October is Breast Cancer Awareness Month - Wear Pink!!!

Although technology continues to improve, the most important thing a woman can do is self-examination. We recently had a patient at our office in Oklahoma City who had found a lump on self exam.  She had followed up with her primary care who had referred her to get a mammogram which showed the mass.  However, the findings were suggestive of scar-like changes and were not thought to be cancer.  However, her lump continued to grow in size and she had two relatives which had had breast cancer.  Due to her concern, 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 presented to Cosmetic Surgery Affiliates wanting to electively enhance the shape and size of her breasts. 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 of the imaging suggesting it was benign.  On the day of surgery, the mass was approximately 7cm and was easily identified.  In all honesty, it could not be missed! It had likely doubled in size over the 4 weeks between her consultation appointment and day of surgery.  This rapid growth is not characteristic of benign growths, but instead is much more worrisome for a malignant process. 

The mass was removed and sent to pathology who determined from the biopsy that it was in fact invasive lobular breast cancer.  After having a the difficult conversation with our 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 that she persevered in obtaining the diagnosis she knew to be true. With appropriate treatment, the form of breast cancer she has, has approximately a 90% survival rate at two years.  

How can this be? The truth is that no diagnostic test is 100% 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 disease is present, a true positive.  A test with a high sensitivity will have very few false negatives - i.e. reporting a person does not have cancer when she really does. The specificity of a test is its ability to accurately show a negative result when disease is absent, a true negative. High specificity would mean very few false positives - i.e. diagnosing a person with cancer when she really 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% to 90% with specificity from 90% to 95%. (1). 

Our patient fell into this 10-25% of people who tested negative even though 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 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-examination, 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 more about how to one, 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.