Expert: Claes-Gustaf Nordquist, M.D. - 12/27/2009

Question
7 years ago, at age 49, I found a hard mass in my armpit, which when biopsiedshowed adenocarcinoma presumably from breast cancer. I had mammograms, breast ultrasound a breast MRI. Nothing showed except a mass in the breast that was diagnosed as a fibroadenoma. Incredible as it seems now, this mass was never biopsed. I went ahead with a lymph node dissection, chemotherapy and radiation and 5 years of Tamoxifen. I had felt uneasy about the "occult cancer" diagnosis, so I insisted upon another breast MRI. The so called fibroadenoma was gone. I went to a national cancer center where experts there told me that there was no fibroadenoma and that the mass was most certainly cancer. The surgeon told me I could either have a mastectomy or undergo MRI surveillance of the breast yearly. I chose the MRI surveillance and for 7 years, there has been no sign of a returning cancer on the breast MRI. The surgeon told me that my problem was not returning cancer in the breast, because then I could just have a mastectomy, but a distant metastasis. I realize that this is a long involved story of a misdiagnosis, but do you think I should have a mastectomy at this point? The oncologist tells me the good news is that we know the chenotherapy worked as the mass in my breast disappeared. Expert radiologists at this center told me withh absolute certainty that the mass was a breast cancer even though it was never verified by biopsy. What do you think?

Answer
Well, honestly I do not KNOW! It is possible maybe even probable that that mass was indeed a cancer but now it seems to be gone due to your hormonal treatment and chemotherapy (and maybe also your radiation therapy if your lesion happened to be inside your radiation fields). Like you I'm surprised and upset by the fact that in spite of finding an axillary caqncerous mass AND a breast mass close by no biopsy was done on your breast mass! such a situation is ridiculous! Even in my opinion criminal! Now it is too late to do anything diagnostic of this situation (except maybe yet another second opinion with regards to your old mammography, ultrasound & MRI breast scan pictures). A mastectomy now is probably worthless. So you should concentrate on having follow up check ups with regards to any new cancer and distant metastases. Good luck!


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