Breast cancer remains to be the most commonly diagnosed cancer among American women. Approximately one in eight women in the United States will develop breast cancer over the course of her lifetime. In fact, it’s estimated that 266,120 women in the U.S. are expected to be diagnosed with breast cancer this year. As we recognize October as breast cancer awareness month, it is vital to shed light on what is and isn’t an early sign of breast cancer, specifically breast lumps.
M. Michele Blackwood, MD, FACS, Chief of Breast Surgery, Rutgers Cancer Institute of New Jersey, Surgeon and Director of Breast Health and Disease Management at RWJBarnabas Health and a member of Barnabas Health Medical Group offers guidance and reassurance for women who find a breast lump.
“The good news is, most lumps are actually not cancer,” said Dr. Blackwood. “The bad news is, if you feel a breast lump you have to investigate it. You must see a doctor or specialists to clinically determine what it is.”
Breast Lumps – Types and Causes
There are four common types of breast lumps: fibroadenoma, a breast cyst, other benign fibrocystic masses and breast cancer.
- A fibroadenoma is a type of benign (non-cancerous) mass that occurs most often in young women
- Breast cysts are benign, soft fluid-filled sacs
- Other benign fibrocystic masses are a benign combination of fibrous mass
- Breast cancer is usually painless and firmer than both cysts and fibroadenomas
A number of things can cause non-cancerous breast lumps, and most are related to your menstrual cycle. Your hormones are fluctuating, and fluid build-up can occur.
If a young woman, who just started to get her period notices a small lump, Dr. Blackwood assures that sometimes a cyst can form because the hormone levels in your body are increasing and your breasts are responding.
If you’re nursing or pregnant, your breasts change dramatically and those changes can be very scary. Again, Dr. Blackwood reassures that the breasts are doing what they are supposed to be doing. “Your breasts are getting ready to be able to nurse a baby so the tubes and ducts in the breasts swell up in order to start producing milk.”
When women are starting menopause, Dr. Blackwood says they might notice a lump. “A cyst often occurs when women are just at the beginning of their menopause because the hormones are still coming and going, and the breast will respond to that fluctuation with a cyst.”
If a woman feels a breast lump, the concern is that there’s no way for her to know exactly what that lump is. “There are some general rules of thumb about identifying the different types of breast lumps, but there’s really no surefire way for a woman to know exactly what it is on her own,” said Dr. Blackwood. “We don’t want women to self-diagnose. We urge women to visit their doctor for some very simple tests that can help us delineate exactly what the lump is.”
Finding a Breast Lump – Next Steps
“The first thing a woman should do is breathe. And try not to panic,” said Dr. Blackwood. “It’s amazing how your mind can race, and you can jump to conclusions, so that’s number one. Patients should never lose sleep over these things, so if a woman feels a breast lump, the next thing she should do is to call her gynecologist or internist and get a very simple test called an ultrasound.”
The ultrasound is an imaging test that uses sound waves to determine whether a lump is solid or it’s fluid-filled.
“If it’s a fibroadenoma or cyst, which is benign, we will just monitor the lump or aspirate it. We don’t even take these out surgically,” said Dr. Blackwood. “However, if it’s a solid lump, there is some additional imaging that will need to get done and we will perform a needle biopsy.”
The next imaging steps might include a mammogram, an additional follow-up ultrasound as well as a needle biopsy.
“A needle biopsy can be done by a radiologist or a surgeon and it’s done with numbing medicine, so for most women it really doesn’t hurt,” said Dr. Blackwood.
The tissue that is removed in the biopsy is then sent to a pathologist for evaluation. If it’s benign, your doctor may recommend a follow-up ultrasound every six months for a couple of years to see if it grows. If it grows, the lump may be removed surgically. However, if it doesn’t grow and it’s not bothering the patient, the surgeon will most likely leave it alone. Alternatively, if the lump shows a papilloma, cancer or any abnormal tissue at all, a breast surgeon would likely perform a lumpectomy to remove the lump. While only a small percentage of breast lumps are breast cancer, if you detect a persistent lump, you should consult your doctor as soon as you can.
Self-Breast Exams
Finding breast cancer early is the main goal of routine breast care, but other benign conditions such as cysts can also be discovered during routine care, including a self-breast exam.
And although the self-breast examine literature has really changed dramatically over the years, Dr. Blackwood says, “There’s no right or wrong way to perform a self-breast exam. I think it can be helpful, but some women do find it to be incredible nerve-wracking because normal breast tissue can feel a little lumpy and bumpy.”
What it comes down to is being aware of your own body. Dr. Blackwood recommends that all women become familiar with what looks and feels normal for their breasts. This can help you notice any changes or anything abnormal more easily.
Changes to your breasts may include:
- A lump, thickening or swelling in or near your breast or under your arm
- A change in the shape or size of your breast
- Nipple problems (bloody discharge, pain, redness, flaking or nipple inversion)
- A leaky fluid or discharge other than breastmilk
- A change in the look of the skin of your breasts, areola or nipple, such as dimpling or puckering or turning red or purple
- A change in the feel of the skin of your breast, areola or nipple, such as turning itchy or scaly
Breast Screening Recommendations
Detecting cancer early gives you the best chance of successful treatment. Screening options for breast cancer include a clinical breast exam, a mammography, an ultrasound or a breast MRI. Mammography is almost always the initial imaging study used for the detection of breast cancer. It offers a potentially lifesaving benefit and it’s relatively easy, but when to start getting mammograms can be confusing.
“The standard of course is a mammogram every year starting at age 40,” said Dr. Blackwood. “But each patient and case are very different. I like to personalize by the patients themselves. We take all of the information we have and help to make the right screening decision.”
Dr. Blackwood prefers to examine the whole patient, including her family history and lifestyle, to arrive at an accurate recommendation for screening. Age, genetics, risk factors and pathology exams are all taken into consideration.
“For example, if a young woman has a mother or aunt or sister who has breast cancer before age 40, then they should start real screening, meaning mammogram, ultrasound, possible MRI, 10 years prior to when that person was diagnosed,” said Dr. Blackwood. “So, if their mom had breast cancer at 35, they need to start regular screenings at 25.”
Women may have gene mutations that leave them at a high risk for breast cancer or may have had multiple biopsies at a young age. These patients may need to start screenings much earlier. Dr. Blackwood urges women to openly talk to their doctors to determine the best approach to breast cancer screening for you.
To schedule a mammogram or for more information, visit www.rwjbh.org/mammo. Let’s beat breast cancer together.