Anecdotal Report - The Disappearing Breast Mass

18. NARRATION Med Anecdotal Report - The Disappearing Breast Mass

19. NARRATION In 2020, she consulted with a 1 to 1.5-cm dominant mass at the outer upper quadrant of the right breast. My diagnosis was another macrocyst at the right breast this time. This was supported by a cyst finding on ultrasound. The said macrocyst disappeared thereafter according to her as we did not a check-up / follow-up during the COVID19 pandemic. Med Anecdotal Report - The Disappearing Breast Mass

20. NARRATION June 25, 2024 was her first consult with me after the COVID19 pandemic. I was alarmed and worried about the relatively big breast mass this time and it felt solid, not evidently cystic on palpation. With the background history of macrocysts in 2018 and 2020 and she claimed the mass had decreased in size 4 to 5 days before she saw me on June 25, 2024, my primary clinical diagnosis was still a macrocyst and my secondary diagnosis was a breast cancer. Med Anecdotal Report - The Disappearing Breast Mass

21. Med Anecdotal Report - The Disappearing Breast Mass

22. NARRATION She agreed to a needle evaluation with aspiration biopsy right after my clinical evaluation. The gross evaluation finding showed solid mass. It was not cystic to indicate a macrocyst . I was forced to suspect or consider more of breast cancer. I submitted a sample for biopsy. Med Anecdotal Report - The Disappearing Breast Mass

23. NARRATION A week after, the biopsy result showed “few benign ductal cells.” Somehow, there was a sigh of relief, at least temporarily, because there was no report of malignant cells seen. Med Anecdotal Report - The Disappearing Breast Mass

24. NARRATION However, I had an ultrasound of the breasts done right after the needle evaluation procedure. The ultrasound result showed BI-RADS 4B – moderate suspicion for malignancy as the diagnosis for a 2.2 x1.1 x 1.8 cm solid fairly circumscribed lobulated hypoechoic mass, right breast at 10 o’clock. There was mention of multiple cysts and solid nodules on both breasts. Med Anecdotal Report - The Disappearing Breast Mass

25. NARRATION However, I had an ultrasound of the breasts done right after the needle evaluation procedure. The ultrasound result showed BI-RADS 4B – moderate suspicion for malignancy as the diagnosis for a 2.2 x1.1 x 1.8 cm solid fairly circumscribed lobulated hypoechoic mass, right breast at 10 o’clock. There was mention of multiple cysts and solid nodules on both breasts. Med Anecdotal Report - The Disappearing Breast Mass BI-RADS Category: Category 4B – moderate suspicion for malignancy

26. NARRATION On follow-up on July 2, 2024, about a week after consult on June 25, 2024, on physical examination, instead of the 4.5 to 5 cm single mass previously noted, there was now noted two distinct masses, one was about 1.5 cm and the adjacent one, 2 to 2.5 cm. Obviously, there was decrease in size of the mass palpated on June 25, 2024. With these findings, my primary clinical diagnosis was benign, most likely fibrocystic changes. I recommended observation and follow-up after 2 weeks to which the patient agreed. Med Anecdotal Report - The Disappearing Breast Mass

27. NARRATION Med Anecdotal Report - The Disappearing Breast Mass

28. NARRATION On July 16, 2024, the previously noted two right breast masses on the outer upper quadrant on July 2, 2024 had further decreased in size to the point that there was practically no dominant mass, just a little prominence or thickening. So, again, my primary diagnosis was fibrocystic changes. Med Anecdotal Report - The Disappearing Breast Mass After 3 weeks of observation

29. NARRATION Wanting to clear-up the suspicion of breast cancer on ultrasound, the patient had a follow-up ultrasound on July 30, 2024, two weeks after. The result showed regression of the suspicious 2.2 cm mass to 1.5 cm. Thus, BI-RADS 3 (probably benign) was given by the ultrasonographer . Thus, my final diagnosis at this time was FIBROCYSTIC CHANGES. Med Anecdotal Report - The Disappearing Breast Mass

30. NARRATION Wanting to clear-up the suspicion of breast cancer on ultrasound, the patient had a follow-up ultrasound on July 30, 2024, two weeks after. The result showed regression of the suspicious 2.2 cm mass to 1.5 cm. Thus, BI-RADS 3 (probably benign) was given by the ultrasonographer . Thus, my final diagnosis at this time was FIBROCYSTIC CHANGES. Med Anecdotal Report - The Disappearing Breast Mass June 27, 2024 BI-RADS Category: Category 4B – moderate suspicion for malignancy July 29, 2024 BI-RADS Category: Category 3 – Probably benign finding Regression in size

31. MAR: The Disappearing Breast Mass GIST of MAR A 41-year-old Filipina with history of fibrocystic changes and macrocysts of the breast who developed a “big” solid non-tender dominant mass in which a breast cancer was suspected and created an alarm to all concerned. With mere observation, the big mass disappeared spontaneously. Med Anecdotal Report - The Disappearing Breast Mass

32. MAR: The Disappearing Breast Mass Some reflection and learning points and issues: Can breast masses disappear on their own? If yes, what kind of breast masses? Can they recur after they disappear? If a hormonally related breast mass spontaneously disappears, if it recurs, is it always the same diagnosis? Can it be a cancer appearing this time? Can breast cancers disappear on their own? How long can you observe breast masses hoping for disappearance ? ROJoson’s tips on management of similar situation Med Anecdotal Report - The Disappearing Breast Mass

33. MAR: The Disappearing Breast Mass Reflection and learning points and issues: Can breast masses disappear on their own ? YES, there are breast masses which CAN disappear on their own. But NOT all breast masses CAN disappear on their own. Med Anecdotal Report - The Disappearing Breast Mass

34. MAR: The Disappearing Breast Mass Reflection and learning points and issues: What kind of breast masses can usually disappear on their own ? Usually, breast masses secondary to hormonal changes can disappear on their own without treatment at all. FIBROCYSTIC CHANGES, MACROCYSTS, and ADENOSIS are breast masses secondary to hormonal changes that can disappear on their own without any treatment at all. Med Anecdotal Report - The Disappearing Breast Mass Fibrocystic changes (not disease) – presence of fibrosis (thickening) and cysts (usually microcysts – less than 1 cm). Macrocysts – big cysts – palpable – usually more than one cm – part of FIBROCYSTIC CHANGES. Adenosis – enlargement of the lobules (glandular elements) of the breast FIBROCYSTIC CHANGES most common changing findings on the breasts due to hormonal changes.

35. MAR: The Disappearing Breast Mass Reflection and learning points and issues: What kind of breast masses can usually disappear on their own ? Usually, breast masses secondary to hormonal changes can disappear on their own without treatment at all. Galactocoeles – cystic collection of milk fluid Fibroadenoma – may also disappear, especially as one nears menopausal stage Med Anecdotal Report - The Disappearing Breast Mass

36. MAR: The Disappearing Breast Mass Reflection and learning points and issues: Can they recur after they disappear? Usually, breast masses that spontaneously disappear may recur or reappear again as long as the inciting cause is still present, such as hormonal changes in the body, which are constantly present throughout life. If the inciting cause has disappeared or decreased, risk of recurrence is lower. Med Anecdotal Report - The Disappearing Breast Mass

37. MAR: The Disappearing Breast Mass Reflection and learning points and issues: If a hormonally related breast mass spontaneously disappears, if it recurs, is it always the same diagnosis? Can it be a cancer appearing this time? If it recurs, usually it has the same diagnosis or category of diagnosis – hormonally-related cause. However, a cancer can occur also. The cancer is a new disease that has appeared. Med Anecdotal Report - The Disappearing Breast Mass

38. MAR: The Disappearing Breast Mass Reflection and learning points and issues: Can breast cancers disappear on their own? NO, unless there is a medical miracle. Med Anecdotal Report - The Disappearing Breast Mass

39. MAR: The Disappearing Breast Mass Reflection and learning points and issues: How long can you observe breast masses hoping for disappearance? If one is quite certain that the breast masses are hormone related, then one can observe and hope for an early disappearance. They can be observed as long as months and years unless the breast masses are causing ill-effects on the patient’s health. Med Anecdotal Report - The Disappearing Breast Mass

40. MAR: The Disappearing Breast Mass ROJoson’s tips on management of similar situation If you have a breast mass, consult a breast specialist right away. Do not just wait for a spontaneous disappearance as it may not happen especially if the breast mass is something that may not go away such as breast cancer. A breast cancer will not go away unless there is a medical miracle which is quite a rare happening nowadays. Med Anecdotal Report - The Disappearing Breast Mass

41. MAR: The Disappearing Breast Mass ROJoson’s tips on management of similar situation The breast specialist will tell you what is the diagnosis of the breast mass. Wait for his diagnosis and advice. If the breast mass is something related to hormonal changes, a big chance it will go away spontaneously. Med Anecdotal Report - The Disappearing Breast Mass

42. MAR: The Disappearing Breast Mass ROJoson’s tips on management of similar situation After getting the definitive diagnosis from a breast specialist that the mass is hormonally related, then that is time you can do watchful waiting and pray and hope that the mass will disappear soon. Med Anecdotal Report - The Disappearing Breast Mass

43. MAR: The Disappearing Breast Mass ROJoson’s tips on management of similar situation To allay your constant fear of possible occurrence of breast masses in your body and their ill-effects, REMEMBER Majority of breast masses are due to hormonal changes and can be observed using the watchful waiting approach, without need for medical treatment. Med Anecdotal Report - The Disappearing Breast Mass

44. MAR: The Disappearing Breast Mass ROJoson’s tips on management of similar situation To allay your constant fear of possible occurrence of breast masses in your body and their ill-effects, REMEMBER If they are not hormonally related, majority of breast masses are still benign with a ratio of 90% to 10% in the general population. Med Anecdotal Report - The Disappearing Breast Mass

45. Summary Take Away Med Anecdotal Report - The Disappearing Breast Mass Contents What is a medical anecdotal report or MAR? Narration Insight / Reflection MAR Title: The Disappearing Breast Mass Reporter: Dr. Reynaldo O. Joson Date of Medical Observation: 2024

46. MAR: The Disappearing Breast Mass GIST of MAR A 41-year-old Filipina with history of fibrocystic changes and macrocysts of the breast who developed a “big” solid non-tender dominant mass in which a breast cancer was suspected and created an alarm to all concerned. With mere observation, the big mass disappeared spontaneously. Med Anecdotal Report - The Disappearing Breast Mass Summary Take Away

47. MAR: The Disappearing Breast Mass Some reflection and learning points and issues: Can breast masses disappear on their own? If yes, what kind of breast masses? Can they recur after they disappear ? If a hormonally related breast mass spontaneously disappears, if it recurs, is it always the same diagnosis? Can it be a cancer appearing this time? Can breast cancers disappear on their own? How long can you observe breast masses hoping for disappearance? ROJoson’s tips on management of similar situation Med Anecdotal Report - The Disappearing Breast Mass Summary Take Away

48. Take Away in relation to Patient Empowerment Be always in touch with reliable medical information on Disappearing Breast Mass. Knowledge is power; it gives power. Use the 4Ks of Patient Empowerment: Kaalaman , Kakayanan , Karapatan and Kapangyarihan to gain greater control over decisions / make better decisions on management of DISAPPEARING BREAST MASS as part of your health management. Med Anecdotal Report - The Disappearing Breast Mass

49. Med Anecdotal Report - The Disappearing Breast Mass Empowerment objective - for laypeople to have an essential  understanding on “The Disappearing Breast Mass” as part of their health management. This ends my PEP TALK today on: Med Anecdotal Report - The Disappearing Breast Mass

50. t Reminder after the PEP Talk: Take the Online Learning cum Evaluation Test Exercise (OLETE) for mastery of learning and have a perfect score to get a Certificate. Link is in Chat Box.

51. Reminder: 25 OLETE Certificates = 1 Voucher for ROJoson Medical Consultation either Face-to-Face or Telemedical.

52. Med Anecdotal Report - The Disappearing Breast Mass Empowerment objective - for laypeople to have an essential  understanding on “The Disappearing Breast Mass” as part of their health management. ROJOSON’S REQUEST: FEEDBACK TO THIS PEP TALK! Pls. type in your feedback in the chat box during the open forum and before we adjourn! Thank you!

53. Med Anecdotal Report - The Disappearing Breast Mass Empowerment objective - for laypeople to have an essential  understanding on “The Disappearing Breast Mass” as part of their health management. LET’S NOW HAVE A GROUP PICTURE TAKING BEFORE WE START Q&A AND INTERACTIONS! Pls. turn on your video! Show your face!