 |
How Are Breast Lumps Evaluated By Physicians?
Whether a breast lump is first detected by a physician during a clinical breast exam or
by the woman herself, the process of evaluation usually begins with a detailed patient
history. The physician will ask the patient specific questions about the lump and her
medical history to help identify the cause of the lump. Sample questions may include:
- How long have you had the lump?
- Does the lump change in size with your menstrual cycle?
- How long has it been since your last menstrual period?
- Have you recently been pregnant or are you breast-feeding?
- Have you experienced discharge from the nipple?
- Do you use hormone replacement therapy?
- Have you experienced any recent trauma to the breast?
- Have you had any previous breast biopsies? If yes, what were the
diagnoses?
- Do you have a history of cancer?
- Do you have a history of other medical conditions?
- Have you had a mammogram or other breast imaging test
before?
These questions can provide important information as to what is causing the lump. For
example, a woman who has recently been pregnant and who is breast-feeding may have a
galactocele (milk-filled cyst). A woman who is taking hormone replacement therapy (HRT)
may have more nodules in her breast due to the therapy. Trauma to the breast may cause a
hematoma (a blood-filled packet), fat necrosis (swelling of fatty breast tissue), or a ruptured cyst
(fluid-filled packet).
Learning the patient’s family and personal medical history can also be helpful. A
family history of breast cancer can increase a woman’s chances of developing breast
cancer herself. A personal history of non-cancerous conditions such as atypical hyperplasia (an abnormal increase in breast cells)
or lobular carcinoma in situ (LCIS) can also increase the risk of
breast cancer.
Once a thorough patient history is taken, the physician will perform a thorough clinical breast exam to investigate the lump and other
areas of the breast and axilla (armpit). In addition to feeling for breast masses, the
physician will check for any skin dimpling, nipple retraction, or other visual changes.
The clinical breast exam typically lasts several minutes and the patient will usually need
to raise her arms, place her hands on her hips and exert pressure, and lie down during the
exam so the breasts can be examined from different angles.
After the clinical breast exam, the evaluation of a breast lump will differ depending
on the woman’s age, history, and characteristics of the lump. The following
descriptions provide information on how women in different age groups are typically
evaluated:
- Women age 30 or older: A diagnostic mammogram is
usually ordered. A diagnostic mammogram differs from the routine screening
mammogram in that it involves additional x-ray views from different angles and/or
special magnification. A diagnostic mammogram is used instead of a screening mammogram
when a breast abnormality is present. Depending on the results of the mammogram,
additional breast imaging (such as ultrasound) may be
ordered. In many cases, further breast imaging will be ordered even if a mammogram does
not show a suspicious abnormality. This is because a small percentage of breast cancers
can be missed with mammography. Depending on the results of the mammogram and additional
imaging tests, a breast biopsy may be performed. A biopsy involves
removing a sample of breast tissue and examining it under a microscope to determine
whether cancer cells are present. Sometimes, a biopsy (or fine
needle aspiration—sampling of a few breast cells) will be performed even if
breast imaging tests are normal. This usually happens when the physician suspects that the
breast lump is suspicious regardless of the results of the imaging tests.
- Women under age 30: In this group of women, a mammogram may or may not be the first
test ordered. This is because mammography is not always beneficial in younger women who
tend to have dense breast tissue which can mask breast cancer and other abnormalities on a
mammogram film. In some cases, ultrasound or other tests may be performed. However,
mammography can still be beneficial in some women younger than 30. If the breast imaging
tests reveal a suspicious abnormality, a biopsy may be ordered to examine a sample of
breast tissue. As with women over age 30, a biopsy (or fine needle
aspiration—sampling a few breast cells) may be performed even if breast imaging tests
are normal. Again, this usually happens when the physician suspects that the breast lump
is suspicious regardless of the results of the imaging tests.
In approximately 80% of cases, breast lumps are benign (non-cancerous). Benign
conditions that can cause breast lumps include:
- Fibrocystic breasts
- Cysts
- Fibroadenomas
- Papillomas
- Phyllodes tumors (usually benign)
- Galactoceles
- Granular cell tumors
- Duct ectasia
- Fat necrosis
 Click here
to learn more about these benign conditions.
If a biopsy reveals breast cancer, then the woman and her cancer
team will discuss treatment options. Treatment options include surgery (lumpectomy or mastectomy), radiation, chemotherapy, and/or
other drug therapies, such as tamoxifen.
Practicing monthly breast self exams, receiving regular clinical breast exams, and yearly
screening mammograms (the latter beginning at age 40) can help detect breast cancer early
when the chances of successful treatment and survival are the greatest.
Click here
to learn more about treating breast cancer.
Breast Lumps During Pregnancy
Breast cancer during pregnancy can be difficult to diagnose
because the breasts naturally undergo several changes. During pregnancy, the breasts
increase in size and become more tender, especially during the first half of pregnancy.
The most rapid period of breast growth is during the first eight weeks of pregnancy. As
the pregnancy progresses, the breasts become firmer and more nodular to prepare for lactation (breast-feeding). It is very important for women to
continue to perform monthly breast self-exams during pregnancy and
receive monthly physician-performed clinical breast exams
so as not to delay the possible diagnosis of breast cancer.
As in non-pregnant women, the majority of breast lumps found during pregnancy are
benign (non-cancerous). However, because a lump can signal breast cancer, all persistent
lumps should be evaluated by a physician. Approximately one in 3,000 (0.03%) to one in 10,000 (0.01%) women are
diagnosed with breast cancer during pregnancy. Breast cancer itself does not appear to
harm a fetus.
If a lump is detected during pregnancy, an ultrasound exam
and/or mammogram will typically be performed. Ultrasound is
excellent at distinguishing cysts (packets of fluid) and is routinely used for fetal
imaging because it does not harm the fetus. Mammography is also considered safe for
pregnant women and the fetus because it uses a very low dose of radiation. In many cases, a biopsy will be performed if a suspicious breast lump is
detected in a pregnant woman. A biopsy confirms or denies the presence of breast cancer.
Non-cancerous conditions that are common during pregnancy include:
- Cysts (collections of fluid)
- Galactoceles (milk-filled cysts)
- Fibroadenomas (tumors; existing ones may enlarge during pregnancy)
If breast cancer is detected during pregnancy, it is not necessary to terminate the
pregnancy. Treatment options should be discussed with the patient’s cancer team.
Surgery, such as lumpectomy and mastectomy,
can be performed safely during pregnancy. Radiation, chemotherapy, and drug therapies (such as tamoxifen) are usually delayed until after childbirth.
Click here
to learn more about pregnancy and breast cancer.
Additional Resources and References
Updated: May 4, 2008
< Prev | 1 | 2
Click here to learn how to perform breast self-exam
Return to the Breast
Health Main Menu |
