True Story Number 1

Sally is a nurse practitioner working in the employee health service of a large company. Her job is to do health physicals for new employees. She was the chairperson who led the breast cancer support group at the company.

Sally noticed a lump in the middle part of her breast, toward the center of her chest. She went to her primary care doctor who ordered a mammogram. The mammogram was negative. Her mammogram did not show any sign of cancer. To be on the safe side, her primary care doctor referred her to a general surgeon. The surgeon examined Sally’s breast, reviewed her mammograms, and gave her complete assurance that she had nothing to worry about.

Sally was very relieved, and she returned to work.

Sally continued to feel the mass every day until finally, about nine months later, she had to admit to herself it was getting bigger. She then went back to her doctor who ordered a second mammogram and ultrasound. The mammogram was still negative, but the ultrasound identified a slight abnormality.

The surgeon did a biopsy because of the ultrasound and the biopsy found that the lump was cancer.

When the surgeon looked at the mammogram, he agreed that there was no sign of cancer on the mammogram itself even though there had been a cancer in Sally’s breast that was already big enough to be felt. It was the lump that could be felt that prompted the additional ultrasound and biopsy, which finally resulted in the life-saving diagnosis.

When Sally talked about what happened to her, she said, “I, of all people, should have known better; but I just wanted to believe it was OK.”

This story is not unfamiliar to anyone who cares for women with breast cancer. In fact, it is fairly common. It was so familiar that we decided to find out how often this sequence of events happens.

To learn how often a woman is told not worry because her mammogram is negative, we reviewed the history of several hundred women with breast cancer and asked them how they found out that they had cancer.

We learned that at least five percent of women who are diagnosed with breast cancer have an experience just like Sally’s. Their physician agrees that they have a mass and orders a mammogram. When the mammogram is negative, the same physician reassures the woman that she is OK — even though he or she can feel a mass.

Today, when needle biopsies are available in almost every major hospital, this can often be avoided. Sally’s breast cancer could have been diagnosed and treated sooner if she had just had a needle biopsy.

If a mass is felt, a negative mammogram is not enough. When a mass is felt, a biopsy must be done.