All Breasts Are Lumpy...
Randy A. Birken, M.D.

"Eighty percent of all breast lumps turn out to be benign." Even more encouraging. What really matters -- when it comes right down to it -- is that you discover a suspicious lump if you have one. 

Far too many women -- for whatever reason -- do not regularly inspect their breasts at all. Perhaps avoiding the simple breast self exam (BSE) allows them to maintain the comfortable denial that anything could be wrong.

According to the Susan G. Komen Breast Cancer Foundation, in 1999 over 175,000 women will be diagnosed with breast cancer -- that’s one woman every three minutes -- which makes this the most common form of cancer in women of all ages. And, although often overlooked, 1,300 men will also be diagnosed with breast cancer this year.

Some women are more at risk than others: those with a mother or sister with the disease, childless women, women who have their first pregnancy after age 30, and have either early onset of menstruation or late menopause.

Experts report that more than half of all women discover a lump themselves or have a "questionable" mammogram result at some time in their lives. Only twenty percent of these breast anomalies turn out to be malignant.

Breast "geography" changes and may feel differently at different times of the month. A woman's hormones can also cause breast tissue to fill with water, making them feel tender as well as lumpy. 

Lumps tied to hormonal cycles are sometimes called "fibrocystic disease," although some argue that is only a convenient term used to group all breast conditions that aren't cancer. For many women, being diagnosed with any disease other than cancer is the branch of hope they cling to.

The important thing is to learn to distinguish the difference between what is normal and what is not. The only way to do this is to perform monthly breast self exams and have anything unusual checked out. Ideally, breast self exams should be performed at the same time each month -- avoiding examinations in between -- to really get a good "map" of your breasts. Some women find it is helpful to draw a diagram of their breasts and indicate the location of any lumps they want to track.

In women between age 30 and 50, smooth, round, soft and somewhat moveable lumps are very often fluid-filled pockets called cysts. They can be tiny or larger than a golf ball, but they are usually harmless. The best way to find out is to have a fine needle aspiration to find out if the contents of the cyst are fluid or solid, and to have the cells analyzed.

There are other types of benign breast tumors that are sometimes removed to prevent them from hiding a malignancy in the future. And then, sometimes that lump is cancer.

Unlike benign lumps -- which can feel like grapes you can push around, or feel like they are surrounded by a capsule -- cancerous lumps are most often hard and irregular to the touch and usually can't be moved. 

Finding a lump is an unsettling, subjective experience, and sometimes words are inadequate when it comes to describing "how" something feels. If you feel something different while performing BSE, think very carefully about where it is and what it feels like. Is there a matching "lump" in the other breast? Is it soft or hard, moveable, or painful? Does your breast look different? Any color changes or dimpling? How about the shape and symmetry? Do any visible changes occur when you raise your arms over your head?

Resist the temptation to dismiss any lump as unimportant. Try to be realistic -- are there changes that don’t go away in a month? Is the area becoming harder or larger? Is the lump immobile and in only one breast?

Whatever shape or texture the lump may be, if it doesn't go away after your next menstrual cycle, have it checked out by your doctor, who may recommend an ultrasound, mammogram, or fine needle aspiration based on your own medical history, age and risk factors.

Before ordering additional tests, your doctor will want some pertinent information, including: the date you found it; the exact location of the lump (mark it in permanent ink if it is difficult to find); what was the lump like when you found it and has it changed; describe how it feels as best you can; and provide information about your family history and your own personal breast history, if you have one. 

Our patients tell us that waiting for the results of the diagnostic tests is one of the most difficult thing they ever have to do. I think that most doctors understand that today, and we try to minimize this natural anxiety by getting the results to you as promptly as possible. 

Depending upon the results, a biopsy may be indicated which, in some cases, can be performed in the doctor’s office. Remember, 80 percent of the lumps prove to be benign, so a biopsy does not automatically lead to surgery. In fact, nothing is "automatic;" possible treatment options and alternatives will be thoroughly discussed along with the results of the biopsy. 

Again, if you do find a lump, don't just worry about it; get it checked. Here are some facts to consider:

n Only about 5 to 10 percent of women with breast cancer have the hereditary kind; that means that 90 to 95 percent of breast cancer does NOT run in families.

n When a malignant lump is discovered early enough -- when the cancer is confined to the breast -- the 5-year survival rate is better than 95 percent.

n More than three-fourths of all women with breast cancer are over 50, and 50 percent of all breast cancer occurs in women over 65. That doesn’t mean breast cancer cannot occur in younger women -- it can and it does. It’s just that the majority of breast cancer patients are over 50. 

There are many new successful treatment options for breast cancer today. When that is the outcome of the diagnostic tests, we urge our patients to learn as much as possible about the disease, and to become an active partner with their physicians and specialists in making the important treatment decisions along the way.
 

Reprinted from yourfamilyshealth.com