When You Find a Breast Lump
You may have just found a lump in your breast. Or your healthcare provider may have seen one on a mammogram (breast x-ray). If so, you are likely to have many questions and concerns. It's normal to worry. But the welcome news is that most breast lumps are not due to cancer, and they often need little or no treatment. Read on to help you learn more.
Learning About Breast Lumps
Many women have at least one breast lump in their lifetime. Most are caused by harmless (benign) changes in the breast. But sometimes a lump is cancerous (malignant). When this is the case, finding and treating it early gives you the best chance for a healthy future.
Finding the Cause
After a lump is found, your doctor may suggest having certain tests. These can reveal more about the lump you have. Tests can also be used to screen for other breast changes.
Treatment Options
You and your doctor will decide on the treatment that is best for you. Many benign lumps need no care at all. If a lump is malignant, more options exist than ever before. Any treatment you choose will be tailored to your needs.
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All recommendations for breast monitoring are based on the American Cancer Society's guidelines.
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Understanding the Breast
Breasts come in all shapes and sizes. But all women have the same basic breast features. Learning about these features can help you understand breast changes when they occur.
Your Breasts Do Change
Your breasts are constantly changing. Sometimes they may seem larger, more tender, or more lumpy. At other times, they may feel firmer or smoother. Normal shifts in female hormones cause most of these changes. But you always have the same basic breast features.
Normal Breast Changes
Because the breasts contain fatty tissue, their size changes when you gain or lose weight. Other normal breast changes occur at different stages of life.
Puberty
Your breasts start growing before you get your first period. Both breasts may not grow at the same rate. But they become more even in size over time. If your breasts are not exactly alike, don't worry. It's normal for them to be a little uneven.
Menstrual Cycle
Your breasts may swell before and during your period. They might also feel more tender, sore, or lumpy. After your period, the soreness and swelling often go away. Birth control pills can make your breasts firmer, more tender, and slightly larger.
Pregnancy
The lobules enlarge as your breasts prepare to produce milk. This makes your breasts bigger. Your breasts are also likely to be tender and the areola may be darker. When you stop breastfeeding, or if you don't breastfeed, your breasts slowly return to normal.
Menopause
As you get older, your breasts may be less firm. They also may not seem as lumpy, sore, or swollen. These changes are less likely to occur if you use hormone replacement therapy (HRT). Instead, your breasts may feel the way they did before menopause.
Checking Your Breasts at Home
Your breasts change throughout your life. But monthly breast self-exams can help you learn what is normal for you. That way, you are more likely to notice any unusual changes. Try to check your breasts 1 week after your period each month. If you don't have periods, aim for the first of each month.
Look for Changes
Look in the mirror with your hands at your sides. Then raise your arms. Do you see any flattening, bulging, or puckering on your breasts?
Raise your arms, then put your hands on your hips. Look for changes in your breast movement or shape as you move your arms.
Feel for Changes
Lie on your side with a pillow under your right shoulder. Put your right arm above your head. (You can also do this exam in the shower with soapy hands.)
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Feel your right breast with your left hand.
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Use an up-and-down or circular pattern. Use the same pattern each month.
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Use the pads of your three middle fingers.
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Feel for a lump or thickening.
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Repeat on your left side.
Gently squeeze your nipples to check for hardness or other changes. See your healthcare provider if you notice a rash or bloody discharge.
Use just the pads of your three middle fingers. Move over the breast in small circles (the size of a dime).
Your Medical Evaluation
If you notice a new breast change or a lump, have it checked by your healthcare provider. Your health history, a physical exam, and certain tests can help find the cause.
History and Physical Exam
Your healthcare provider will want to know when you found the lump and whether it has changed. You also may be asked about your periods, and any pregnancies or prior breast problems. Tell your healthcare provider if you're using birth control pills or HRT. During your visit, your healthcare provider will check your overall health as well as your breasts. He or she will perform a clinical breast exam, using gentle pressure to feel your breast tissue for lumps and other changes.
Common Tests
Diagnostic tests can provide more information about a change in your breast. You may have one or both of the following tests.
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Mammogram. This is an x-ray of your breasts using a low dose of radiation. It may be used to check a lump or some other breast change. Mammograms are also used to screen (regularly check for problems) women who have no symptoms.
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Breast ultrasound. This test uses painless sound waves to produce a picture of your breast. It can help determine whether a lump is solid or filled with fluid.
What's Ahead
Your healthcare provider may wait to see if your lump goes away in a month or two. If it doesn't, he or she may ask you to have a biopsy. This procedure removes a sample of tissue from your breast lump. The cells are then studied under a microscope to see if cancer is present. There is more than one type of biopsy. The procedure you have depends on the size and location of the lump.
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Percutaneous Biopsy
Percutaneous biopsies use needles or special probes to remove samples through the skin. In most cases, these biopsies can be done in a doctor's office or in an outpatient setting. If a lump cannot be felt, an image-guided biopsy is done.
Fine Needle Aspiration
Fine needle aspiration is the simplest type of biopsy. It is used for lumps that can be felt. Once removed, the biopsy sample is checked in a lab. This type of biopsy needs no anesthesia.
Before the Biopsy
Your healthcare provider will talk with you about the risks of this procedure. These are often very minor. You may have a little bleeding, pain, or bruising where the needle is inserted.
During the Biopsy
This simple biopsy takes just minutes to perform. A very thin needle is placed into the lump. Fluid is sampled, or cells are removed if the lump is solid. Clear fluid from a cyst may be discarded.
After the Biopsy
Any bruising or pain should go away quickly, and you won't have a scar. You should receive your test results in just a few days. Be sure to discuss them with your healthcare provider. Sometimes an aspiration gives a false negative result. This means you may have cancer cells that don't appear in the biopsy sample. If the results aren't clear, you are likely to have another type of biopsy.
Core Needle Biopsy
Core needle biopsy provides a larger sample than fine needle aspiration. A core needle can be used for solid masses that you can feel. Once removed, the tissue samples are sent to a lab.
Before the Biopsy
Tell your healthcare provider about medications, vitamins, or herbs that you take. He or she will also talk with you about what to expect after the biopsy. You're likely to have some bruising and swelling. There is also a small chance of infection at the site where the needle is inserted.
During the Biopsy
You'll be given a local anesthetic so you're awake but pain-free. The doctor then uses a hollow needle to remove a section of the mass or breast change. More than one sample may be taken. The needle may be inserted more than once.
After the Biopsy
You can go home shortly after the biopsy. You may have a small bandage, but stitches are not likely. A small, freckle-like scar may form at the biopsy site. Be sure to discuss your results with your healthcare provider. In some cases, a biopsy may give a false negative result (cancer cells may exist but not appear in the biopsy sample). If the results aren't clear, you are likely to have another type of biopsy.
Image-Guided Biopsy
If a lump or breast change cannot be felt, an image-guided biopsy is done. In these cases, breast changes are pinpointed with the help of computer mapping guided by mammograms. Breast changes can also be located using sound waves (ultrasound guidance). Once located, the tissue sample may be taken using a core needle. Sometimes a vacuum-assisted probe is used instead. This experience is similar to that of a core needle biopsy. But the probe usually is inserted only once.
When to Call Your Surgeon
Call your surgeon if you have:
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A fever over 101°F (38.3°C)
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Severe pain after the biopsy
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Bloody drainage that lasts for days
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Surgical Biopsy
A surgical biopsy allows a large sample of tissue to be removed. In fact, the whole lump is often taken out. If a breast change is due to microcalcifications (tiny deposits of calcium), tissue containing the calcifications is removed. The lump or tissue sample is then sent to a lab. There, the sample is checked under a microscope. Most surgical biopsies are performed in a hospital or clinic on an outpatient basis.
Before the Biopsy
Tell your surgeon about any medications, vitamins, or herbs you take. This includes aspirin and any other over-the-counter drugs. Some may affect your body's response during the biopsy. Others may affect healing afterward. The day of your biopsy, wear a loose shirt that buttons in front. Also, be sure to arrange for a trusted adult to take you home.
If You Need Wire Localization
Often, a breast change that can't be felt is hard to locate. In such a case, one or more guide wires may be placed in the breast before biopsy surgery. These thin wires help mark the tissue that is to be removed. A mammogram or ultrasound is used to direct the wire's placement. First the breast area is numbed, then the wire is inserted with a needle. After this, you will be taken to the operating room for the biopsy. The wire is removed during this procedure.
Risks and Complications
Risks that may occur with surgical biopsy include:
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Excessive bleeding or bruising
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Infection
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Problems from general anesthesia
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Poor wound healing
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Small change in breast contour
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Swelling due to fluid (seroma)
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During the Biopsy
To keep you from feeling pain during the biopsy, you may be given intravenous sedation. This produces a light sleep. The surgeon then makes one incision in your breast. If possible, this will be done in a way that hides the scar. In most cases, the lump is completely removed. The incision is then closed with stitches. Some stitches dissolve on their own. Others need to be taken out later.
After the Biopsy
You can go home the day of the biopsy. In most cases, you won't be too uncomfortable. But your surgeon may prescribe pain medications just in case you need them. Ice packs can also help ease soreness or swelling. Leave the dressing on as long as your healthcare provider instructs. Also, follow his or her advice about bathing and exercise.
When to Call Your Surgeon
Call your surgeon if you have any of the following:
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A fever over 101°F (38.3°C)
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Increased pain, warmth, or redness at the incision site
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Pus draining from the incision site
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Severe swelling or bloody drainage that doesn't go away in a few days
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Bleeding that soaks through the dressing
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Cough, chest pain, or shortness of breath
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If the Problem Is Benign
Most breast problems aren't serious. Even breast pain is rarely cause for concern. In fact, some benign breast changes need no treatment at all. Others may be helped with simple measures or lifestyle changes.
Fibrocystic Changes
Fibrocystic changes can cause your breasts to feel thicker and more lumpy. They also may be swollen, sore, or tender. Your symptoms may be worse a week or two before your period.
Cysts
Cysts are fluid-filled sacs that can feel like lumps. It's common to have more than one. Cysts tend to become larger and more painful before your period.
Fibroadenoma
A fibroadenoma is a knot of fibrous and mammary gland tissue that feels like a solid lump. It may be tender, or cause no pain at all.
Discharge
It's common to have some clear or milky discharge from one or both nipples. But any bloody discharge should be checked. It may be a sign of a papilloma. This is a benign growth in one of the breast ducts.
Microcalcifications
These are deposits of calcium in one or both breasts. They're not caused by calcium in food or supplements. Most are benign, but certain patterns of calcifications may be a sign of breast cancer. Because of this, you may have further testing.
When Tenderness Is a Problem
Breast tenderness is often related to hormones. But it can have other causes. Mastitis (a breast infection) or an injury to your breast can cause soreness and swelling. If the tenderness is severe or doesn't go away after your period, see your healthcare provider.
Treating Benign Lumps
Lumps that come and go with your menstrual cycle may not need treatment. But you may want to have a painful or growing lump removed. Here are some options:
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The fluid inside a cyst can often be drained with a thin needle. Although the cyst goes away, it may come back later.
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A lump that is solid, large, or painful may be removed. This is a surgical procedure, and it may leave a small scar.
Relieving Symptoms
A few common ways to relieve symptoms are listed below. Your healthcare provider may suggest trying one or more.
Watching Your Diet
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Avoid caffeine. This may help lessen pain.
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Avoid or limit alcohol. This may also reduce your risk of breast cancer.
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Eat a low-fat, high-fiber diet.
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Limit salt to help reduce swelling.
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Ask your healthcare provider whether certain vitamins may help relieve swelling and pain.
Taking Medication
Exercising
Exercise can help regulate hormones and relieve symptoms. Try to get at least 30 minutes of exercise on most days.
Other Tips
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Wear a bra that provides good support, such as a sports bra.
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Use a cold compress to help ease tenderness.
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Use hot compresses if you have an infection such as mastitis. Your doctor may also prescribe antibiotics.
If the Problem Is Cancer
Learning you have breast cancer is never easy. But the outlook today is hopeful. There are new and better treatment options. And you play an active role in choosing your own care. Knowing more about breast cancer can help you make the best choices.
How Cancer Grows and Spreads
Unlike normal cells, cancer cells divide and grow in an uncontrolled way. In time, some of these cells may spread beyond the breast.
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Early (in situ) breast cancer is confined to the ducts of the breast.
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Invasive breast cancer refers to cancer cells that have spread beyond the ducts or lobules. These cells first invade nearby breast tissue.
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Over time, cancer cells may move into the lymph nodes or bloodstream. They can then travel (metastasize) to other parts of the body.
Early breast cancer occurs in the ducts of the breast and has not spread.
Invasive breast cancer has spread beyond the ducts or lobules.
Over time, cancer cells may spread to the lymph nodes or the bloodstream.
Getting the Facts
You are likely to have many questions about your cancer and its treatment. Finding the answers can help you make wise choices. These tips may help:
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Talk to all the members of your treatment team. Your team may include a surgeon, a cancer specialist (oncologist), and a radiation oncologist. Keep a list of questions. Then ask your team for answers during a phone call or office visit.
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Try reading books on breast cancer and checking cancer sites on the Internet. Look for government sites and those sponsored by cancer organizations.
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Consider joining a group for women with breast cancer. Other women can be a great source of information and support. Ask your treatment team about a group near you. Or contact one of the organizations listed below.
Common Treatments
Cancer can be treated in several ways. The best approach depends on your feelings and needs as well as your cancer. Be sure to take time to weigh your options. Common treatments include the following:
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Surgery is used to remove the cancer. Your options include lumpectomy and mastectomy. Lumpectomy spares the breast by removing only the lump. Mastectomy removes the whole breast.
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Chemotherapy uses drugs to destroy cancer cells. These medications travel throughout your body in your bloodstream. You may have chemotherapy before or after surgery, or on its own.
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Radiation therapy focuses x-rays on the breast and sometimes the lymph nodes. It's almost always used after a lumpectomy. This helps destroy any cancer cells that may remain after surgery.
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Hormonal therapy is used to combat cancers that respond to the female hormones estrogen and progesterone. Hormonal therapy may help prevent cancer from returning after surgery. You take it in pill form for at least 5 years.
Breast Health for Life
Now is the best time to start taking care of your breasts. Mammograms, clinical exams, and breast self-exams can help you stay healthy.
Screening Guidelines
A positive plan for breast health includes:
If you're wondering whether to start screening sooner, talk to your healthcare provider.
Resources
The following resources can help you learn more about benign breast lumps and breast cancer:
American Cancer Society
800-227-2345
www.cancer.org
National Cancer Institute
800-422-6237
cis.nci.nih.gov
National Women's Health Information Center
800-994-9662
www.4woman.gov
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