Lump not seen on US or Mammogram?

LeeK

Thanks to all of you who respond here.

I have a small lump that completely failed to appear on mammogram or US. I just felt it for the first time 2 weeks ago. I'm 40 years old, no family history of breast cancer. I got the imaging at my primary care practice. The dr who felt the lump wrote that it was "small, soft and mobile." I haven't seen the US or mammogram report (it's not in my online record yet).

After imaging the primary doctor just said I should feel reassured, and that if I'm worried I should follow up with another mammogram in another year and remind her to check it at my regular appointments. "Breasts are lumpy," etc. Except I can feel some "normal" lumpiness in my breasts and this feels different. Another mammogram seems pointless if the invisible lump is what I'm actually worried about.

Should I feel reassured by the US/ mammogram? Am I crazy for wanting an actual identification of this lump?

Peregrinelady

No, you are not crazy. While there is a good chance it is benign, a negative mammmo and ultrasound do not rule out cancer. I found that out the hard way and kept a lump in my breast for almost two years because my incompetent PCP did not suggest further testing for my round, mobile lump. I assumed it was a fibroadenoma. Even it is a fibroadenoma, standard of care is to get it removed to make sure it is not cancer.

momto3sons

I don't think you're crazy either. My breast surgeon swears that the lumps I feel are just my dense tissue, plus I have several cysts. Can you get a second opinion with a breast doctor?

LeeK

Peregrinelady, what did your negative mammogram and ultrasound see? A lump that appeared benign, or nothing at all?

I don't know if there's any reason to think mine is fibroadenoma - all they saw was normal breast tissue. I'm being told this lump is just normal breast tissue with a different shape, which I know is possible, but just feels weird.

I wish someone would try to explain to me how ultrasound and mammography work that they could completely fail to see something that I can so easily feel.

Peregrinelady

Lee, I felt a lump that felt like a small marble right after a negative mammogram. My PCP sent me for an US, then called me and said it was negative and left it at that. I then had another negative mammogram a year later and it wasn’t until my breast started hurting that I was diagnosed. That is when I saw the US report that said, “The tissue in the area of the lump appears benign.” I couldn’t believe that neither the radiologist nor my PCP recommended further testing after that report. I learned the hard way that you should always ask for copies of reports. I was not seen by a breast surgeon, so maybe you could ask for a referral to a breast surgeon or go to a breast cancer center. (I live in a rural area and didn’t even know they existed.) In my experience, PCPs know very little about cancer.

LeeK

Peregrine lady I'm so sorry for what you've been though. I can only imagine how infuriating.

I haven't seen my reports and know that I should ask for them. I'm uncomfortable being this squeaky wheel but I guess it's probably good practice for other things in life, if nothing else.

I have an appt with my obgyn to get another opinion, but that person is not a cancer specialist either. I think I need a referral to see a specialist, and I've been reluctant to ask since my primary is so completely certain this is nothing.

Thanks for your response. Is really helpful to hear that I'm not completely overreacting. I've been on and off feeling like maybe I'm a crazy person. My husband was satisfied by the scans, but...I'm not quite there.

LeeK

Mom to 3, are you now waiting on MRI results? How did you end up getting the MRI?

Good luck to you - I hope your breast surgeon is right and your results come back clear!

djmammo

LeeK

"I wish someone would try to explain to me how ultrasound and mammography work that they could completely fail to see something that I can so easily feel."

It comes down to physics. Here goes.

Mammography, if you are familiar with old fashion film photography, is basically a contact print of your breast. Light source------->negative------>photo paper or with mammography xray beam----->breast------>electronic receptor. Same exact principle. If you hold up a golf ball in one hand between a lamp and the wall, you will see the shadow of the golf ball on the wall. If you put a piece of cardboard between the lamp and the ball you will only see the shadow of the cardboard, and not the golf ball. The cardboard is dense breast tissue.

Picture a fish tank in a dark room and you are looking for fish by directing a flashlight down into the water from directly above the tank. That's ultrasound. Ultrasound uses sound waves (instead of light waves or Xray). Sound travels at different speeds through different materials or tissue types, that is, it is "transmitted" better in some materials and reflected back in varying degrees by others. Some materials/surfaces will scatter it.

So the sound travels this way: US probe------>through breast tissue---------->partially reflected back to probe------> grey on image/screen.

US probe------>through water -----------> not reflected back to probe------->black on screen

If you have a cyst (which is filled with water basically) the sound will go through the cyst and be partially reflected back by the surrounding tissue thus you wind up with a black cyst surrounded by grey tissue on the screen. A cyst has a smooth surface so it is well defined. A cancer has an irregular surface that will scatter the sound, and show a fuzzy or ill defined border. For this and other reasons a cancer will show a shadow behind it ("posterior shadowing") The cyst will show a bright area behind it as less sound was reflected back and relatively more went through ("through transmission").

Peregrinelady

Thanks, Lee. I did go through a period of depression and anxiety due to the misdiagnosis, but I am much better now. I respond to posts like yours to let people know that mammos and US don’t always catch cancer. It is rare (I hope), but something to be aware of. Good luck and keep us posted!

momto3sons

Lee - I am waiting on MRI results. I had the MRI on Thursday afternoon, and as of Friday afternoon the radiologist was still reading everything. The center told me that they'll send the report to my surgeon, and she'll be the one who calls me with results. I'm hoping I'll hear on Monday.

My surgeon's PA had to do a peer-to-peer review in order to get my MRI approved. Luckily it didn't take nearly as long as I thought it would to get it approved!

LeeK

djmammo, wow. Thanks for that response.

So, I (sort of) get the part about mammograms, golf balls and cardboard - at least the analogy, if not how that exactly works with x-rays. Mammograms can't always see through your regular breast tissue. I was a physics major so I understand something about the waves themselves, but not much at all about what you can actually see or not see.

Is there a similar thing with ultrasound? Could an ultrasound see only normal tissue if there was something abnormal there?

Most of all, how common is it to feel a lump and see only "normal" breast tissue on ultrasound? Are there any numbers on how unusual it is for a cancer to be missed in this way?

LeeK

Momofthree, I will be thinking of you and your family tomorrow and hope you get your results. I'm a mom of two - it's the worst part, thinking of the what-ifs.

LeeK

Peregrinelady, thank you for being willing to connect. I wish all the best for you.

dtad

LeeK....since you are young, I would suggest a MRI. There is a really good chance it's benign but better safe than sorry. MRI is the best screening tool for dense breasts. Good luck and keep us posted.

bettysgirl

I strongly agree that MRI is best at detecting. Unfortunately insurers don't want to pay for it. I felt something a year before mamo found it and then detected it as 1cm. US showed it a tad larger, but it was the MRI that lit it up like a Christmas tree at 4 cm and was 5 cm's at surgery. I was told that mine was invasive ductal with lobular features. I was told by the Breast surgeon that lobular tends to hide more on Mammograms.

Lodle

LeeK I am in the same boat. I have a palpable lump in my left breast lower quadrant. Mammogram and US looked fine per the radiologist. He said my lump (that is the size of a pea) is a ligament. I follow up with the Breast Clinic next week. I am hoping that is the case but I’m anxious. I hope you get some answers soon!

LeeK

Lodle, let me know how it turns out!

One of my concerns is that I'm not at a breast clinic or specialist - just my primary. And all I've been told is that my breast tissue looks "normal." I'm mostly surprised that they didn't want to do any follow up at all on the lump I (and the doc) can feel. Even if it doesn't warrant a immediate MRI or biopsy, I thought at least they'd want to keep an eye on it!

TaRenee

djmammo. Wow. That is a great explanation. Thanks for that. I never really understood it I just knew I NEVER showed anything on mammogram. And when I had my US I was terrified by the “black hole” I saw as she was working. Wish I had known that information back in July! Thank you