<![CDATA[Introduction: Bilateral breast cancer (BBC) is relatively uncommon but increasingly detected due to advancements in imaging and preoperative screening. In Indonesia, where screening is limited and patient awareness is low, BBC poses unique diagnostic challenges. Case Presentation: We report the case of a 55-year-old woman diagnosed with synchronous bilateral breast cancer (sBBC). The patient initially presented with a left breast mass diagnosed as invasive ductal carcinoma (IDC) via core biopsy but deferred treatment. Eighteen months later, she re-presented with pain in the left breast. Imaging revealed bilateral lesions, and subsequent surgery showed invasive lobular carcinoma (ILC) in both breasts. Magnetic resonance imaging (MRI) was not performed due to limited facility availability. The patient underwent modified radical mastectomy (MRM) of the left breast and lumpectomy of the right breast. Postoperative ultrasound revealed a residual right breast lesion, but the patient declined further treatment due to financial and cultural reasons. Conclusions: This case highlights diagnostic limitations and systemic challenges in Indonesia, including lack of screening coverage, patient delay in seeking care, limited imaging modalities, and refusal of further therapy. Histopathological discrepancies between biopsy and surgical specimens also underscore diagnostic complexity. Addressing these systemic barriers is essential for improving outcomes of BBC in Indonesia.]]>
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