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You’ve found a breast lump: Now what? (focus on postmenopausal women)

What happens if you find a lump?

If you ever find a lump in your breast, your first step should be to make an appointment with your physician. He or she will do a clinical breast exam to evaluate the lump. Based on that evaluation, the doctor may recommend one or more of the following tests and procedures:

MAMMOGRAPHY, or breast X-ray, may be advised to determine the exact size and location of the lump. This test also can give some indication of whether the lump is cancerous.

ULTRASOUND examination can be used to determine whether the lump is a fluid-filled cyst or a solid mass.

FINE-NEEDLE ASPIRATION is a procedure your doctor can do in the office. Using a thin needle, he or she will draw fluid out of the lump. If the fluid is clear and the cyst disappears, you won’t need a biopsy. However, if the fluid is bloody or if the mass is solid, your doctor will probably recommend biopsy.

STEREOTACTIC BIOPSY is performed with a thin needle that takes a small tissue sample for analysis. Computerized imaging is used to guide the needle with pinpoint accuracy to the exact location to be sampled.

SURGICAL BIOPSY is usually performed on an outpatient basis. The surgeon usually removes the whole lump, but in certain cases—if the lump is very large, for example—he or she will remove only part of it. The tissue is sent to a laboratory where a pathologist will examine it for cancerous cells.

[Note that this version of the article is for women ages 45–70.]

The thought of finding a breast lump is frightening to most women, and understandably so: Most of us know someone who has had breast cancer. For some of us, the fear is so great that we avoid getting regular mammograms—the very habit that could save our lives if breast cancer develops. If you’re in that group, you’ll be glad to hear that four out of five breast lumps investigated turn out to be noncancerous.

But if they’re not cancer, what are they? The most common causes of breast lumps are described below.

1. Cysts are fluid-filled sacs that tend to get bigger—and more sensitive—before a woman’s menstrual period. They can be either soft or firm and almost any size—from a fraction of an inch to nearly the size of a golf ball. They’re typically found in both breasts and appear most often in women between ages 35 and 50, although the odds of developing a cyst increase as menopause approaches. Estrogen replacement therapy can also stimulate the development of cysts in postmenopausal women. Your doctor may use a thin needle to draw the fluid out of a cyst to collapse it. If the fluid is cloudy or colored, or if the lump turns out to be solid, the material may be further analyzed.

2. Intraductal papillomas are tiny lumps that occur in the milk ducts near the nipple. They usually affect women in their 40s and can cause a watery or bloody discharge from the nipple. Intraductal papillomas should be removed to confirm that they aren’t cancer.

3. Traumatic fat necrosis occurs occasionally in older women and in women with very large breasts. This condition can result from a bruise or a blow to the breast. The injury causes the fat in the breast to form round, firm lumps that are sometimes tender.

4. Fibrocystic breast changes are the most common cause of benign (noncancerous) breast lumps. Women with this condition develop one or more solid or fluid-filled lumps. In a small number of cases, the lumps increase in size and tenderness about five days before each menstrual period and shrink again when menstruation ends.

Experts estimate that up to half of all women between ages 35 and 50 develop fibrocystic breast changes. It’s so widespread among the premenopausal population, in fact, that some experts consider it a normal condition rather than a disease. Reducing your caffeine intake may help relieve the symptoms.

Although fibrocystic lumps don’t pose a threat to your health and aren’t considered a risk for cancer, they’re often difficult to distinguish from malignant breast lumps. As a result, they should always be professionally evaluated.

5. Fibroadenomas are most common in women under age 30 and are twice as common in African-American women. These smooth, solid, round masses feel like marbles and move easily. Most doctors recommend removing fibroadenomas, because they won’t go away on their own and may continue to grow. Another reason for removal: It’s the best way for a physician to make certain that the lump is indeed a fibroadenoma and not a malignant mass masquerading as one.

6. Lipomas usually occur in younger women. These painless, fatty lumps are soft and slow-growing. Like cysts, they move freely and vary in size. Although they’re noncancerous, most experts recommend removing a sample of the tissue, if not the entire lump, to confirm that it is a lipoma.

A final word of caution: If you happen to find a lump, don’t use these descriptions to try to diagnose it yourself. There is no substitute for a professional examination by your doctor, and while four out of five breast lumps turn out to be noncancerous, those statistics apply to the female population as a whole. The odds are a bit grimmer for postmenopausal women, whose lumps turn out to be cancerous 50 percent of the time.


© 2014 Dowden Health Media