Cancer that does not show on MAMMO.?

Pray · 09-21-2011, 02:28 PM

Hello Everyone,

My cancer as well as many others did not show on mammograms. Is dense breast tissue the only reason? Or are there other reasons? (I hope I'm not showing my ignorance here.)

Also I have read on this site that some people their cancer did not show on mri.? Is this for a different reason?

Is there a test that will show all cancer and maybe the cost is to high?

I appreciate any info that follows!

Thanks so much!

Nancy

snolan · 09-21-2011, 02:35 PM

My Her2 did not show on mamogram or US, but may have been hidden by my DCIS which was covering a large area. But my HER2 was 1.1 cm and .5 cm don't know if that is too small to show up on mamo or not. They found it during the pathology after my mastectomy.

ElaineM · 09-21-2011, 03:20 PM

Sometimes dense breasts make it difficult for tumors to show up on mammograms. Digital mammograms are a little better at finding things in dense breasts. Sometimes things don't show up on MRIs either.
However if a person feels a lump or there is a suspicious area that was not found on a mammogram or an MRI that person should request an ultrasound or a biopsy.
Take care.

rhondalea · 09-21-2011, 04:08 PM

Mine didn't show on any of my mammograms from 2009 to 2011 or in the core needle biopsy pathology reports of 2008 and 2011.

Given that I had a 1.2 cm tumor (with lymphovascular invasion, no less, not to mention the 1.4 cm non-palpable tumor in one of my nodes) when my gynecologist felt the lump, it's a good bet that the cancer was already present at the time of the 2008 biopsy. (Either that, or it grew really, really fast--which is always possible, I suppose, because even six months earlier, there was no lump.)

To the best of my understanding, my breast tissue was not dense, so that doesn't explain what happened. Nor had I ever had any other breast problems except for slight swelling right before my periods.

Mammograms are not a panacea (and neither is a needle biopsy). The failure rates aren't horrifically high, but to the woman who gets a false negative, it's not very comforting.

Pray · 09-21-2011, 10:51 PM

Thank you Snolan, Elaine and Rhonda for your responses! Can anyone give us any more info. on this topic?

sarah · 09-21-2011, 11:24 PM

Hello,
My recurrence was found because a lump developed around the cancer and a biopsy was done. Because the margins were unclean I had ever test done: Mammo, Ultrasound, PetScan, MRI. None showed the cancer which was micro metatastic but wide spread over my sternum. More surgeries that in biopsy again showed the cancer and still no tests could. The MRI did show some suspicious inflammation but because I had so many surgeries it was inclusive.
It seems to be a question of size, if it's smaller than a certain size, it doesn't show up.
This was part of the reason I was told I would be on Herceptin for life but went off it after 6 years.
My oncologist requests a yearly: PetScan, Mammo, ultrasound of breasts, abdominal and pelvis.
health and happiness
Sarah

NEDenise · 09-22-2011, 06:03 AM

Nancy,
My surgeon, who is also a prominent researcher at the Univ. of PA, told me that my cancer had likely been growing for years, microscopically. Evidently, it can spread along the duct walls, without forming masses, for quite a while. But boy, when it does form masses, they grow really fast! That's why my mammos were clear, but I was already stage III when I found a lump a few months later.
Be well, my friend!
Denise

rhondalea · 09-22-2011, 06:16 AM

Well, Pray, when you get to googling, the results are interesting and all over the place.

NCI cites a 20% false negative rate that it blames mostly on dense breast tissue. The report out of EBCC-2 (2000) cites radiologist error as the main cause of false negatives, with a different percentage rate that appears to be slightly less, but is not actually cited numerically (we are left to do the math from a single review), because the point was to demonstrate that a breast exam prior to mammogram cut the false negative rate by 11.5%.

The more you read, the more confusing the numbers and the reason for those numbers becomes.

For example, mammography gives its greatest benefit to women 80 years of age and older (!), whereas it is not so useful in women under 50. Younger women are alleged to have a higher false negative rate than older women because of their denser breast tissue. These are just two of the not very useful facts I picked up in PubMed and a couple of sites specific to radiologists, but they lead one to ask why there isn't a better way. Obviously, medicine hasn't quite figured out how to cost-effectively (always an issue) streamline diagnosis. Maybe someday.

The false positive rate is also high, and the effort to avoid false positives may account for some of the false negatives, but I couldn't find anyone actually tackling that issue head-on.

Right now, it's just discouraging. I have taken to telling everyone to have that mammogram but not to skip the annual exam or the monthly exam, and if they have any doubt at all, to demand extra testing.

Pray · 09-22-2011, 12:37 PM

Thank you ladies for all of your responses!

Rhonda, Thank you so much for all of your efforts! Tis puzzlement! I have trouble making out all the informatione here on trials when there posted and much more searching the net!
Gods blessings to all of you.

Your Friend,

Nancy

AlaskaAngel · 09-23-2011, 11:20 AM

When one considers that over 50% of the bc diagnosed is known to be in women over age 65 (who are likely postmenopausal), and additional women over age 50 (who are also mostly postmenopausal) it means that the vast majority of bc diagnosed in any manner is being diagnosed in women with less dense breasts and who are postmenopausal. The medical system has invested in mammography and breast exams for ALL of us for first-line detection, with ultrasonography as second-line detection, which still probably works well most of the time for general breast cancer, since general breast cancer is what the majority of people diagnosed have.

So, we need something fairly inexpensive to use for the entire group of younger women (made up of both those who will develop bc at earlier ages when they are pre or perimenopausal as well as those who would go on to later develop bc when they are over 50 and generally menopausal or postmenopausal).

Imaging doesn't seem to work very well for younger people to find the cancer, and it also means cumulative radiation effect over a longer period of time for those who are tested annually and end up either never having bc at all or having it detected at an older age.

If cancer does involve inflammation, it makes sense to try to find tests that are less toxic and cheaper that will test for inflammation. The problem with testing for inflammation is that many things cause inflammation, not just cancer. Therefore, often tests like markers would show inflammation, but that doesn't always mean there is cancer.

It also might make sense to focus research on greater understanding of the endocrine system, since obviously it is involved, given that hormonal levels are involved in changes in menopausal status.

Again, we are talking about how to allocate resources. How do you get a medical system that already has mammogram equipment and trained personnel for that purpose to move toward finding less toxic, cheaper, and better testing for breast cancer for all patients, when "mammograms work okay for the majority who are diagnosed". Younger people with breast cancer are in the minority.

AlaskaAngel

Kellennea · 09-23-2011, 12:31 PM

Because my grandmother was dx with breast cancer @ 85, I started doing regular mammograms when I turned 39. They always came back clear, even the year before my dx.

I found my lump and went to see my primary Dr. who sent me to the hospitals breast center. Guess what... my mammogram came back clear. My breast surgeon told me that if she didnt feel the lump herself, she would have sent me home. Instead she sent me for an immediate ultra sound and there it was, plain as day, a 2.5cm tumor. So scary!

My hospital was the first in the midwest to recieve a new 3D mammography machine - Tomosynthesis. It's a pretty amazing machine.

Pray · 09-23-2011, 01:32 PM

Thank you very much AlaskaAngel!! I appreciate and Understand everything you wrote! Sad as it is for all the younger women! We actually felt mine and because I had no premen. signs they blamed it on dense breasts. Only because I went to a new gyn. who wasn't buying it she told me to have an ultra sound right away. She literally saved my life! She moved to Texas 3 months later and I truelly believe God has angels here on earth and she was supposed to stay here long enough to save me! Also all of you knowledgeable Women are to help so many of make sense of this awful cancer that is so heard for us new girls to comprehend and make our lives better knowing we are not alone! There are a great many Angels looking outMammo. machine does that see through dense breasts? (does it show all cancers? for US! Thank you! Thank you!

Kellennea, Thank you for your response! Is the 3D machine able to see through dense breasts? (to see all cancers?) When was it your hospital received that machine?

Your Friend,

Nancy

Kellennea · 09-23-2011, 02:23 PM

Nancy -

The machine was brought in earlier this year. I watched a preview of how it works and it was very interesting. Once they have the image, they kind of "scroll" through it, removing layers of muscle and tissue in the image. The test patient's image that we saw had VERY dense breast tissue and where we thought her tumor was, was not a tumor at all - just tissue. Her actual tumor (2cm) was hidden.

I was very impressed by it.

Sheila · 09-23-2011, 03:27 PM

My sister who was just diagnosed at age 50 had a digital mammography, which was clear, an ultrasound, which was clear. She insisted on a fluid filled cyst being removed as it had been drained 2x and filled up again. When it was removed, a Papillary cancer was found behind the cyst. She then underwent an MRI of both breasts, which came back with dense tissue. She opted for a bilateral mastectomy, and pathology revealed 2 more cancers ( one in each breast that were invasive ductal) and a large amount of DCIS. Makes me wonder how good the screening is. Mine however was calcifications found in a routine mammo, so who knows.

AlaskaAngel · 09-23-2011, 03:31 PM

To answer the question, "what can see cancer", tomosynthesis sounds like it does a better job than mammography. There are plusses and minuses, though, with applying it to all those who are young.

Tomosynthesis is done with somewhere between 10 and 15 images, and takes more time (and $) because the rads doc has to put in more time to look at more images than they see with most mammograms.

Here's one description of tomosynthesis that is fairly current. The second part of it gives some info on disadvantages, which then would need to be considered in terms of applying them to all those who are younger with denser breasts on an annual basis (including those who will never develop breast cancer). You probably will have to register with the site to see the second part.

http://www.medscape.com/viewarticle/738988

AlaskaAngel

suzan w · 09-26-2011, 07:41 PM

The type of cancer I had, Invasive Lobular, often does not show up on mammograms. Nor does it usually form a mass. If it weren't for digital mammograms that picked up a slight anomoly, I wouldn't be here writing this today.

Westcoastgirl · 10-08-2011, 03:20 PM

I had no lump, had had several mammograms and the results were inconclusive/come back in 6 months. Finally after a couple of 6 month recalls I begged for a biopsy and I was diagnosed. I was told at the radiation clinic that because of where the tumor was (deep in the breast tissue) it would probably have been another year before it showed up on the mammogram and holy smokes what a pickle I would have been in then.