Understanding Breast Lumps FAQ

Understanding Breast Lumps and Other Breast Changes

Breast changes are a common event. These change can include those that normally occur during the menstrual cycle and pregnancy, as well as those that occur with aging. Most breast lumps (8 out of 10) are not cancerous, but only a doctor can tell whether or not the condition is malignant (cancerous) or benign (non-cancerous).

This Quick Fact Sheet explains how your doctor will evaluate breast lumps or other breast changes that you might experience.

A Look Inside the Breast

The breast consists of glandular tissue, fatty tissue, and fibrous tissue. Each breast has 15-20 sections, called lobes, each with many smaller lobules. The lobules end in dozens of tiny bulbs that can produce milk. The lobes, lobules, and bulbs are all linked together by thin tubes called ducts.

What could Be Causing Lumps or Other Changes?

Occasionally the breast feels lumpy, but this is normal. Many women experience swelling, tenderness, and pain before, and sometimes during, their periods. Every woman should become familiar with how her breast feels by doing breast self-examination (BSE).

The following are some of the conditions the doctor will be considering:

• Fibrocystic Changes - General breast lumpiness, which is a benign condition
• Cysts - Fluid-filled sacs. These occur most often in women 35-50 years of age. The cysts often enlarge and become tender just before a woman's menstrual period. Cysts are usually handled by observation or by withdrawing fluid with a small needle.
• Fibroadenomas - Benign masses of tissue that do not contain fluid.
• Cancer - When cells grow without control or order.

Breast Pain - Is it Serious?

Breast pain is very common in pre-menopausal women. The pain can be shooting to the nipple, burning, itching, or aching. One breast may hurt more than the other. Usually it starts two weeks after menstruation and gets worse until the beginning of your period. It gets better for two weeks, then the cycle starts over.

Breast pain is more common in women in their 30's and 40's, and gets better after menopause. If you have pain or soreness with a lump or redness, you should call your doctor immediately.

How Does the Doctor Evaluate the Lump or Other Breast Changes?

Your physician will evaluate your breast changes using a combination of a breast examination, mammography, ultrasound, and/or biopsy. Although no one of these procedures is 100% accurate, when combined they will usually diagnose your condition correctly. Therefore you, your personal doctor, radiologist, and surgeon need to work together as a team.

What is Mammography?

A mammogram uses a weak x-ray to take pictures of the breast. The breast is compressed between two plastic plates and two x-ray pictures are made of each breast. The mammogram is read by the radiologist who will give your physician the results. A mammogram is 85-90% accurate. Therefore,10-15 percent of cancers cannot be seen by mammogram.

There are two types of mammograms:

1. Screening for women without a breast problem (appropriate for all women over the age of 40, who should have a screening mammogram on a regular basis.
2. A diagnostic or complete mammogram for women with a lump or other breast concern.

Some women worry about the effects of radiation from a mammogram. Nowadays, the amount of radiation received is less than what we get from a chest x-ray. A mammogram can cause some discomfort due to compression of the breasts. If a women has tender breasts, it is best to have the mammogram done after menstruation when the breasts are less tender.

What is Ultrasound?

Ultrasound is used for women under 30 years old, or as a complement to mammography. It is used if a mammogram shows a change that needs to be diagnosed as a real mass or fibrosis. If it is a real mass, ultrasound can distinguish a benign cyst from a solid mass that may need to be biopsied. Also, ultrasound is used when the mammogram is normal but an abnormality is detected through a physical examination.

What is a Biopsy?

Often the best way to kind out the cause of your condition is to have a small piece of tissue removed from the breast and sent to the laboratory to be examined under a microscope. There are four types of biopsies:

1. Fine Needle Aspiration - A thin needle is inserted into the suspect tissue and some cells are moved.
2. Core Biopsy - A large needle removes a small piece of tissue.
3. Incisional Biopsy - A surgeon removes only a slice or wedge of the suspicious area.
4. Excisional Biopsy - The surgeon removed the entire lump and some of the surrounding tissue.

A Final Word

Breast lumps and changes cab be frightening. Remember that most lumps and changes are normal, and often disapear on their own. Every lump that does not go away on its own or is not filled with fluid needs to be evaluated further. Some lumps and changes are more difficult to diagnose, and requires several tests. It may take several weeks to reach a final diagnosis. Waiting for the results causes anxiety, but is the best way to avoid unnecessary surgery.

Alert your doctor to changes noticed in your breasts, and be sure to follow his recommendations for follow up procedures. You should be advised of all test results, and feel tree to ask any questions you have.

Copyright 1996, Florida Early Diagnosis Steering Committee and Florida Academy of Family Physicians. Reprinted with permission.