Pneumonia can hide cancerous mass

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. During his last day, my brother told his son that he had lung cancer and that it was not diagnosed earlier.

N.W.

Answer: 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.

Advanced lung cancer is only very rarely missed on X-ray, and should essentially never be missed on a CT scan.

Dear Dr. Roach: Iam an 82-year-old 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.