Found a Breast Lump: What to Do Next?

Finding a lump in your breast can be scary. Right away you probably fear it is cancer. Breast lumps can be caused by cysts, benign (non-cancerous) tumors, infections, and menstrual cycle changes. Only a small percentage of breast lumps turn out to be cancerous.

Key takeaways:
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    Only a small number of breast lumps are cancer.
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    Most noncancerous breast lumps do not require any treatment.
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    50% of women have dense breasts.
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    Routine screening results in early detection and treatment.

It is recommended that you see your primary care provider (PCP) sooner rather than later.

Should you do a breast self-exam at home?

The American Cancer Society no longer recommends monthly breast self-exams. Dr. Priya Krishnarao at the El Camino Health Women’s Imaging Center in California, USA says that the recommendation for monthly self-exams ended when research showed they did not improve the survival rate. She stressed that women should be familiar with how their breasts look and feel, which makes it easier to recognize any changes.

Types of breast lumps

Breast cancer is caused by a group of breast cells growing very quickly. This unchecked growth can allow the tumor to enter the lymph nodes in the armpit. Once the cancer gets into the lymph nodes, the cancer cells can travel all through the body via the lymphatic system.

There are also several types of noncancerous breast lumps in addition to breast cancer:

Cysts. A cyst is a collection of fluid that usually does not need treatment unless it is large and causes discomfort, in which case it can be drained. Cysts often change with the menstrual cycle.

Fibroadenoma. A common non-cancerous breast lump is called a fibroadenoma. This is a clump of breast tissue that often feels firm and can get bigger over time. It might be tender just before your period. This type of breast lump usually causes no pain and does not require any treatment.

Lumpy breast tissue. Often dense breast tissue or a ridge of breast tissue can feel lumpy. A mammogram is the only way to know if you have dense breast tissue. Dr. Krishnarao says that 50% of women have dense breast tissue.

Fat necrosis in scar tissue. Fat necrosis can develop where breast tissue has been injured, due to a fall, being struck by an object like a ball, a car seatbelt or surgery. It can feel like a firm lump. The injured tissue does not have a good blood supply and the result is an accumulation of an oily fluid. Unless it is a large area there usually is no treatment and it will resolve over time. Large areas can be surgically removed.

Pseudoangiomatous stromal hyperplasia (PASH). The word hyperplasia means an increase in the number of cells. PASH results from an increase in the number of cells of connective tissue and smooth muscle in the breast. Many women don’t know they have these lumps which do not require treatment unless they cause discomfort due to their size.

Seeing your PCP

Your PCP will begin the process of finding out what kind of lump you have. Testing is the only way to know for sure. Your PCP will order a mammogram to examine the lump and a radiologist will interpret the mammogram.

Dense breasts make it difficult for radiologists to see the lump well, therefore women with dense breasts may need additional images of their breasts, especially as these women are six to eight times more likely to get breast cancer.

Types of breast imaging

Breast imaging technology is used for routine screening tests and diagnostic tests when a lump is found. Current breast imaging is done using 2D mammogram, 3D mammogram, ultrasound, breast MRI and ABUS.

2D mammogram is the mammogram that is routinely used. If the mammogram reveals dense breast tissue, other types of imaging can be used. Research has shown that 3D mammograms get fewer false positive results and are better at detecting cancer.

Ultrasound. Women with dense breasts can benefit from ultrasound imaging which can look specifically at an area of concern that was found on a mammogram.

MRI of the breast is not a good screening tool as it can miss suspicious areas that can be found on mammograms. However, MRI can be used to view areas of concern that were identified on mammograms and/or ultrasound.

ABUS, which stands for automated breast ultrasound, was approved by the FDA in 2012 for women who have dense breasts. This type of scan makes a movie from three to five different angles of between 3,000 and 5,000 images. The radiologist can control the speed of the movie and can rewind it to see areas of concern.

The type of imaging you receive will depend on what the radiologist recommends and what is available in your area. After the images have been reviewed you might need a needle or a biopsy of the breast lump to determine what it is made of. The lump might contain fluid as in a cyst, or cancer cells, or be a noncancerous lump.

One in eight women will have breast cancer at some point in their life, and 85% of breast cancers occur in women with no family history and are often related to aging.

Only a small number of breast lumps are cancerous, but women with dense breasts face a greater risk.

Breast cancer is a group of breast cells growing very quickly that can travel all through the body via the lymphatic system. This is why screening is so important. Finding the cancer cells before they have invaded the lymphatic system can significantly improve the rate of survival.

Women are urged to get annual screening mammograms beginning when they turn 40. The radiologist will compare your current mammogram to your previous mammogram to look for changes.

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