Danee: I went through the same.....wasn’t caught on my mammo either. I felt tumor. Which prompted ultrasound. I agree they should always do both for all women. But that’s just my opinion. I know mammos catch a lot of breast cancer but didn’t catch mine. So I understand.

hi Danee:

Well my cancer journey was in 2017. Yeah my tumor was at the top of my breast so easier to feel. But I wasn’t doing manual exams like I should have been doing. So it was a miracle I felt it.

Yeah I’ve wondered if a tumor was further inside the breast I don’t think anyone could feel that unless the tumor was larger.

Danee78, your mammogram DID see your tumor. It showed the distortion which prompted the ultrasound to use a different modality “look.” Just like my mammogram showe calcifications which led to further investigation that found my LCIS.

I am nearly 38, but I was DX at age 31 after palpating a lump in my L breast. I was scheduled for a mammogram AND an ultrasound by my physician. Perhaps it was due to my age? My sister then had her first mammogram at age 34 and they immediately set her up for both as well.

Most cancers have been in the breast for 3-5 years before they become large enough to be detected. It's believed that some have even been present for as long as 10 years. So it's highly likely that any invasive breast cancer that's found would have been there a year earlier, but if it is small when detected, it almost certainly would have been too small to be seen on any imaging - mammogram, ultrasound or MRI - a year prior.

This chart shows how the size of a cancer changes based on a 100 day doubling cycle. While smaller cancers are sometimes found, no screening modality is reliable at finding cancers that are smaller than 5mm in size.

The objective of screening, with any modality, is to find cancer. However no screening modality clearly identifies cancer without the need for further investigation, whether it's additional screening with a different modality, or a biopsy.

One thing that mammograms are good at showing is architectural distortion. While this type of distortion could be caused by something benign or it could be caused by DCIS, IDC is frequently associated with architectural distortion.

Architectural distortion found on a mammogram

"Breast cancer with architectural distortion frequently presents with some kind of fibrosis.

Sometimes architectural distortions are associated with DCIS as well, or, quite often, invasive breast cancers cause an architectural distortion because they stimulate extra fibrosis.

Therefore if a mammogram finds distortion, usually invasive cancer will be considered a possibility and further investigation will be done. That seems to be what happened here. So I agree with Melissa. The mammogram did it's job. That's not to say that mammograms always find breast cancer - they don't. But it appears that it did exactly what would be expected in this situation.

Violet, since you already had a palpable lump, your doctor probably had you skipping the basic screening stage and moved you right to diagnostics. This usually means both a mammogram and ultrasound. Given your young age, it is highly likely that you had dense breast tissue; because mammograms are less effective with dense breast tissue, the initial screening for younger women is usually an ultrasound and not a mammogram. So in your case, it may have been the mammogram that was added on because you were in a diagnostic situation. In any case, since you had a palpable lump, whether it was done in one step or two, it's pretty certain that you would have ended up with both a mammogram or ultrasound.

I completely agree that women with dense breasts should get both mammograms and ultrasounds, and in fact a few days ago in a different thread, I wrote this:

"When you look at this chart (I'd posted a chart showing breast density by age) it begs the question as to why all screenings don't automatically include both a mammogram and ultrasound, dropping off the ultrasound only if the breast density is low and mammogram imaging is very clear."

It's important understand what mammograms can and can't do. They remain very useful and find many cancers, even in women with dense breasts, because they show architectural distortion and are much better than ultrasounds at showing calcifications. It's also important to understand that while ultrasounds may catch some cancers that mammograms miss, mammograms will find some cancers that ultrasounds miss.

I think I read somewhere that the average breast cancer is 1.8cm when found. So whether a different screening modality the year prior would have found any of these cancers can't be known, although undoubtably some of these people with 1.8cm (or larger) tumors did have screening with more than one modality the year before. The unfortunate truth is that cancer screening - not just breast cancer - is far from perfect.

No diagnostic imaging is infallible. My cancer did not show up on either 3D mammography or diagnostic ultrasound on my dense breast tissue. I had both these tests, repeated within a 3 month window because after my annual testing, I went back in concerned with how I was feeling. My breast doctor repeated imaging, nothing was found, then she ordered the MRI. Thank goodness that showed my tumor. I had not felt a lump either as my tumor was close to my chest wall. Do I wish we had found it earlier? Yes, then maybe it wouldn't have been IDC. I am so thankful for my breast surgeon who listened to me (this was a first appointment even) and pursued further imaging.

Danee, I totally agree with you. From reading on these posts they are doing betting screening in other countries. Mightlybird said they do USs in Germany. I recall reading one of the countries gives PET scans to everyone with cancer. I had a 13 cm LSIS that was not seen on mam at all, was I think 10 cm on US and 13 on MRI. It had to be there for over 10 years. I think related to my pregnancies. If that had been found early, I would not have ILC or 2 or more positive nodes, LVI and ee. When I found out my friend got periodic mri's for dense breasts I couldn't believe my ears. I don't think my breasts were "dense" enough to warrant further treatment. All women should get an ultrasound and periodic mri. Why did I never have an mri. My breasts were filled with fibrocystic lumps my whole life and had grown to completely ignore any lumps. It could be the difference between life and death for me down the road, as ILC comes back many years later. But that is the past for you and me. I've been told by many Drs. that after mx no scans at all, ever. This is insane to me and driving me insane. Except my MO who said he will try and justify to insurance periodic mris. This is the reason I stay with him, when not happy about other things. Someone has to unite and get our voices heard and make changes in the insurance system.

Mightlybird: I completely agree! We have to be vigilent advocating for ourselves! If we don't have a doctor who supports us.....we find a new one. Until we have a team who supports us and listens to us! Completely agree!

I had a palpable lump that initially didn't show up on Mammogram OR Ultrasound. Because of that and my age at the time (29), I didn't go back for nearly two years, at which point it did finally show up...

SarahSmiles - I think it's different for everyone, especially the type/grade/stage of their cancer! I am going for my first mammogram since diagnosis this week...and I was diagnosed two years ago. For the first year after finishing chemo, I was getting bloodwork about every 6 weeks. None of the labs indicated a reason for concern, so I go less frequently now. With all the damage done to our bodies from chemo and radiation, my doctor tries to limit scans unless there is a concern.

I had routine 3D mammograms annually, including one year prior to my diagnosis-all negative. My BC finally showed up as architectural distortion, but only after I could feel the thickening from it and pain. My BS said I was lucky that the radiologist caught it- that she'd seen people with similar results on mammograms get missed, even with tumors larger than mine. I've never seen the chart that Beesie posted before-that is insane! Going by that, my BC would have been there back in my 30's. Scary to think that it can hide out so long.

what just happened: I am assuming that you must also have dense breast tissue? My tumor wasn’t seen on mammo. I have very dense tissue. But some women’s cancer tumors are seen.

Alice: that dr who wouldn’t do the d&c without biopsy first.....that’s a good dr! What a blessing she did that! She was being thorough. I think too many drs aren’t always thorough

Because of my age and family history, my oncologist was willing to order (and so far my insurance has been willing to pay for) MRIs in addition to mammograms. We are working on getting them spaced out throughout the year. Also, since my original lump was caught my gynecologist at her manual breast exam, that's an important element for me of screening and I will have that done any time I am seeing either my gyn or any of my oncological practitioners.