By Dr. Kathleen Ruddy
One of the most disconcerting things to happen to a woman is for her to find an unusual lump in her breast. Lumps in the breast do not necessarily indicate breast cancer as 80 percent of all lumps are benign. However, in all cases, follow-up is warranted. Early diagnosis of breast cancer is key to achieving a good prognosis.
Finding a Lump
Breast self-exams (BSE) are important for one reason, and that’s the ability to find a lump yourself. When done monthly, BSEs enable you to understand what your normal breast tissue feels like. You are far more likely to notice an abnormality when you are comfortable with what feels normal to you. BSEs should not take the place of a yearly mammogram, but should be done in conjunction with imaging tests to ensure a new lump is not missed. If you find a lump in your breast, make an appointment to see your primary care physician or gynecologist as soon as possible.
Clinical Exam and Diagnostic Testing
Your physician will conduct a full exam and perform a clinical breast examination. Your doctor will palpate the lump and determine if it’s fixed and firm, or movable and soft. If it is moveable and soft, it is likely a benign cyst, but an ultrasound may be ordered to confirm this diagnosis. If the lump is fixed and firm, a mammogram and ultrasound will likely be ordered to determine if a biopsy is warranted. A biopsy of the lump will provide a definitive diagnosis.
Lumps in the breast do not necessarily indicate breast cancer as 80 percent of all lumps are benign. However, in all cases, follow-up is warranted. Early diagnosis of breast cancer is key to achieving a good prognosis.
A mammogram is a series of low-dose x-rays that provide images of the breast. Digital mammography is an advancement that provides much more detail with even lower doses of radiation than its predecessors. The images provide the radiologist with views, typically four different views, of the breast tissue. A mammogram can help determine and diagnose breast calcifications, benign fibrocystic breast disease, and most types of breast cancer. If more information is needed for the radiologist to make a diagnosis, an ultrasound may be performed immediately following the mammogram.
A breast ultrasound uses sound waves to produce images of the breast, which provides additional information when determining the nature of lumps of a breast lump. Ultrasound technology, also referred to as a sonogram, is particularly effective in identifying whether a lump is a fluid-filled benign cyst or a suspicious, solid lesion. An ultrasound is painless and uses no radiation. Once the radiologist has reviewed the mammogram and ultrasound images, he or she may order or suggest additional diagnostic tests. This may include a biopsy of the tissue.
Several types of breast biopsy procedures exist. The most commonly used is the ultrasound-guided core needle biopsy. It is a fairly simple procedure, relatively painless, and highly accurate. There is a slight risk of bleeding inherent with any insertion into the skin, although temporarily stopping any blood-thinning drugs lessens this risk significantly. The area of the lump is located using ultrasound and numbed with a local anesthetic. A needle is inserted into the lump, and a sampling of cells are withdrawn, which will be analyzed by a pathologist for a definitive diagnosis.
The treatment of lumps in the breast is highly dependent on the diagnosis. A fluid-filled cyst may require no further treatment. A breast cancer diagnosis will require a thorough treatment plan designed by your medical oncology staff that will safely provide the best opportunity for a good prognosis and full recovery. This plan may include surgery, chemotherapy, radiation, and/or hormone therapy. You will work very closely with your oncology team to develop, monitor, and conduct your treatment plan.
The diagnosis and treatment of lumps in the breast should not be viewed with irrational fear or dread. Most lumps are benign. If it is determined that the lump is breast cancer, early diagnosis is the best prognosticator for achieving a long-lasting remission and a long, full life. The formulation of new, safe and highly effective breast cancer treatment is ever-evolving and exciting for researchers. More and more, treatment plans are becoming more specifically targeted and customized to ensure the best possible outcome.
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