What is lobular breast cancer, and why does it feel different?
Lobular breast cancer often feels like thickening or fullness, not a hard lump. That is because it tends to grow in thin lines through the breast instead of forming a round ball.
Its full name is invasive lobular carcinoma. It starts in the lobules, the glands that make milk, and spreads into the tissue around them. The American Cancer Society says it makes up about 10 to 15 percent of invasive breast cancers.
Most breast cancers grow as a mass that pushes tissue aside. Lobular cancer cells often line up single file and weave between normal tissue. The result can feel like a firm or thick area. It can also change the size or shape of the breast, or pull the nipple inward.
This is why it is easy to miss. Many women have lumpy or uneven breast tissue. A doctor feeling for a distinct lump may not find one. A thick area can seem like normal tissue, especially in an older woman or a woman with dense breasts.
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Article written by Gregory Unatin, Esq. Greg is a managing partner in the law firm of Lupetin & Unatin, a medical malpractice law firm located in Pittsburgh and serving Western Pennsylvania.
Our practice is limited to high-value catastrophic cases because that is where we can do the most for our clients and for patient safety.
The following is a hypothetical situation designed to demonstrate a common form of medical error. It is not a real case, and no physician has reviewed it or offered an opinion about it.
Margaret is 64 and lives near Johnstown, PA. She tells her family doctor that her right breast feels firmer and fuller, and her bra fits differently. He feels some thickening but no lump. He says breasts change with age. Her screening mammogram a month later is read as normal.
Eight months later, the right breast is smaller and harder, and the nipple has started to pull inward. She has a diagnostic mammogram, aimed at the problem area, and an ultrasound, which uses sound waves to make a picture. She also has an MRI, a scan that uses strong magnets. A biopsy, which removes a small piece of tissue for testing, shows invasive lobular carcinoma.
Margaret wonders whether the thickening should have been checked more closely. This article can help you sort out what careful care looks like, and when a delay may support a claim.
Can a mammogram miss lobular breast cancer?
Yes, sometimes. Lobular cancer is often harder to see on a mammogram than other types, though mammograms still find many lobular cancers.
On a mammogram, a typical cancer shows up as a white spot with edges. Lobular cancer may not form that spot. It may show only as a subtle change in the pattern of the tissue, or as one breast looking a little different from the other. The American Cancer Society notes that it is often harder to see on a mammogram.
That does not mean a mammogram is useless for this cancer. Many lobular cancers are found on screening. The important point is narrower. When a woman reports thickening or a change, a normal mammogram should not end the workup.
What should a doctor do about breast thickening?
A new area of thickening, fullness, or change in breast shape or size calls for a workup, not reassurance alone. That usually means a diagnostic mammogram and an ultrasound, and sometimes an MRI.
Careful care usually unfolds in this order.
First, the doctor examines both breasts and compares them. A change on one side only is more concerning than the same feel on both sides. The doctor writes down where the area is and how it feels.
Second, the doctor orders imaging. The American College of Radiology is a national group of imaging doctors. Its 2022 guide on palpable breast masses describes the first tests to evaluate a lump or change that can be felt. For women 40 and older, that is a diagnostic mammogram plus an ultrasound.
Third, if the imaging is normal but the change persists, the doctor looks further. That may mean an MRI or a referral to a breast surgeon. MRI can show lobular cancer that other tests miss.
Fourth, if anything looks suspicious, the next step is a needle biopsy. A thin needle takes small samples of tissue for testing.
Fifth, the doctor sets a date to recheck the breast and writes the plan in the chart.
Where does the chance to find it earlier get missed?
- Thickening was called normal lumpiness. The doctor felt a firm area but no lump. The note says normal or age-related changes, with no imaging ordered.
- A normal mammogram ended the workup. You reported a change, and a mammogram was read as normal. No ultrasound or MRI was ordered, even though the change was still there.
- A change in breast size or shape was not imaged. You said one breast looked smaller, larger, or a different shape. No one ordered a test aimed at that change.
- The report flagged a subtle change, and nothing happened. The mammogram report noted that the tissue looked distorted or uneven on one side and suggested more imaging. It was never done.
- You were told to come back if it got worse. No recheck date was set. Months passed before anyone looked again.
What should I check in my own records?
You can answer most of these from memory, your patient portal, or your records.
- When did you first report thickening, fullness, or a change in your breast?
- Does the visit note describe where the area was and how it felt?
- Was the mammogram a screening exam or a diagnostic exam?
- Did any report mention distortion, asymmetry, or a difference between the breasts?
- Was an ultrasound or MRI ever ordered? Was it done?
- Did anyone set a date to recheck the breast?
- How much time passed between your first report and your biopsy?
Did the delay change the outcome?
A missed step alone is not enough for a claim. The question is whether earlier testing would likely have found the cancer at an earlier, more treatable stage.
That depends on the cancer. Breast cancers grow at different speeds. Many lobular cancers grow slowly, though some do not. That cuts both ways. A slow cancer may have changed little over a few months. But a cancer missed for a long time can grow large before anyone finds it.
Medical malpractice lawyers and the experts they consult to review a case focus on a few things. They compare the size of the area at the missed chance to its size at diagnosis. They check whether the cancer had reached the lymph nodes, the small glands under the arm that filter fluid, or other organs. They look at the type of cancer and how fast it tends to grow. And they measure the time between the missed chance and the diagnosis.
A delay can also change treatment. A woman who might have needed a small surgery may have needed a mastectomy, which removes the whole breast. Or she may have needed chemotherapy, strong cancer drugs, that might have been avoided.
In Pennsylvania, a family does not always have to prove that an earlier diagnosis would have saved their loved one. It can be enough to show that the delay meaningfully raised the risk of harm. That added risk must also have played a real part in what happened.
When is a missed lobular cancer not malpractice?
Not every delay is malpractice. A bad outcome does not prove someone made a mistake.
- The right tests were done and read correctly. You had a diagnostic mammogram and an ultrasound, and they were read well. Some cancers do not show on a mammogram or ultrasound, even when the test is done and read correctly. A doctor who did the right workup is not at fault just because the cancer was found later.
- No change was ever reported. A lobular cancer found on routine screening, with no earlier symptoms, is often no one’s fault.
- The change cleared, then came back later. If the thickening went away and a new change appeared months later, the first doctor may not have missed anything.
- The delay likely made no difference. The cancer may have already spread when the change was first reported. Or the stage would likely have been the same months earlier.
What harms matter in these cases?
Our firm focuses on delays that led to death or catastrophic injury. In breast cancer cases, these are the harms that usually matter:
- Cancer that spread to distant organs, such as the bones, liver, lungs, or brain, before it was found. It can still be treated, but it can no longer be cured.
- Death from a breast cancer that, if found earlier, would likely have been curable.
What to expect when you contact our office
Before we take a case, we review the records and imaging with medical experts. Pennsylvania requires a medical professional’s written statement that a claim has merit before a case can go forward. That review also helps answer whether the delay changed the outcome. A doctor, a nurse practitioner, a radiologist, a practice group, or a hospital system may each have played a role.
Pennsylvania has filing deadlines. For a living patient, the deadline is generally two years from a key date. That is when she knew, or should have known, that she was harmed and that medical care may have caused it. In delayed diagnosis cases, that date is often near the cancer diagnosis. After a death, claims generally must be filed within two years of the date of death. Learn more about how long you have to file a medical malpractice in Pennsylvania. For additional information on breast cancer misdiagnosis, see our main article on delayed diagnosis of breast cancer.
Frequently Asked Questions
It often feels like thickening, firmness, or fullness rather than a hard lump. It can also change the size or shape of the breast.
Sometimes. It is often harder to see than other types, but mammograms still find many lobular cancers.
Usually, a diagnostic mammogram and an ultrasound. If those are normal and the change persists, an MRI may follow.
No. A claim needs a medical error and proof that the delay likely changed the outcome or raised the risk of harm.
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Lupetin & Unatin, LLC represents Pennsylvania patients harmed by physicians who failed to meet the standard of care.