Breast Lumps

Facts every woman should be aware of. 

Breast Self Examination for lumps.

Most women find the task of performing regular breast self examination daunting mainly because of perceived lack of ‘expertise' in breast examination and inability to know what constitutes a ‘lump' and when to seek or when not to seek medical attention. This dilemma can be particularly frustrating for women with ‘lumpy breasts'. However a woman who performs self breast examination on a regular basis over a period of time learns the feel of natural ‘landscape' of her own breast and may find it easier to notice a change when a breast lump develops. Self breast examination is ideally performed about a week after commencement of periods when the breasts are least tender and swollen.

Current recommendations for physical examination of the breast.

The American Cancer Society has updated guidelines for Breast Self examination to reflect the lack of concrete and consistent evidence of the benefit of breast self examination as a method of screening for breast cancer [BSE]. BSE is a way to become familiar with the landscape of the breast and to notice any changes. This approach focuses on the importance of self awareness compared to early detection. Clinical Breast Examination[CBE] meaning breast examination by a physician or trained health professional is recommended once every three years for women between 20 and 39 and annually in women older than 40. It is ideally performed before undergoing a mammogram. BE may pick up some cancers not detected on mammograms.

What comes after finding a breast lump?

Once a breast lump is found the primary care physician generally refers the patient to a Breast Center for Mammographic and Sonographic assessment. The American College of Radiology recommends initial evaluation with sonography for women under the age of 30 years, pregnant and lactating women. In all other women mammography followed by sonography is the standard recommendation.

Several clinical research studies including a prospective one conducted at the Woman's Hospital have shown that the diagnostic accuracy of a combined mammographic and sonographic evaluation approaches 100%, however so as not to miss the rare case of cancer in a woman with negative mammogram and ultrasound close clinical surveillance is still advised with a need for biopsy if the lump enlarges or is considered clinically suspicious.

What is to be expected following imaging assessment.

If a mass is determined to be a fluid filled cyst it can be left alone or may be aspirated. If the breast lump is determined to be a solid tumor, biopsy of the mass will be needed to determine whether the tumor is benign or cancerous. Such biopsy procedures are generally performed by the Radiologist percutaneously under local anesthesia; this is an outpatient procedure and is particularly suited in younger women or for those sold masses that have a high likelihood of being benign. These minimally invasive procedures avoid the need for a woman to undergo unnecessary surgical procedure for a lump that is very likely to be benign. In some cases a solid palpable mass may have to be surgically excised.

About 3-5% of all palpable breast lumps turn out to be cancerous.

However in younger women i.e. those under 30 years of age most of the breast lumps turn out to be prominent ridges of breast tissue or non cancerous abnormalities such as cysts or fibroadenomas, with cancer accounting 0-1% of breast lumps.

Take home points:

Self detection of a breast lump should always prompt a physician consultation

In most cases an ultrasound examination is needed for a complete evaluation of a breast lump.

If the mammogram and sonogram reveal no abnormality, cancer is excluded in about 99% of cases.

References:

Shetty MK et al.Prospective evaluation of the value of negative sonographic and mammographic findings in patients with palpable abnormalities of the breast. J Ultrasound Med. 2002 Nov; 21(11):1211-6.

Saslow D et al.Clinical Breast Examination: Practical Recommendations for Optimizing Performance and Reporting. CA Cancer J Clin 2004; 54; 327-344.

Shetty MK et al.Prospective evaluation of the value of combined mammographic and sonographic assessment in patients with palpable abnormalities of the breast. J Ultrasound Med. 2003 Mar; 22(3):263-8.

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Board-certified radiologists interpreting imaging procedures for women and newborns in Houston, Texas. Imaging interpretation services to inpatients and outpatients, including emergency services, at The Woman's Hospital of Texas.
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