I am back! Recently, two breast cancer patients were diagnosed by us in time, so I would like to post some thoughts. One patient (A) had an obscure lump and a locally thickened and hard gland on palpation. However, the initial ultrasound did not show any abnormality, as if only BI-RADS grade 2 was reported, and mammography BI-RADS grade III suggested asymmetric dense shadow without calcified foci. There were no further hints of glandular disorders, etc. A small amount of bleeding from the nipple was seen later and the follow-up was done. The young doctor felt something was wrong and asked me for a consultation. After physical examination, I thought that a middle-aged woman with an atypical, relatively diffuse but hard mass and combined with blood overflow should be alerted to breast cancer, with a higher possibility of carcinoma in situ, and was admitted to the hospital immediately. Intraoperative freezing report only reported atypical hyperplasia, but we were not careless, and the final paraffin report was mucinous adenocarcinoma and ductal carcinoma in situ. The other patient (B) was an outpatient with regular review. Last year, three examinations: physician physical examination, ultrasound and mammography were all unremarkable. A lump of 1 cm in diameter was found on palpation in the left breast with negative lymph nodes. Ultrasound revealed a solid mass with a non-specific description and BI-RADS grade 4. Mammography revealed a problem: burr-like changes around the mass, BI-RADS grade IV C. The result was surgically confirmed as an early invasive carcinoma with a cancerous lesion of only about 5 mm in diameter. In retrospect, these two patients were “atypical” cancer patients whose adjuvant examinations had not been particularly suggestive, but only had abnormal findings by mammography. Of course, their negative frozen section reports should be incidental and related to the pathologists’ personal experience. There have been similar patients in the past, probably because the lesions of carcinoma in situ are more diffuse, and it is difficult to detect lesions that are not confined to the surrounding tissues with little difference in texture on ultrasound, so the diagnosis is easily missed on ultrasound; however, some patients show calcified foci along the ducts on mammography. If there is no overflowing blood, local thickening and hard tissue texture found by palpation alone should not be ignored, so the need for surgical biopsy should not be decided by imaging alone. In the past, I have had patients who had suspicion based on physical examination alone, despite the fact that ultrasound and mammogram were fine, and eventually biopsy confirmed to be carcinoma in situ. B is a patient who benefits from insisting on regular checkups. Last year, there was no abnormality in physical examination and imaging, and this year, I thought it was a routine checkup and was not prepared for any thought. There was still an appointment to attend to in half a month. However, at that time we found a nascent palpable solid mass and recommended excisional biopsy. The patient’s initial reaction was no, I didn’t have the time or the mindset to prepare. But I helped her analyze it in the clinic. 1. the mass was solid and palpable, and it would not go away without excision. 2. excision of the mass would clarify the diagnosis. 3. two conditions after excision. If it is a benign tumor, it does not affect things after half a month; if it is a malignant problem, deal with the problem half a month to twenty days earlier. She did a little thinking and accepted our suggestion. The surgery turned out to be an early stage cancer, with a cancerous lesion of only about 5 mm, so that she won time to beat the breast cancer, which made sense in all aspects of treatment outcome, surgical approach, chemotherapy regimen, and financial cost. In our work, we do not be doctors who just read reports; we value our physical examinations. Therefore, I often have to appeal to outpatients in the clinic to be patient and wait for the doctor’s examination. Nowadays, society makes people impatient and impatient. But you are here to see a doctor, if the doctor has the patience to take a step-by-step medical history, physical examination and work step by step, do you have to be more impatient than the doctor? You will miss an equally important examination – the doctor’s physical examination. So, don’t be too impatient to see a doctor. I hope that the doctor and patient can have adequate communication and have enough trust so that you can give yourself a chance and give the doctor a chance to reduce misdiagnosis and missed diagnosis. Secondly, I hope everyone will have a sense of regular medical checkups. The guidelines for breast cancer screening are very detailed. If there is no problem, breast physical examination should be performed once a year above 30 years old; above 35 years old and below 40 years old, breast physical examination + ultrasound examination should be performed once a year, and mammogram should be done once during this period for baseline control; 40 years old and above, breast physical examination + ultrasound examination + mammogram should be performed once a year. Note that you should go to the hospital for examination whenever you have any problem. In this way, we can improve the early diagnosis rate of breast cancer, and accordingly, the cure effect such as disease-free survival time and overall survival rate can be improved.