Cancer not detected in MRI or Mamogram

[betsy1606]

Friday I do a regularly mammogram. Monday I get asked back for a calcification magnifying view plus that night (Friday) I find a physical lump. Monday I go in for the view & all is clear, I ask about the lump, ultrasound shows a concern, we needle biopsy on Wednesday, Friday we get an all clear that this is fibrocystic breast changes showing no cancer. Due to family history surgeon is not at ease. Lumpectomy/mass removal complete to show .6 by .7 tumor with .3 by .4 cancer (margins not clean).  MRI complete & showed sprinkling of involved tissue around original site. Nipple Sparing  Double Mastectomy with sentinel lymph test and immediate reconstruction complete. Pathology showing 2nd tumor (1.5 cm), lymph node involvement and DCIS cancer throughout right breast. How can this be as there was no indication on either mammogram or MRI?

[Cleveland Clinic]

Dear betsy1606, All tests give different pieces of information, and none of the tests are perfect.  This is why test results are put into context of the individual patient.  Very small and microscopic disease often will not be seen on a mammogram or MRI, so when a cancerous area is confirmed the whole breast is considered when planning next steps and treatment.  If lumpectomy alone is the surgery the remainder of the breast would need to be treated (with radiation) just in case there was microscopic disease.   Checking lymph nodes is always part of the surgery whether lumpectomy or mastectomy.  

[japdip]

Not in defense of Medical testing but there was something seen on the initial mammogram or you wouldn't have been called back ... also there was something seen on Ultrasound. It all comes down to the human Radiologist who is reading the films.Your Surgeon should certainly be commended and you are lucky to have him/her. Things like this no doubt happen more often than we would like and I'm sorry it happened to you. Hope you're on the road to recovery now though ... Regards.

[donatelli]

I had breast cancer in 1996 at the age of 44. It was in my right breast. The tumor was .9 mm x .9 mm x .9 mm in size. The tumor was 20% DCIS with the remaining part being invasive tubular lobular cancer.I had a lumpectomy and axillary dissection followed by 6 weeks of radiation.

In 2006, over a period of weeks I noticed the nipple of my right breast flattening. I went to my oncologist's office and had a clinical breast exam performed, and nothing suspicious was felt. Though I had had my yearly bilateral mammogram about six months earlier, my oncologist sent me for a mammogram of my right breast.

Nothing was seen on the mammogram, but while I was in the radiology office, the doctor suggested I also get a sonogram of the breast, which I and my oncologist agreed would be wise,so the oncologist faxed over the script so I could have the test right then and there.

The ultrasound technician did the sonogram, then a radiologist came in and told me nothing was seen. I told her that something had to be wrong as I could see the change in my nipple over the period of a few weeks. She then performed the sonogram procedure herself and told me there was nothing there. I asked her to explain to me what she thought the cause of the change in the nipple could be.  She said it was due to changes still going on from the radiation treatment 10 years earlier.  I told her it did not make any sense to me; that explanation only seemed reasonable if the change occurred over a period of years, but this was not the case - the change occurred in a matter of weeks.

I went back to my oncologist. He did a clinical exam and still nothing unusual was felt. He assured me things were okay.  I got dressed, and he said to be absolutely sure, I could have a breast MRI.

I did have the MRI and it turned out that there was cancer (invasive lobular cancer) throughout that breast. I ended up having a mastectomy and chemo and 52 Herceptin treatments.

P.S.     After the cancer in the right breast was confirmed with a biopsy, I asked for an MRI of my left breast (knowing that lobular cancer is often bilateral).  The breast MRI showed a small suspicious area (not visible on a repeat mammogram).  

My oncologist recommended a double mastectomy and my surgeon agreed. I got a second opinion from another surgeon (in a National Cancer Institute-designated Comprehensive Cancer Center) who said whatever it was was small, and that in a few weeks the hospital would have equipment set up to do a biopsy under MRI guidance.  There was a delay in getting the equipment set up and I could not wait, so I had my right breast removed and then had 8 chemo treatments and started Herceptin.

I was going to have the MRI-guided biopsy, but my regular surgeon said to have a mammogram first. The cancer in my left breast was now visible by mammogram, so I had a mammogram-guided wire localization and a breast biopsy.

It turned out to be a very tiny (.7 mm) invasive lobular cancer.  I had a mastectomy. Sentinel node biopsy found a micrometastasis in the sentinel node.  A subsequent axillary node dissection  found no additional cancer.