When you find a lump in your breast or a mammogram shows something suspicious, it's normal to think of breast cancer and to worry. While breast cancer is a very serious illness, it helps to know that many women get lumps in their breasts over their lifetime and that most lumps are not cancerous. Even for breast lumps that require a biopsy, more than 80 percent prove to be benign (non-cancerous). Still, it's important to see your doctor right away if you detect anything unusual.
WHAT CAUSES BREAST LUMPS?
There are many causes for breast lumps other than cancer. Menstrual cycles or pregnancy may cause women to notice changes such as swelling and lumpiness. In other instances, some women may have breasts which often feel a bit lumpy or "granular." This condition is sometimes attributed to "fibrocystic changes" or even "benign breast disease." Other non-cancerous breast lumps may be caused by cysts, which are fluid-filled sacs, or formed by fat or other breast tissue.
HOW IS A BREAST LUMP DETECTED?
There are a number of ways a breast lump is discovered. Many lumps are found by women themselves, who find a lump through a breast self-examination (BSE), or when dressing or bathing. Sometimes it's a partner who discovers something "different." When you know how your body normally feels, it's easier to notice when something is not quite right. Breast self-examination is highly recommended as a method of getting to know the normal feel of your breasts, so you can tell when there are changes. Medical experts recommend that all women perform a BSE once a month. For women who are still menstruating, the best time to perform a BSE is within the first ten days after the start of a menstrual period.
Clinical Breast Exam
A lump may also be found in a routine exam by a medical professional, called a clinical breast examination. Women should have a clinical breast exam every year as part of their regular preventive health regimen. It's especially important for women over 50, who are at higher risk for breast cancer.
Ultrasound, another imaging technique, is a painless process which uses high-frequency sound waves to find and examine lumps. The pattern of echoes from these sound waves is converted into an image (also called a sonogram) of the breast's interior, which is then displayed on a video screen. An ultrasound is especially good for distinguishing between a fluid filled cyst or a solid mass in the breast.
Researchers are studying other techniques, such as MRI and CT scan, to detect breast abnormalities earlier than conventional mammograms by possibly producing better images of breast tissue. They are also studying tumor markers - substances that can be detected in blood or urine tests before a tumor forms.
Imaging techniques, such as digital mammograms, can discover suspicious areas in breast tissue, often before a breast lump can even be felt. Mammograms are special X-rays of the breasts. A mammogram involves two or more images of each breast, from horizontal and vertical angles. For each image, the breast is placed between two plastic plates, gently squeezed as flat as possible, and then X-rayed. Although some women find this uncomfortable, each X-ray only takes a few seconds. These X-rays use only a very small amount of radiation that presents little or no risk.
Mammograms are very important, but they are not perfect. Breasts of younger women contain many glands and ligaments. Because their breast tissue appears dense on mammograms, it is often difficult to detect small tumors or to distinguish between normal and abnormal breast conditions. Also, since mammograms only look at breast tissue that is between the plates, abnormalities in other areas of the chest will not be detected. Your doctor may want to do other tests even if your mammogram doesn't show anything suspicious. If you get a normal mammogram but still feel something is wrong with your breast, discuss your concerns with your doctor. You may want to ask about a second opinion or another mammogram.
WHEN SHOULD A WOMAN HAVE A MAMMOGRAM?
While there is a lack of consensus within the medical community regarding the age at which to begin screening, medical experts do agree and recommend that women over the age of 50 receive a routine mammogram every year.
For all women who have undergone a breast biopsy or have been diagnosed with breast cancer, it Is important that they discuss their personal risk factors and diagnosis with their doctor in order to determine an ongoing care plan including mammography screening.
WHAT IS A BIOPSY?
If you do discover a lump or something "different," the first step should always be to call your doctor, who will do a careful examination. In many cases, your doctor will want you to have a biopsy.
A biopsy is a procedure performed by a surgeon or other specialist in which a part or all of a lump is removed for testing. A pathologist then looks at the cells under a microscope to determine if the tissue is cancerous.
There are two types of biopsies: needle and surgical. The type of biopsy performed depends on the size and location of the lump and what the mammogram shows, as well as your health history and risk of breast cancer. Before you schedule your biopsy, you'll want to ask your doctor what kind of biopsy is planned, how much tissue will be removed, and what your breast will look like after the procedure.
Needle biopsies take a small amount of tissue and result in the least amount of scarring. These biopsies are performed with a local anesthetic and don't require a hospital stay, although you may have some discomfort and bruising after the procedure. Since more than 80 percent of lumps turn out to be benign, many women and their doctors opt for a needle biopsy procedure. However, you may need more tests or biopsies if the fluid or tissue shows cancer cells or if the lump doesn't go away. There are three kinds of needle biopsies: fine needle aspiration, needle core biopsy, and stereotactic needle biopsy, each of which requires that the tissue specimen be sent to the pathology lab for analysis.
Fine needle aspiration: A thin needle is guided into the lump to remove fluid from a cyst or clusters of cells from a solid mass. This procedure usually leaves no scar. 0 Needle core biopsy: A thicker needle is used to remove a small piece of tissue from the lump. This technique is used when the lump appears solid. It usually leaves a barely noticeable scar.
Stereotactic needle biopsy: When the lump can't be felt but can be seen on an X-ray, the spot to be biopsied might be pinpointed by using two mammograms taken at different angles. A woman lies on her stomach on a special table that has an opening for her breast, and a technician uses the mammograms and a computer to guide a needle to the lump for the biopsy. Ultrasound imaging can also be used to show the lump. Either a fine needle aspiration or a needle core biopsy might be used in this procedure.
You and your doctor may decide it's best to examine more breast tissue or to remove all of the lump. There are two kinds of surgical biopsies: incisional and excisional, both of which are performed by a surgeon under local anesthesia but do not require an overnight hospital stay.
Incisional biopsy: A small section of suspicious tissue is removed for microscopic examination.
Excisional biopsy: All of the lump or suspicious tissue is removed for microscopic examination.
If the lump can be seen on a mammogram but cannot be felt, your doctor might use a needle localization biopsy technique to locate the breast abnormality. Using a mammogram or ultrasound to locate the lump, the doctor inserts a fine needle or thin wire into the suspicious area to mark its location. The tissue is then removed with a surgical biopsy.
If the pathologist finds that the biopsy tissue is cancerous, an estrogen and progesterone receptor test can be performed. Using the breast tissue taken at the time of the biopsy, the pathologist can determine if the cancer cells are using the female hormones, estrogen and progesterone, to grow. In that case, you and your doctor may want to consider hormonal therapy to keep cancer cells from getting the hormones they need to grow.
WHAT ARE THE NEXT STEPS AFTER RECEIVING BIOPSY RESULTS?
When your biopsy results are normal, it's a relief to know that you don't have cancer. However, that's not a signal to relax about regular checkups. It's important to keep up your monthly BSE, in addition to scheduling an annual clinical breast exam and mammogram.
If your biopsy results show that the breast tissue is cancerous, there are many options for treatment. Knowing as much as possible about the type, size, and location of the cancerous tissue will help determine which treatment is right for you. If you have any questions or concerns about your test results or treatment options, or would like to get a second opinion, be sure to talk to your doctor.
Most importantly, try to keep a positive attitude. Although breast cancer is a serious disease, the survival rate is more than 97 percent when it is diagnosed and treated in its early stages.'
WHO IS AT RISK FOR BREAST CANCER?
No one is sure why some women get breast cancer and other women don't. There seem to be many factors, and almost all of them are beyond your control. However, the risk does seem to be greater for those who:
- have had breast cancer before, or whose mother or sister has had breast cancer
- are age 50 or older
- had an early first period (before age 12) or late menopause (after age 55)
- gave birth after age 30 or have had no children.
Risk is also age-related; the longer you live, the greater your risk for any kind of cancer. If you have questions or concerns about your own personal risk, talk with your doctor.
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