A 27-year-old medical student at Philadelphia College of Osteopathic Medicine, Angela Ellis, was watching TV on her couch one night when she discovered a lump in her left breast.

Med student, 27, found a breast lump. Her surgeon neglected to tell her it was cancer. TODAY.com.

 

 

Ellis saw her OB/GYN, who suggested that she undergo an ultrasound and mammogram. Eventually, the ultrasound and mammograms both confirmed a mass. Ellis had no family history of breast cancer. 

After the mass was confirmed, Ellis consulted a breast surgeon, who told her that he wasn’t worried about the lump and that it was a benign mass. “‘He did a breast exam and was like, ‘Yeah, I’m not worried about this at all. This is 99.99%...a benign mass…He’s like,...‘you’re a medical student, so why don’t you come back in three months? We can worry about it after you take your board exam,’” Ellis continued. 

The surgeon also told Ellis that he’d seen another young woman with fibroadenoma, a noncancerous breast tumor, who “went backpacking for three months and was fine when it was removed after her trip.” 

Ellis was reassured by this, but her intuitions challenged what she’d been told. As a result, she opted to have the mass removed right away. 

The diagnosis shocked her: “‘I had an idea of what it said because I was learning about it in medical school,’” she told TODAY.com. Ellis explained that when she asked the surgeon if he was ever going to let her know about the results, he responded, “‘I didn’t know what your med school schedule was like.’”

Med student, 27, found a breast lump. Her surgeon neglected to tell her it was cancer. TODAY.com

 

“‘If I listened to [his] advice to begin with…I could have been looking at a much different outcome,’” Ellis told TODAY.com.

Med student, 27, found a breast lump. Her surgeon neglected to tell her it was cancer. TODAY.com

 

According to Natalie J. Klar, MD, a medical oncologist and member of the Breast Cancer Center at NYU Langone’s Perlmutter Cancer Center, Ellis’s diagnosis is an aggressive subtype of breast cancer that makes up 15–20% of all breast cancer cases. 

“Triple-negative refers to this subtype of breast cancer being negative for the three biomarkers we test all breast cancers for: the estrogen receptor, the progesterone receptor, and HER2,” Dr. Klar says. 

According to Bhavana Pathak, MD, board-certified hematologist and medical oncologist at MemorialCare Cancer Institute at Orange Coast and Saddleback Medical Centers in Orange County, CA, symptoms of triple-negative breast cancer may look similar to those of other breast cancers. Symptoms may include:

• Breast lumps

• Inverted nipples

• Discharge from the nipple

• Dimpling in the breast skin

• Redness in the breast skin

In some cases, patients may be entirely asymptomatic except for what’s picked up on a mammogram or ultrasound, Dr. Pathak says. Additionally, certain patients may be at higher risk for triple-negative breast cancer, including African American patients and those with BRCA gene mutations, she adds. 

Eventually, Ellis learned she had a mutation to her BRCA1 gene, and she was diagnosed with stage 2 breast cancer. As it turns out, she also had fibroadenomas in her right breast. Ellis opted for a double mastectomy with breast reconstruction.

Dr. Klar says that because this subtype of breast cancer is fast-growing and aggressive, proper treatment—as Ellis sought—is key. 

“This diagnosis should be addressed promptly. The first step after a patient has an abnormal breast finding on exam and/or breast imaging will be a breast biopsy. If the breast biopsy is positive for cancer, the patient will be sent to meet with a breast surgeon. For triple-negative breast cancer, if the cancer is <2cm and lymph node–negative, the patient should have breast surgery immediately,” Dr. Klar says. 

But, she continues, if the patient with triple-negative breast cancer is >2cm and/or has positive lymph nodes, “the patient should see a medical oncologist first and receive neoadjuvant chemotherapy with immunotherapy prior to surgery.” 

Triple-negative breast cancer is more complicated to treat, Dr. Klar says: “Given [that] triple-negative breast cancer is negative for these biomarkers, we cannot treat this type of breast cancer with targeted therapy—such as endocrine therapy and HER2 therapy, which we use for the other subtypes of breast cancer—for these receptors.”

 

Reflections on this misdiagnosis

 

According to Nathan Goodyear, MD, the medical director at Brio Medical in Scottsdale, AZ, Ellis’s case is an “indictment of the modern medical system,” and the surgeon’s dismissal of Ellis’s concerns showed not only patient bias but also medical gaslighting. 

“The patient did not fit into a one-size-fits-all protocol style of medicine. This empowered woman showed that the only way forward in the ever-changing world of cancer is an individualized approach,” he says. 

Dr. Goodyear also says that this case presents an opportunity to reflect on how the medical system works today: “The role of a physician, as a teacher and as a healer-servant, has been lost in the sea of advocacy confusion. This is no more evident than in the teaching and practice of medicine, but particularly [in] the practice of oncology today,” he says. “Doctors today have become more of an advocate for everything except the patient: for pharmaceutical companies, medical equipment manufacturers, health insurance companies, medical governing bodies, money, and—worst of all—self.” Dr. Goodyear says that it’s in this very sea of issues that a diagnosis gets lost. 

He says that MDs should aim to truly listen to a patient’s fears and concerns, no matter what—especially given the fact that incidents of early-onset cancer are increasing.

Koh B, Tan DJH, Ng CH, et al. Patterns in cancer incidence among people younger than 50 years in the us, 2010 to 2019. JAMA Netw Open. 2023;6(8):e2328171-e2328171

 

 

“If a redirection is needed, one can lead with the scientific evidence with the patient's concern at hand,” Dr. Goodyear says. “This approach of leading via the open discussion and debate of the scientific evidence with the patient regarding their concern embraces the patient’s concerns as valid. Then, it doesn’t dismiss, but instead embraces, dives deeper, or redirects when necessary.”

All of this said, humans make mistakes; Goodyear adds: “Physicians are placed on a pedestal above the potential or ability to make mistakes. Physicians need to do more to embrace their humanity and the potential for mistakes in their mind, but more with regard to their patients directly.”