On reactive lymph nodes and delayed diagnosis

[bejuce]

Hi everyone,

In my disease understanding/acceptance quest, I've talked to quite a few doctors about my delayed diagnosis. I've heard from a few now that told me that it was unfortunate that my diagnosis was delayed but in their opinion, there was nothing wrong in the wait-and-see approach the doctors took with me when I first showed up with a swollen lymph node under my arm in July 2008.

The lymph node was ultrasounded, and the results showed a reactive, benign-looking, 2.5 cm lymph node. I was breastfeeding my 3rd for comfort at night at that time, but weaned him the weekend after I found my node in the hopes of doing a mammogram. The doctors told me to do a mammogram when I was 40 (I was 37 at the time) and come back in 3 months to check the lymph node.

Three months later, in October 2008, another ultrasound still showed a benign-looking, reactive lymph node, but this time, it was 2.1 cm. They again told me to come back in 3 months.

When I did so in January 2009, it was clear that my right breast was swollen, bigger and much denser than the left, with skin edema and nipple changes. I was diagnosed in February 2009.

Maybe I had the "explosive" tumor kind (there was an article recently in the NYT about it posted on another thread), but maybe the tumor was there for a while and no one could identify it.

In any case, my question is: if a young woman shows up in a doctor office with a clearly palpable lymph node under the arm, shouldn't the node be biopsied with a fine needle aspiration? And if the node is still there after 3 months, isn't this a stronger probability that the node indicates cancer?

I find it very distressing to know that women (especially young women not yet at the mammography age) may be showing up at doctors' offices with swollen lymph nodes and not getting the proper biopsy until much later. I could feel my right breast being "denser" than the left back in 04/05 when I was nursing my 2nd, and I suspect my tumor showed up around that time. Or maybe not - maybe it did show up in 08, but it still bothers me that doctors (not all, thank God) have been telling me that nothing was wrong with the care I received and the wait-and-see approach.

Any opinions? As someone who strongly believes in breast cancer advocacy, shouldn't we be sending the message out that underarm lymph nodes should be FNA'd immediately? It's such a simple procedure and I don't know why not more is done (I don't believe in the theory that cancer could spread as a result of a needle inserted in the lymph node, but I'm not sure if the verdict is out on that). After all, everything I know about lymph nodes is that they either become swollen due to infection or cancer, with other causes being much less likely. And lymph nodes under the arm drain the fluid from the breasts, so if a lymph node is swollen under the arm and there are no signs of an infection, then why don't doctors immediately raise the red flag of a cancer diagnosis? What other causes could be affecting the underarm lymph nodes to be swollen?

Not sure what I'm missing, but it just seems logical to me. No infection? Then cancer becomes much more likely.

I'd appreciate all your comments!!!

Thanks!

Marcia