by Marcelle Pick, OB/GYN NP
First take a deep breath and keep breathing. Most women seem to find a breast lump just by chance or something draws them to it — an itch, a pull or a pain. The point of doing breast self exams is to know what is normal so that when you feel a “lump” – you will know it is different. Most women and doctors can find many normal or benign lumps in breasts. I’ve found that most breasts are lumpier than not lumpy. It is a rare woman whose breasts are lump-free. However most of these “lumps” are normal fatty, fibrous, cystic breast tissue.
I encourage women to get to know their breasts — they should feel comfortable touching themselves all over. I do not think there should be a strict way to examine your breasts. A woman should just feel good about knowing her breasts and realize that at different times of the month they may be lumpier than other times. Usually the week before one’s period they get more swollen, tender and lumpier and the week after they are less.
However if you do find something that feels different, after breathing, and remembering where you are in your cycle, I recommend making an appointment with your provider as soon as possible. Most practices try to accommodate women quickly. Some women are comfortable waiting through a cycle and seeing if the lump goes away or gets smaller — cancers won’t. Women should be able to obtain an ultrasound of the lump also in a timely fashion. An ultrasound will be able to tell if the lump is a fluid filled cyst, something solid, or more likely breast tissue. A mammogram may also be helpful if one hasn’t had one recently. Mammograms are less useful in younger women, less than 35 or 40 years old. I would not rely on a mammogram only however. I have seen too many women who present with breast cancer after having been told their mammograms were normal.
If the ultrasound is solid or questionable, a woman should be seen by a provider who specializes in breast problems. He or she can then decide if the lump should be tested with a tissue sample. This can be done usually at the same visit with a fine needle aspirate or a core needle aspirate. These tests done in experienced hands are quite accurate. I personally have not seen needles tract or spread cancer except in rare cases of a rare type of breast cancer called colloid cancer.
Results of these tests should be available in 24 to 48 hours. Women should not be subjected to unnecessary delays. All breast lumps do not have to be surgically excised. The decision to remove a breast lump should be made with as much information as possible, i.e. ultrasound, mammogram, a woman’s and her doctor’s input. If a woman wants a breast lump removed this wish should be respected.
Likewise no woman should be rushed into having a lump removed if she isn’t comfortable with that decision- she has the time to contemplate it or get a second or third opinion.
- Breathe and breathe again
- Find a support person
- Ask questions
- Sleep on any decision