BREAST LUMPS AND CYSTS PAGE

I just found a lump in my breast. What should I do?

I have a lump, but my mammogram is normal, so it’s not cancer, right?

I had a routine mammogram and it showed “calcifications”, or a “nodule”. I have been referred to a surgeon. Does this mean I have cancer?

My doctor says I just have a cyst in my breast. What causes cysts? Should I have it removed? Should it be drained with a needle? Will it come back?

I had a cyst drained, and the fluid looked green. Should the fluid be tested for cancer?

My teenage daughter found a lump in her breast. What should we do?

 

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I just found a lump in my breast. What should I do?

Any lump in your breast should be checked by a qualified physician to determine what it is. If you are not sure whether it’s really a “lump”, or not, you may wish to wait through a menstrual period to see if the new finding is still present. But if it is a definite lump, you should not delay.

It is not uncommon for me to see a woman in the office who is not sure whether they are feeling a “lump” or not. Sometimes what they describe as a “lump” feels to me like just some thickening of the breast tissue. Distinguishing between a “lump” and thickened breast tissue is not always easy. We rely a lot on any corresponding findings on mammogram or, particularly, on ultrasound, to guide us. If there is a definite finding on mammogram and/or ultrasound, a biopsy is almost always recommended. If the area feels more like a “thickening” to me, and the mammogram and ultrasound don’t show anything, and these situations, a biopsy may not be necessary.

A new lump may simply be a benign cyst, or it may be the first sign of a breast cancer. So it is important to be examined promptly, to see which you might have. There is no need to remain anxious about whether your lump is cancer or not. In most cases, at DeKalb Surgical, if the biopsy is necessary you can usually be done at your very first visit, with a result in just 1-2 business days.

As noted above, ultrasound is frequently used to evaluate a breast lump, and this is often more helpful than the mammogram, though the mammogram of course is important. At DeKalb Surgical, a biopsy is often done at the time of your very first visit for any well-defined breast lump. We utilized the findings on ultrasound to decide if a biopsy is necessary, and then to guide the biopsy. Here are some examples of what different types of breast lumps may look like on ultrasound.

Here is a typical cyst (also showing a needle tip in it):

Breast1

Here is a typical fibroadenoma, which is a very common finding in teenage girls and young women:

Breast2

Here is an example of what a cancer might look like on ultrasound:

Breast4

If a biopsy is done, it is important to be sure that the biopsy is taken from the right place. The ultrasound visualization makes it very clear that the needle is placed within the lump as you can easily see here:

Breast3

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I have a lump, but my mammogram is normal, so it’s not cancer, right?

You must understand that not all cancer shows up on mammography. Any lump needs to be examined by a qualified physician, whether it shows up on mammography or not. If the lump is not seen on mammography, it may be still need to be biopsied. An ultrasound may be helpful. But the most important thing to remember is that if you have a lump, it should be evaluated promptly, regardless of what the mammogram might show.

I had a routine mammogram and it showed “calcifications”, or a “nodule”. I have been referred to a surgeon. Does this mean I have cancer?

Screening mammograms have become an important method to screen for breast cancer. We have learned that mammograms can often detect the earliest signs of breast cancer, at a point in time when it can not yet be felt. Early breast cancer often shows up as a small cluster of calcifications, which look like a small grouping of tiny white flecks on the mammogram, or as a small nodular area which is more white than the surrounding breast tissue. But, these same abnormalities can be caused by breast changes that are not breast cancer as well. Only about one in six of these abnormalities end up being cancer when they are biopsied. But the only way to be sure is to sample the tissue with some sort of biopsy. This means that most of those who have a biopsy will find out that there is no evidence of cancer.

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BREAST CYSTS

My doctor says I just have a cyst in my breast. What causes cysts? Should I have it removed? Should it be drained with a needle? Will it come back?

Breast cysts are very common. They are frequently quite large, and often a bit tender. They may seem to have popped up overnight, as a very large lump, the size of a grape or larger. Although we don’t know why they occur specifically, it seems they develop as a response to the normal hormone variations that occur through the monthly menstrual cycle. Sometimes they will go away on their own as quickly as they come, but often they remain for some time.

Cysts can be classified as “simple” or “complex”. An ultrasound is especially helpful in evaluating cysts; in fact, if a lump has all the characteristics of a simple cyst on ultrasound, it can be safely “left alone”. But when it can be clearly felt, and doesn’t go away, it may be best to drain it with a needle. This is simple to do, and it can relieve any tenderness. What’s more, there is nothing more reassuring about a new lump in your breast than to make it disappear!

Cysts can come back, but most do not. Some women tend to develop new cysts over and over, and some women develop so many cysts that it seems impossible to try to drain all of them. This situation is challenging, because it makes it hard to decide if there may be a “new” lump hiding in the background of all the cysts. In such cases, it may be best to plan to have your breasts checked by a physician more frequently, perhaps every 3-6 months. Though this is no guarantee of finding any beast cancer early, it should help. Having lots of cysts does not appear to increase your chances of having breast cancer; it just makes it harder to check.

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I had a cyst drained, and the fluid looked green. Should the fluid be tested for cancer?

In years past, doctors routinely sent cyst fluid to be analyzed for cancer. But it turns out that the information obtained is not really helpful in deciding what to do, so most doctors have stopped doing this routinely. There may still be situations in which cyst fluid analysis is helpful. This may include cases in which the fluid is crystal clear, bloody, in cases where the cyst looks unusual on ultrasound, or in a patient who has an especially high risk of cancer.

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My teenage daughter found a lump in her breast. What should we do?

It is very rare for lumps in teenagers to be cancer, but it should still be checked out by a physician. In most cases, it is a benign growth called a fibroadenoma, which is not cancer, and except for rare cases, will not turn into cancer. If left alone, they usually will eventually go away (regress), but this process may take years.

Fibroadenomas usually have very typical features on ultrasound, and they have a very typical rubbery feel, and can be “pushed around” in the breast tissue very easily, so your physician may be quite certain that your lump is a fibroadenoma even without a biopsy. But, a biopsy is very simple to do, using a “fine needle” or a “core biopsy”, so if you or your doctor have any anxiety about it, a biopsy or excision should definitely be done.

Sometimes it may make more sense to just remove the lump rather than do a biopsy. A lump brings with it a certain amount of anxiety even if a biopsy is “benign”. If you feel that leaving the lump in would cause you too much anxiety, even if benign, then you and your doctor may want to skip the biopsy and just remove it.

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