On Finding the Smallest Breast Cancers

Yesterday was a busy day in the mammography screening world. One technologist commented, “It looks like the beginning of the July to January mammo push.” I don’t know whether to be excited at the possibility of finding occult breast cancers for more women, or to be a bit scared of the increased opportunities for missing a small breast cancer.

I am in the breast imaging business to help to find small breast cancers. Statistics indicate that treatment of breast cancers smaller than 1 cm gives the woman a 99 percent chance of living a life as if she had never had breast cancer.

So sometimes I wonder what is the point of debating whether a cancer will kill a woman or not. It’s kind of a conundrum. If the parameters used to decide if a cancer is a killing cancer are 100 percent reliable and 100 percent accurate in prediction, then analyzing a cancer for its effect on mortality would be useful. However, the evaluation of cancers for killing potential is not a useable technology at the present time. So, I rely on trying to find cancers smaller than 1 cm to help women to live normal lives in spite of their breast cancer.

The little ones are tough to identify sometimes. They do not have typical appearances. They easily hide amongst the fibroglandular densities, protruding slightly from the contour of the tissue or appearing in a small previously fatty area. Sometimes time tells the story when a small nondescript nodule declares itself with speculated margins and increased density. Using the 20/20 retrospectoscope is disconcerting because the small nondescript density usually can be seen, benignly sitting amongst other similar breast densities.

Radiologists do miss lesions on screening mammograms. Leonard Berlin, MD, in his book “Malpractice Issues in Radiology” quotes studies indicating of miss rates of 25 percent. The itty-bittys just don’t stand out in the crowd.

I’ll just keep trying to find the little ones anyway. Happy beginning of screening mammography season!