Spread of cancer

As ravdeb says, I've been told that our current model says most breast cancers have been in the breast for 4-8 years before they can be detected by *any* means.



One woman I saw here had waited some 3-4 months trying to decide whether or not to do chemotherapy as she had not wanted to do chemotherapy. I don't know the particulars in her case, but her oncologist said her window of opportunity for doing chemo was closing. So usually women have some time to decide what to do.



*If* you are diagnosed with cancer, your doctor should be telling you something about the 'personality' of your cancer. In any event, we often can't speed up the process.

Do you possibly mean 5 mm. ? 

Its hard to find a direct answer to your question, but I hope this study may provide some comfort. It found breast cancers that were missed on routine mammos, so the delay was an average of >600 days, were found not to be larger on initial assessment than those who were initially diagnosed. It could impact long term diagnosis, but this delay is like an average of more than 1.5 years.



1: Breast Cancer Res Treat. 2007 Sep;105(1):37-43. Epub 2006 Nov 18. Links

Minority report - false negative breast assessment in women recalled for suspicious screening mammography: imaging and pathological features, and associated delay in diagnosis.



Ciatto S, Houssami N, Ambrogetti D, Bonardi R, Collini G, Del Turco MR.

Centro per lo Studio e la Prevenzione Oncologica (CSPO), Florence, Italy.

AIM: We studied imaging, pathology and diagnostic aspects of false negative assessment (FNA) in women recalled for suspicious screening mammography. METHOD: Subjects were women aged 50-69 years undergoing biennial screening mammography within the Florence District screening programme from January 1992-December 2001 (339,953 consecutive screens). We identified all cancers occurring in women recalled to assessment and ascertained, and reviewed, all cases considered as negative on assessment and subsequently diagnosed with breast cancer. We compared imaging features, tumour histology and stage, and diagnostic testing on assessment for all women with cancer, and presentation and length of delay in women falsely negative on assessment. RESULTS: Eleven thousand six hundred and twenty four women were recalled to diagnostic assessment (recall rate = 3.4%) predominantly for suspicious mammography (9,216 positive screens). Breast cancer was missed in 57 cases: a FNA rate of 0.50% (0.37-0.62%) and comprising 4.1% (3.0-5.1%) of cancers occurring in women recalled after a positive screen. Two types of abnormalities were significantly more frequent in FNA cases than cancers detected at assessment: mass with regular borders (21.1 vs. 5.6%, p = 10(-5)), and asymmetrical density (22.8 vs. 5.4%, p = 10(-5)). On review 56% of FNAs were benign or probably benign BI-RADS categories. FNA occurred in 1.4% of early recalls and in 0.4% of initial assessment (p=0.0001). Significantly fewer tests were performed when assessing missed cancers than detected cancers with the most significant difference noted for FNAC (29.8 vs. 96.0%, p=10(-6)); mammography as the only evaluation on assessment was more frequent in missed cancers (31.5% vs 0.2%, p = 10(-6)). The 57 missed cases were subsequently diagnosed at early recall (2 cases), next biennial screen (11 cases), or as interval breast cancers (44 cases) with a mean delay in diagnosis of 628 days. Tumour histology, size and nodal status did not significantly differ between cancers missed and cancers diagnosed on assessment. CONCLUSION: False negatives on assessment represent a minority group in whom screening has failed. They might be reduced by adopting a more intensive diagnostic approach to assessment. Although there was no evidence of a worse prognosis in cancers missed at assessment, the delay in diagnosis is substantial and may impact long-term outcomes.

PMID: 17115112 [PubMed - indexed for MEDLINE]





In this study, they didn't find a correlation with delay by clinicians for 3- 36 months and worse prognostic indicators.



1: Am J Surg. 2006 Oct;192(4):506-8. Links

The relationships among clinician delay of diagnosis of breast cancer and tumor size, nodal status, and stage.



Hardin C, Pommier S, Pommier RF.

Division of Surgical Oncology, Department of General Surgery, Oregon Health Sciences University, 3181 SW Sam Jackson Park Rd., L223A, Portland, OR 97201, USA.

BACKGROUND: The objective of this study was to determine the impact of delay of diagnosis by clinicians on breast cancer prognostic factors and survival. METHODS: The medical records of patients whose breast cancer diagnosis was delayed by clinicians were reviewed. Data collected included primary tumor diameter, number of positive lymph nodes, tumor grade, pathologic stage, length of diagnostic delay, and follow-up status. Data were analyzed for correlations between prognostic factors and length of delay. The Fisher exact test was used to correlate delay and stage with survival. RESULTS: Forty patients had delays from 3 to 36 months. There were no significant correlations between delay and natural log of primary tumor diameter (r = -.16, P = .33), number of positive lymph nodes (r = .22, P = .90), tumor grade (R = -.16, P = .36), or pathologic stage (R = -.09, P = .59). A higher stage correlated with decreased survival (P = .03), but delay did not. CONCLUSIONS: Clinician diagnostic delays of up to 36 months did not correlate with worsening prognostic factors or with survival rates.

PMID: 16978961 [PubMed - indexed for MEDLINE]



I am so sorry you are going through this, Annie.

Honey, this very issue, among about 100 others, is why cancer scares the cr*p out of us. It is very unpredictable, to the point that you cannot get any help from the medical profession. They just cannot and will not give you predictions, time frames, nothing. Kinda discouraging, but the oddity of each person's cancer is one thing that is so hard.



It took my group 3 months to diagnose me. Then they thought I had Lymphoma, finally sent my slides to White Plains, NY. Shoot, by then I was a total wreck. But this is just the nature of the beast. Nasty.



Good luck to you, gentle hugs, Shirlann