As unsettling as finding a lump can be, women need to keep in mind that 75 to 80% of lumps turn out to be harmless.
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In the story of the princess and the pea, a single pea buried under 17 mattresses torments the princess, destroying her sleep and peace of mind. A breast lump may be smaller than a pea yet it can turn a woman’s world on end, flooding her mind with uncertainty and fears of breast cancer.
More than 1.4 million breast biopsies are performed on American women each year, almost all because of suspicious findings on mammograms or lumps found by women or their doctors during breast exams. As unsettling as finding a lump can be, women need to keep in mind that 75 to 80 percent of all lumps turn out to be harmless.
With more women undergoing mammography on a regular basis the number of false-positive readings has increased. Follow-up on these readings has resulted in an increase in the number of biopsies that turn out to be negative.
Despite the fact that most lumps will turn out to be harmless, when a woman finds a new lump it’s essential to have it checked out by her physician. Any new lump that can be felt or a new area that shows up on a mammogram needs to be evaluated so cancer can be ruled out.
There are a number of options for assessing lumps with varying degrees of invasiveness and accuracy. Options range from watchful waiting with a follow-up mammogram in either three or six months, needle aspiration and surgical biopsy.
Watchful waiting with a follow-up mammogram may be an option when a lump has a low level of suspicion, and the woman is comfortable with that decision. Many women may find that waiting without a definitive answer for a period of months is simply too stressful.
Before any type of biopsy is performed, it’s important to use any available noninvasive method for ruling out cancer. Ultrasound is widely available and is often capable of identifying a harmless lump. When the results of ultrasound are inconclusive, a biopsy is needed.
The least invasive method of sampling breast tissue is with either fine or blunt needle biopsy. Either ultrasound or stereotactic imaging can be used to guide the needle to the site of the mass or lesion ensuring that the tissue sample is drawn from the area in question.
Fine needle biopsy can be done in a doctor’s office and gives results quickly, often the same or the next day. Because the needle is fine, only a sample of cells is removed for testing and there is no scarring. A fine needle biopsy is often able to distinguish a fluid-filled cyst from a more solid mass.
A core needle biopsy can be performed as an outpatient procedure and has an accuracy rate of 95 percent. A thicker, hollow needle is used to withdraw a tissue sample about the size of a grain of rice from the suspicious area.
A surgical biopsy involves cutting a sample of tissue from the abnormal area of the breast. Surgical biopsies can be performed in either a hospital or outpatient clinic and might be done with sedation and a local anesthetic or with a full anesthetic.
The surgical biopsy yields a larger tissue sample for analysis. Rather than having only a sample of a suspicious lump removed, some patients may opt to have the entire lump and a margin of tissue removed, a procedure known as a lumpectomy. If a tissue sample from a lump is positive for cancer, a lumpectomy is one of the possible treatment options. In the event that cancer cells are present, further surgery may not be necessary.
Many women have lumpy breasts, the result of fibroid growth that is common and harmless. Fibrocystic changes affect about half of all women between the ages of 20 and 50 and are often tied to the menstrual cycle. Breasts may be painful and can have lumpy, rubbery areas that seem to move and are tender to the touch. Cysts can also occur in clusters.
Fibroadenomas are smooth, rubbery lumps that occur in about 10 percent of women, most often in their 20s and 30s. The lumps are believed to be benign or harmless but need to be checked out, usually with ultrasound or fine needle aspiration. Some will disappear spontaneously over a period of months but if they are painful or become larger they may need to be biopsied.
Women have good reason to be concerned about breast cancer, but it’s important to maintain a healthy perspective. If you find a lump make an appointment with your doctor to have it checked out. And although it may be impossible to put it out of your mind, like the pea under the pile of mattresses, be reassured by the fact that the odds are greatly in your favor with 80 percent of lumps diagnosed as benign.
New Ways To Screen
Lumps in Future
Researchers at Valley Diagnostic Imaging in Bethlehem, Pennsylvania have developed a new magnetic resonance imaging (MRI) method that they say allows them to evaluate suspicious lumps and lesions discovered on mammography without the need for invasive procedures such as biopsy.
The study involved 59 women with mammogram findings requiring biopsies. The women were evaluated using noninvasive MRI, then underwent biopsies in the following weeks. The MRI technique was found to be 95 percent accurate in its ability to distinguish benign and malignant lesions.
Additional and large-scale studies will be necessary to confirm the value of this new MRI sequencing technique, but it does hold the hope that in the future women may be spared many of the breast biopsy procedures made necessary by suspicious mammogram results.
[SOURCE: “New Method of Magnetic Resonance Imaging Distinguishes Benign from Malignant Lesions,” Women’s Health Weekly, August 23, 2001]
Follow-up for Breast Biopsy
Women who undergo a breast biopsy to evaluate a suspicious lesion and are given the all clear need to return for a follow-up assessment, usually after six months.
False negatives occur in one percent of cases, so follow-up is important for this group of women.
[SOURCE: “Follow-up After Breast Biopsy,” Family Practice News, April 1, 2001.]
Breast Lumps Are Common
If you’ve ever found a breast lump you can take comfort in the fact that you’re not alone. According to the National Cancer Institute, 50 percent of women in the United States will develop a noticeable breast lump at some time in their lives. Most of these lumps will be harmless.
Fibrocystic breast disease, a condition affecting one third of all women, is a major cause of breast lumps. Fibrocystic changes are caused by monthly hormone fluctuations that lead to the formation of fluid-filled cysts.
Fibroadenomas, benign tumors and growths inside ducts (intraductal papillomas) are other conditions that cause lumps but are not a sign of cancer.
If you discover a new mass or lump in your breast have it checked by your doctor but be reassured by the knowledge that the vast majority of breast lumps are benign.
[SOURCE: “What Women Should Know About Breast Lumps“ Body Bulletin, February 2000]
Oral Contraceptives
and Breast Cancer
Women can be reassured by the results of a recent study showing that use of oral contraceptives does not increase a woman’s risk of breast cancer.
Researchers interviewed 4,575 women with breast cancer and 4,682 women in a control group from five cities in the United States. Of those interviewed, 65 percent of women were white and 35 percent were black. The interviews showed that women who had ever used oral contraceptives were no more likely to develop breast cancer than women who had never used oral contraceptives. The risk was comparable for white and black women.
[SOURCE: P. A. Marchbanks et al, “Oral Contraceptives and the Risk of Breast Cancer,” New England Journal of Medicine, June 27, 2002]
Triple Test Highly Accurate A study evaluating the accuracy of three diagnostic tools–physical examination, mammography and fine needle aspiration–found that when all three were in agreement, there was a high level of accuracy.
The study followed 46 women with breast abnormalities that could be felt. The triple test of physical exam, mammography and fine needle aspiration was followed up with open biopsy. Results showed that when all three elements suggested that a lump was either benign or malignant, the findings were confirmed as 100 percent accurate by the biopsy. When findings were not in agreement, fine needle aspiration was the most reliable indicator.
[SOURCE: James Fiorica et al, “Benign Breast Disorders: First Rule Out Cancer,” Patient Care, April 15, 1997]
Regular Mammograms
Offer Helpful Comparison
Because the appearance of breast tissue is relatively stable over time, radiologists rely on previous mammograms to evaluate suspicious areas. Being able to compare a suspicious area with a previous mammogram may resolve the problem without the need for a follow-up biopsy.
When women relocate or change physicians, they should ask for any prior mammogram films or have them forwarded to the radiation facility they will be using in the future.
[SOURCE: Olive J. Peart, “The Importance of Follow-up Views in Mammography,” Radiologic Technology, July 2000]
REFERENCES:
Harold Abella, “Optics Offer Alternatives for Breast Cancer Diagnosis,” Diagnostic Imaging, June 1, 2002.
“Advanced Imaging Technologies Receives FDA Clearance for Breast Biopsy Capability,” Medical Devices and Surgical Technology Week, July 14, 2002.
Phyllis G. Cooper, “Breast Biopsy,” Clinical Reference Systems, Annual 2001.
James Fiorica et al, “Benign Breast Disorders: First Rule Out Cancer,” Patient Care, April 15, 1997.
“Follow-Up After Breast Biopsy,” Family Practice News,” April 1, 2001.
“New Methods of Magnetic Resonance Imaging Distinguishes Benign from Malignant Breast Lesions,” Women’s Health Weekly, August 23, 2001.
Merlina Trevino, “Fine-Needle Aspiration and Core Biopsy Need Fine-Tuning,” Diagnostic Imaging, June 1, 2002.
Ellen S. Weber, “Breast Biopsy,” Gale Encyclopedia of Medicine, 1999ed.
