Advanced lung cancer not likely to be missed by CT scan

Ask Dr. Keith Roach M.D

DEAR DR. ROACH: Is it possible for X-rays and a CT scan to miss advanced lung cancer? My brother worked two days before he died. He went to the hospital, was admitted to hospice and died the next day. I wonder if he knew at least a year ago, but didn’t tell anyone. He said his scans showed pneumonia. His son was called to the hospital and spent the day with him until he died. During his last day, my brother told him that he had lung cancer and that it was not diagnosed earlier. — N.W. ANSWER: I am very sorry about your brother. Lung cancer, especially early lung cancer, is often missed on a regular chest X-ray. Pneumonia can accompany early lung cancer, and the pneumonia can hide the cancerous mass, but experienced radiologists should be able to see something. Also, experienced clinicians should check an X-ray weeks after a pneumonia to be sure there is no cancer in a person at risk, such as a current or former smoker. Advanced lung cancer is only very rarely missed on X-ray, and should essentially never be missed on a CT scan. While I can’t say it’s impossible, it’s much more likely that a year ago he was told that he had lung cancer and did not say anything, perhaps to spare his family’s feelings, or perhaps he didn’t want the sympathy and attention that accompany a diagnosis such as advanced lung cancer. *** DEAR DR. ROACH: What does a person do when symptoms are vague and hard to explain? I am an 82-yearold woman. I started feeling discomfort in one breast about three weeks ago. It felt like irritation from a bra. I did all the things I thought I should, and three weeks later the symptoms are the same or slightly worse. Nothing looks or feels different when I touch it. Do I see my primary doctor (he’s never seen me naked), or find a gynecologist? How do I present this issue? I feel like a fool. — V.B. ANSWER: Both clinicians should be able to appropriately evaluate this concern. You should go to whoever you are more comfortable seeing. What you should not do is ignore it. In your particular case, it’s unlikely that your symptoms are because of something serious. Breast discomfort is common and only rarely due to breast cancer, which is what you must surely be concerned about. You should NEVER stop yourself from seeing your doctor for fear of not being taken seriously. Primary doctors like me and gynecologists are very familiar with women coming in with breast symptoms, and we take them seriously. Clinicians know how justifiably concerned women are about breast cancer. Most often, a woman can be reassured with a careful history and physical exam; other times, a mammogram or ultrasound may be ordered. You don’t want to regret missing that visit to the doctor. It is often said that the only foolish question is the one that is not asked. This situation is analogous: It would be foolish for you not to go. While the overwhelming likelihood is that you will be reassured, in the unlikely event there is something wrong it’s far better to know about it earlier than later. *** Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYour-GoodHealth@med.cornell. edu or send mail to 628 Virginia Dr., Orlando, FL 32803.