The truth about breast cancer diagnosis
by Courtney Caplin, MD, DMD
Cosmetic Surgery Columnist
We recently had a patient at our office in Oklahoma City who had found a lump on her breast on self-exam.
She had followed up with her primary care who had referred her to get a mammogram which then showed the mass.
The findings were suggestive of scar-like changes and were not thought to be cancer.
However, her lump continued to grow. She had two relatives with a history of breast cancer.
Concerned, she persisted, so her primary care provider sent her to get an ultrasound. The ultrasound also showed what was thought to be benign findings.
She came to see me at Cosmetic Surgery Affiliates wanting to enhance the shape and size of her breasts electively.
She discussed her story and her concerns with the lump that she had and asked if it could be removed and sent to pathology despite all the imaging suggesting it was benign.
On the day of surgery, the mass was nearly three inches and was easily identified. In all honesty, it could not be missed!
It had likely doubled in size over the four weeks between her consultation appointment and day of surgery.
This rapid growth is not characteristic of benign tumors but instead is much more worrisome for malignancy.
The mass was removed and sent for testing.
It was, in fact, an invasive lobular breast cancer.
After having a difficult conversation with my patient and breaking the bad news, we referred her to an oncologist at a cancer hospital who specialized in breast cancer.
As upsetting as the news was, we were all glad she persevered in obtaining the diagnosis she knew to be true.
With appropriate treatment, the form of breast cancer she has approximately a 90 percent survival rate at two years.
How can this be? The truth is that no diagnostic test is 100 percent fail-proof.
Sensitivity and specificity are often used when elevating diagnostic tests. The sensitivity of a test is its ability to accurately show a positive result when the disease is present, a true positive.
A test with high sensitivity will have very few false negatives - i.e., reporting a person does not have cancer when she does.
The specificity of a test is its ability to show a negative result when the disease is absent accurately, a true negative.
High specificity would mean very few false positives - i.e., diagnosing a person with cancer when she does not. In an ideal world, a diagnostic test would have both a perfect sensitivity and specificity.
According to the American College of Preventative Medicine, estimates of mammography sensitivity range from 75 percent to 90 percent with specificity from 90 percent to 95 percent. (1).
It’s important to remember that although technology continues to improve, the most important thing we can do is a monthly self-breast examination (SBE).
Our patient fell into this 10-25 percent of people who tested negative even though the disease was present.
The range is sensitivity is due to multiple factors including the quality of the machine, the density of the patient’s tissue, and the skill and experience of the radiologist interpreting the image.
We do not know exactly what the reason was in her case, but thankfully not only did she find her lump on self-exam, but she persisted, and we were able to remove it from her body.
Please remember to do your monthly breast self-examinations. If you need help learning how to perform self-breast exams, please visit csaok.com or www.hopkinsmedicine.org/breast_center.
1. Elwood JM, Cox B, Richardson AK. The effectiveness of breast cancer screening by mammography in younger women. Online J Clin Trials 1993;2: Doc no 32.
Copyright The Gayly. 10/2/2018 @ 11:34 a.m. CST.