Detection of a Mammographically Occult Breast Cancer with a Challenging Clinical History

Screening mammography has helped to identify countless incidences of breast cancer since its adoption in the 1960s. Over time, the screening guidelines and techniques have been refined to better detect malignancies and to avoid false positive results. However, weaknesses remain in mammography and represent an opportunity for improvement. The interference of natural breast tissue and glands can obscure the presence of occult breast malignancies. Additionally, the inability to differentiate breast tissue on the basis of depth, and the compounding of breast densities that occurs as a consequence of two-dimensional imaging, are setbacks when it comes to relying on mammography. User error and bias can also misguide the proper detection of underlying cancers during the radiological interpretation process. The following case represents a combination of these factors and others that culminated in a missed diagnosis of invasive ductal carcinoma in a young woman suffering from mastitis of the contralateral breast.