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Breast cancer missed by mammagram
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Breast cancer missed by mammagram

I had a 2.5cm invasive ductal cancer in my right breast at 2 O'clock position.  I have mamagrams every year and was 10 months from the next one when I found it in self exam.  How could this happen.  I lost both breasts and had nasty chemo and am now cancer free.  I am just very angry that the radiologist missed it!  surgeon said it had been there between 1.5 and maybe 2 yrs.  I need your oppinion!  Thanks
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Avatar_n_tn
Dear nange150:  Unfortunately, mammography is not a perfect test.  There are a small percentage of tumors (about 15%) that do not show up on a mammogram.  Currently, though, it is the best technique we have.  This is the reason that mammography should always be combined with clinical breast examination and monthly self breast examination.

22 Comments
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Avatar_f_tn
WOW that sounds just like me.  I was very diligent about my yearly mammograms and in the past 30 years had seven benign tumors removed or biopsied.  All of a sudden there was something suspicious on my 2004 mammogram.  It was an invasive tumor measuring 2.5 cm. in the right at two o'clock position.  I asked my doctors and the radiologist how it got to be so big but never seen and the answer was, "you have very dense, fibrous tissue in your breasts".  Makes you wonder.
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Avatar_n_tn
The news media makes it sound like mammograms always detect cancer but they don't.  I had yearly mammograms.  Just five months after a mammogram and two routine breast exams (GP and GYN) I found a 1.6cm invasive cancerous lump.  They re-looked at my past mammograms and said it didn't show up.  Now all my yearly mammogram reports start out with "The breasts are dense wich lowers the sensitivity of mammography..."  Since the only follow-up I am receiving is yearly mammograms and clinical breast exams, and they both have failed me in the past, I struggle with trusting/believing the professionals confident opinion that I am NED (no evidence of disease).
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Avatar_f_tn
I've literally seen with my own eyes why mammograms can become more and more difficult to read. Mine were. It is just like a trying to look through a really thick bush (except the branches are white against a dark background) that gets thicker and thicker over time. The doc is looking for calcifications, which are VERY tiny specks, to see the pattern of the specks and the number of specks. But the calcifications are white too, so they can get "lost" behind and among the branches of the white "bush" pattern. The branches of white in mine were really dense by the time my cancer calcifications increased, and couldn't all be seen. Eventually there were enough of them that they looked more suspicious in that one part of the breast, and a mammogram found the lump, which no one could feel yet. After my lumpectomy I was started on tamoxifen, and just 3 months later the breast had MUCH less dense white branches. So now if there are calcifications they are easier to see.

Hope that helps.

AlaskaAngel
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Avatar_f_tn
oops -- meant to say, a SONOGRAM found the lump that nobody could feel, not a mammogram...!

AlaskaAngel
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Avatar_n_tn
I myself was very lucky back 12 years ago. I had my mammogram done and a nodule was found and was in question because of the history of b. cancer on both sides of my family. So a biopsy was done and the pathologist did dissection and found a 6 millimeter infiltrating ductal b cancer. grade II, in the 6 O'clock position,  right next to the nodule. It was a small spot of cancer right next to the nodule that did not show up in the mammogram. Noone ever said anything to me about my breast having dense tissue being the reason the cancer didn't show up. However; on one of my reports it say that between 10% and 15% of cancers are not identified on mammograms. Fibroglandular densities could obscure a lesion on mammography. My question is why do they not have all cancer survivors...do the mammogram, the u/s and every other kind of test that relates to the issue? Maybe if it doesn't show up in one it might the other. Anyway that my thought on the matter.
God Bless each and everyone of you!!!



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Avatar_n_tn
Thanks ladies for your stories.  Don't you think if the breast tissue is so dense you can't see anything...they should go straight to a sonogram or ultra-sound to double check since they can't see?
Let me know what you think!
Nangel50
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Avatar_n_tn
It had been 16 months since my previous mammogram - I had had some extensive female repair surgery was one reason it was that long but I will admit, I wasn't always good at getting mammograms on time.  I did do my self breast exams though.  My previous mammogram was fine and it was one of the few times that I wasn't called back for additional cone views.  I was very surprised when something was found on this mammogram - it was a 2.5cm. spiculated mass with some adjaent calcifications.  
I have also had lumpectomy, chemo and radiation.  This was a mass that neither the surgeon or myself could feel on breast exam.  My daughter is an RN and I worked in medical for 30+ years - we both feel that there had to be something on my earlier mammogram that was missed.  My breast were extremely dense and I know that makes it hard to see the problems sometimes and I know doctors are human and they make mistakes.  I try not to linger on the fact that "something was missed" and am just thankful that it was found.  I certainly didn't enjoy chemo or radiation but I know I would have felt safer to take it even if my had been found a year earlier.  After that little experience, it is good to rejoin the rest of the world and I just don't want to waste time being angry over it.  I know my dense breast made it harder to find.  I think we all will be more questioning now about our mammograms, as everyone should be if they just don't feel comfortable with something.  Good luck everyone - we are SURVIVORS!!!!!!
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Avatar_n_tn
oops, forgot to answer your last question.  I don't know what area of the country that you live but I do know that I have been taken to ultrasound room immediately after a mammogram to check out a lesion - I had generous amounts of fluid cysts and they were what they called "complicated" in that there was stuff floating around in them which made the ultrasound necessary to decide if a cyst or a true lesion.   I have been called back for cone views (more compression; looking at specific area ) several times.  These are just standard procedures were I live. My mammogram from 2003 didn't require either of those but then when I had the one in 2005 (16 Months later) there it was - 2.5 cm.  I did have ultrasound and cone views done in 2002 and nothing was found.  As some of you have stated it takes a long time for a cancer to grow, mine should have been there in 2002 and 2003 but wasn't found until 2005 and even then I could see it on the mammography film.  I think different areas of the country do things differently - part of the problem is that there isn't any "norm" on when to follow up with additional studies.  To much emphasis is put on mammograms alone in my opinion.
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Avatar_n_tn
My breasts are very dense also. I diligently went for yearly mammos.  This year's showed a cluster of microcalcifications that were not present last year--maybe they were hidden due to the density of the breasts.  It does make you wonder.  Mine was 2.4 infiltrating ductal (not palpable), the most common breast Ca. Tomorrow, I begin my chemo course and then radiation. Something just has to give already for better screening.  I think the screening tool of the future will be the MRI.  It is available now, but it is cost prohibitive.  Prevention?  I don't think you can prevent cancer (live in a bubble in outer space?).  Cure?  I doubt it, no time soon.  Cancer is BIG BUSINESS.  My 2 cents:  Cancer will be treated as a chronic disease.  "Living through chemistry".
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Avatar_n_tn
Ladies,  Thanks for your input!  I was never taken for sonagrams, ultra-sounds or MRI's.  I sure wish I had, but I can't go back...just want to help make it better for future women in our place. I am so blessed to be a survivor.  I thank GOD everyday!  The chemo was the worst part for me.  Mine was estrogen negative and very agressive so the chemo had to be very agressive too.  They wanted to do it every wek, but I agreed on every 14 days.  I had one day good each two weeks, but I kept my mind and eye on the future, you know on the otherside of this whole thing.  I was determined to beat it.  I did!
AVIDHIKER*****  Hang in there and God bless you.  You will get thru it fine just like me.  Don't think about today and what is happening to you...think of 6 months down the road and enjoying Christmas with family.  I will be thinking of you and praying for you!  Nangel50
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Avatar_n_tn
Thank you so much.  God bless you too.  I am going in with positive thoughts and my treatment ends in early November so I can concentrate on Turkey Day!  Again, what a phenomenal group of courageous women.  I love you all.  I'll let you all know how it goes.  Everyone stay well.
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Avatar_f_tn
It is partly a money issue. Doing a mammogram with equipment that has already been paid for long ago, using technicians who already have been trained to do mammograms is much, much cheaper for facilities than it is to do either sonograms or MRIs because sonograms and MRI's take much longer to do. Many, many more screening mammograms can be done in a day than ultrasounds or MRI's.

But also, you can't see the tiny calcifications if you don't do the mammogram, and calcifications tell the doc what part of the breast the cancer might be in, so they can focus on that with the ultrasound.

So that means doing both kinds of imaging.

If there are suspicious calcifications and dense breast tissue they do add the ultrasound. But it makes a lot more sense to me that if the breasts are really dense a bilateral whole-breast ultrasound should be scheduled even if there are no suspicious calcifications seen, even if only as a baseline, instead of advising women to "wait" for the next mammogram.

But I don't think the people who decide these things have ever had to go through chemotherapy or have their lives disrupted by it.
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Avatar_n_tn
Almost 2 yrs ago, about a month after a "normal" mammogram, I read an article suggesting women who have dense breasts or a family history of breast cancer should get breast MRI's.  So, since I qualified under both those things, I asked for an MRI....bingo, not 1 but 2 seperate cancers showed up in my right breast!  Needless to say, I have a MRI twice a year now and have no faith in mammograms. Now I read about more and more women like me.  What a shame.
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Avatar_f_tn
This discussion is a real eye opener for me. With dense breast, fibroadenomas, cysts, and suspicious calcifications (and 3 biopsies over the years, all negative) my surgeon recommended another stereotactic biopsy for my new, clustered calcifications this week. Since my last stereotactic was just 6 months ago I decided instead to wait on the biopsy and follow up with another mammo in 3 months time. They
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Avatar_n_tn
This string of emails is so interesting and appropriate to my situation (and obviously many others!). I am 43 and have had mammos every year since age 35 (mother had breast cancer). For the past few years my breasts have become very dense. Last summer I had my first biopsy on a fibroadenoma. In December I had a follow up mammo (normal). And now in June had another mammo (abnormal), had ultra sound (inconclusive), and last week had MRI on both breasts. I am very anxiously waiting for results this week and have appt with surgeon next week. It blew me away that I had to have an MRI as my understanding was 'a tumor is a tumor' - biopsy them. However, my doctor said my breasts are so filled with simple cysts, a few complex cysts, and nodules that they couldn't begin to know exactly what to biopsy without getting an even clearer look at the breasts with MRI.

In the back of my mind is my mother's experience...she had a mammo and biopsy, cancer was found, and lumpectomy suggested. She went in for lumpectomy, they found the tumor had runners, and had to do mastectomy. When her breast was analyzed by pathology, they found another nickle size tumor with runners not detected on her mammo. If she only had a lumpectomy, she would still have had cancer in her breast. Scary!

I'm grateful there are even tests to screen for breast cancer, even if not 100% accurate. And I'm even MORE glad that my doctor and insurance approved the MRI!!

My best to all of you!
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Avatar_f_tn
What did you find out from your MRI? Do you need a biopsy?
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Avatar_n_tn
The results were: Left side - large fluid filled cyst (6cm) with nodule adjacent to it (likely fibroadenoma and benign). Right side - small nodule (inconclusive, though likely a benign fibroadenoma). I will have both areas biopsied on Thurs. 8/17. I had a biopsy last summer on the left side (benign fibroadenoma), so I feel okay about the procedure. It is a challenge though that I feel like I'm 'waiting' for the inevitable BC diagnosis one day and that's just not positive thinking. It doesn't help that every doctor/radiologist that has talked to me in the past 3 years stresses how complex and dense my beasts are and that I should expect many years of watching changes closely. However, it has been extremely helpful to read that other people on this site share some of the same thoughts and feelings. Let's me know I'm not alone.
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Avatar_f_tn
When you say right and left side are you talking about the sides of 1 breast or both breasts? Did your MRI offer more conclusive info than mammogram and ultrasound? I found out we don't yet have diagnostic breast MRI's where I live but it's coming soon. I'm still a bit concerned that they only talk about biopsying my calcifications, not my "possible fibroadenomas with slightly irregular margins." But I do remember the surgeon saying my problems are spread out and removing all of them would involve removing 1/4 - 1/3 of my breast which he didn't advise. Like you, everyone tells me how dense and complex my left breast is. (When I told my friend about my numerous abnormalities she thought it must be freaky looking. I assured her at least it LOOKS normal.) I'll keep you in my prayers as you have your biopsy later this week.
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Avatar_n_tn
Yes, left breast and right breast. I've been told the same thing as you regarding too many fibroadenomas to biopsy as my breasts are filled with them. Evidently there was concern about two new ones (since last Dec.) that they couldn't get a good look at via ultra sound. The MRI contrast helped them see the left nodule very clearly and appears benign. The right nodule still didn't show up well enough for them to see clearly, so they will biopsy it too. Honestly, I have no clue how they determine what to biopsy. They did say we could closely monitor these versus the biopsies, but I said no. I don't want to take any chances.

I have made an appointment with a new family practice doctor for a physical the day after the biopsies. I plan to discuss with her my questions and confusion and ask that either she or a specialist go over my films with me so I can better understand everything. I get the distinct impression that this just is not an exact science and we're having to put a lot of trust in the people who treat us.
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Avatar_n_tn
Myself & my 2 sisters all had routine mammagrams ,and neither of our Cancers showed up,we were all in our late 30's,we had all found our own lumps,but my 2 sisters were told come back in 6 months,so my one sister is now terminal,I can not understand how it can be missed,take it from me My Dr. told me any lump must be investigated no matter what a person is told ,(.you were not born with it)My sisters had to be very aggressive to get further testing cause they were told they were to young,likely not any thing well they were wrong !I wonder if the machines are defective !or are the people who read them think along the lines also your to young !Come back in 6 months!!THank-you for letting me vent!
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Avatar_f_tn
Thanks for sharing your story. Sorry you and your sisters have all had to go through it.
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