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What to Do If You Notice A Lump in Your Breast

Thanks to breast cancer awareness campaigns and early education from doctors, women are more in-tune with their breast health than ever before.

Most understand the importance of regular exams, self-checks and mammograms, and keep an eye out for any changes in their tissue density. However, this awareness can also heighten anxiety and uncertainty when changes arise.

“If you think you feel a lump, try not to panic,” said Francesca M. Delach, MD, a fellowship-trained breast oncology surgeon on the medical staffs of Abington Hospital and Abington-Lansdale Hospital. “It’s important not to ignore a new lump, but they are not all cancerous. A lot of commonly found lumps are benign.”

On Breast Tissue and Self-Exams

Self-exams are a woman’s first defense against undiagnosed breast lumps, but patients should remember that breast tissue is strongly affected by the menstrual cycle, and that exams should be performed at the same time each month.

“Breast tissue is hormonally responsive,” said Dr. Delach, “so changes in texture could be due to your cycle.”

For example, many women experience fibrocystic breasts, a condition that makes tissue feel uneven or ropelike, in the days before their period. Those changes may produce a false positive during regular self-checks or make it harder to perceive differences.

What to Do When You Find a Lump

“The first step after discovering a new breast lump is to make an appointment with your OB/GYN or primary care physician to receive a professional breast exam,” said Dr. Delach.

If they also suspect a lump, breast imaging such as an ultrasound or mammogram may be ordered to get a clear look at the mass. If the results of the imaging are abnormal or inconclusive, you may be referred to a breast surgeon for a biopsy or other test.

At the time of these appointments, it’s important to provide a thorough personal and family health history, including details about previous breast biopsies and any surgery you have had in the past.

“Even if a lump appears benign on diagnostic imaging, this is a good opportunity to have your lifetime risk of breast cancer and family history assessed by a breast specialist,” said Dr. Delach. “If you are at a higher risk, your specialist may recommend risk reduction strategies or incorporate a surveillance program to monitor for changes.”

What a Lump Could Be

Breast lumps are sometimes associated with cancer, but they usually take a variety of other, benign forms including:

  • An island of dense or fibrotic breast tissue
  • Simple cysts
  • Fibrocystic change, or dense or ropelike changes from hormonal variations
  • Benign fibroadenomas, which are benign connective tissue tumors that do not have malignant potential, but can grow over time under hormonal influence
  • Lipomas, which are benign fatty tumors that can occur anywhere in the body, including the breast
  • Trauma resulting in a hematoma or bruise, which can also occur after a breast biopsy
  • Infection or mastitis, complicated by the formation of a breast abscess
  • Scar tissue from previous breast surgery

“Benign lumps like simple cysts, benign fibroadenomas and lipomas do not always need to be removed because they do not increase the risk of breast cancer,” said Dr. Delach. “But it is important to know that some cancers or high-risk lesions can mimic the appearance of benign masses when using breast imaging, so a complete work up is recommended.”

How Breast Lumps are Tested and Treated

In many cases, your physician will request increased surveillance to make sure the lump isn’t growing or changing. But if they request a full work-up, there are a few options for testing and immediate treatment.

  • Fine Needle Aspiration is performed by a radiologist or breast specialist in their office. The procedure is most commonly used to drain fluid-filled masses, like cysts, which occasionally cause discomfort. Your doctor may choose to send a fluid sample out for testing if it has an abnormal appearance. If the cyst reappears, your surgeon may consider repeat aspiration or surgery.
  • Image-Guided Core Needle Biopsies are performed in a breast center by a radiologist or breast surgeon under local anesthesia. The procedure involves the insertion of a core needle device through a small incision into the lump. This can be performed using ultrasound, MRI, or stereotactic guidance. The tissue sample is then sent out to be assessed by a pathologist. A very small, non-magnetic, biopsy clip is often placed at the biopsy site for future reference. Your breast surgeon will make recommendations depending on the results.
  • Surgery is often recommended when the biopsy doesn’t yield conclusive results, the mass is symptomatic or the patient is considered high risk. Most excisional biopsies are done as an outpatient operation and they are well-tolerated by patients.

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