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Background: Breast cancer is a major health concern all over the world, and also in the Kingdom of Saudi Arabia. Despite availability of modern facilities in diagnosis and improvements in healthcare systems, still many of the breast cancers are missed. Careful understanding of situation may help to minimize and even stop such unfortunate outcomes. Aim: To highlight various aspects of missed breast cancers on mammography based on their cause and course of disease. Methods: We retrospectively reviewed clinical information, imaging data and outcomes of mammography in patients who presented for both screening and diagnostic mammography in our hospital. Although we found less number of patients having diagnosed or developed breast cancer (on follow-up mammography and biopsy results) with initial negative mammogram studies. Careful analysis of clinical and imaging findings were made and interviews with the patients conducted to sort out cause of such unfortunate outcome (of missed breast cancer). Results: We found important aspects of missed breast cancers because of patient factors (lack of awareness for importance of regular check-up, social factors, inertia for access to care and late check-up), imaging related (suboptimal acquisition of mammogram views), physician related (unfamiliarity with rad-reports and BIRADS classification, late referral) and natural causes (rapid course of disease). Conclusion: Causes of missed breast cancers may be simple to understand but sometimes overlooked by anyone in the chain of process (from technician, patient, radiologist and physician). Careful analysis, creating awareness and implementing standardized practice may help to overcome such unwanted events.