Why MDs miss breast cancer

The leading cause of physician delay in diagnosis of breast cancer continues to be inappropriate reassurance that a mass is benign without biopsy.
William Goodson, MD, Archives of Internal Medicine 2002; 162: 1343-1348

Several years back, a 40-something year old lady, new to my practice, came to see me for a physical. I was taken aback to find a large mass in one breast. When I asked her what was up with that lump, she replied that she'd had it for years and that her previous doctor assured her it was benign. No biopsy, just negative mammograms and clinical follow up over time.

As far as I'm concerned, you don't know that a mass is benign until you KNOW it's benign, as in tissue in hand and examined microscopically. With my urging, she saw a surgeon and had a biopsy, and it wasn't benign. The final diagnosis was ductal carcinoma in situ, fortunately, and she required no further treatment after the lump was removed.

My current patient of concern is a man who's noted a breast lump for months. He's had a mammogram and an ultrasound, and both were consistent with gynecomastia, a benign enlargement of male breast tissue. But...the surgeon not only said no big deal, come back if it gets bigger, but he also said that insurance wouldn't pay for further testing or excision as they would consider it a cosmetic procedure. Well it's bigger now, and I've urged him to go back to the surgeon to have it removed and not to take insurance won't pay as an answer.

Dr. Goodman concludes: Reducing delay in diagnosis will require less willingness to rely on clinical examination to decide that a mass is benign, [and] less reliance on benign mammography reports to decide not to biopsy a mass. The worst breast cancer I ever found in a woman--already spread extensively to lymph nodes--did not show up on mammography at all.