USF-COM Department of Family Medicine

Breast lumps:

What Every Woman Should Know

by Leila Dhana, Class of 1999

• Why should I do Breast Self-Examinations ?
• When should I do Breast Self-Examinations ?
• What if I'm pregnant or breast feeding ?
• What should I look and feel for during BSE ?
• When should I call my health care provider ?
• Diagnosis
• Common Causes
• Treatment
• Website for more information

Why should I do Breast Self-Examinations ?¹

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When should I do Breast Self-Examinations ?

Breast Exam Schedule²

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What if I'm pregnant or breast feeding ?

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What should I look and feel for during BSE ?

• Changes in size or shape
• Changes in nipples
• Changes in skin, dimpling
• Presence of discharge
• Changes and/or swelling under the arm

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Call your health care provider if: ³

• there is any unexplained breast lump! EVERY breast lump should be    checked by the health care provider.
• you are a woman, 20 years or older, unfamiliar with how to perform breast self-examination.
• you are a woman, 40 years or older, with no baseline mammogram.

There are 3 general rules:

1. ALL lumps should be checked three ways--by breast self-examination, by the health care provider, and by mammography.
2. Any new breast lump, particularly if painless and located in one breast, could be cancer until proven otherwise.
3. Many breast lumps need to be biopsied, particularly if the results of mammography do not clearly show the lump to be benign.

What to expect at your health care provider's office:

• A complete history should be obtained, with special attention to factors that increase the patient's risk of breast cancer.
• A thorough breast examination will be performed. If you don't know how to perform breast self-examination, ask your health care provider to teach you the proper method.
• Medical history questions documenting breast lumps include:
• How did you notice the lump?
• What part of the breast is affected?
• How many lump(s) are present?
• Are both breasts affected?
• Has there been an injury to the breast(s)?
• What other symptoms are present?
• Is there fever?
• Is there any breast pain?
• Is there any nipple discharge?

Diagnostic tests that may be performed include:

• cytologic examination of nipple discharge (a study of the types of cells)
• mammography
• needle aspiration or open biopsy of the nodule to see if the fluid indicates a cyst
• thermography (similar to mammography)
• transillumination
• mammography to delineate a breast mass
• ultrasound to detect cancer.
• breast biopsy to confirm or rule out suspected cancer in solid masses:
• needle biopsy involves removal of cells for evaluation directly from the mass (can be done in conjunction with needle aspiration procedure)
• incisional biopsy involves surgical removal of a portion of the mass for evaluation
• excisional biopsy includes surgical removal of entire mass for evaluation

Common causes:

• benign breast tissue changes (fibrocystic breast disease)
• injury to the breast or breast infection (often accompanied by breast pain)
• drug reaction (certain medications can cause the breasts to swell and even leave them lumpy and painful)
• breast cancer (more likely if the lump is painless and present in only one breast, but may be painful)

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Treatment

1. Treatment for known, diagnosed fibrocystic breast changes includes the following:
• Perform a breast self examination monthly
• wear adequate bras for good breast support; and
• avoid caffeine
• The effectiveness of vitamin E, vitamin B6, and herbal preparations such as evening primrose oil are somewhat controversial and should be discussed with your health care provider.
• Oral contraceptives may be prescribed because they often decrease symptoms.
2. For a lump in the breast caused by a benign cyst, see your health care provider who may take a biopsy or aspirate (use a needle and syringe to obtain a sample of fluid) to be sure the cyst is benign.
3. For a lump in the breast caused by an injury, it should clear up eventually without treatment.
4. For a lump in the breast caused by a drug reaction, consult with your health care provider about discontinuing the offending drug. NEVER CHANGE MEDICATIONS WITHOUT CONSULTING YOUR HEALTH CARE PROVIDER.
5. For a lump in the breast caused by cancer, follow the provider's recommendations for appropriate treatment. The choice of initial treatment for biopsy-confirmed breast cancer is based upon the extent of the disease and it aggressiveness. Currently, breast cancer is viewed as a systemic disease that requires both local and systemic treatment.  Most women receive a combination therapy including surgery, radiation, chemotherapy, or hormonal therapy.
• Local treatment may include lumpectomy, mastectomy (partial, total, or radical with axillary dissection) and radiation therapy, all directed at the breast and surrounding tissue.
• Systemic treatment includes chemotherapy and hormonal therapy--both of which circulate throughout the entire body to, hopefully, eliminate cancer cells that may be present in distant parts of the body.
6. Note: Self monitoring of a breast lump may be done in remenopausal women for 1 to 2 months to observe for any cyclical changes associated with the menstrual period. Self care may also include restricting dietary fat to approximately 25% of the total daily calorie intake and eliminating caffeine intake and cigarette smoking to see if symptoms subside.

Where can I find information about breast lumps ?

• RadNet - Breast Self Exam Information (http://radnetmgt.com/patient/mamself.html)
• Kaiser Permanente's Health Reference: Breast Self-Exam (BSE) (http://www.scl.ncal.kaiperm.org/healthinfo/bse/bseschedule.html)
• Welcome to family internet (http://www.familyinternet.com/mhc/top/003155.htm)

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