Finding a lump in your breast can be frightening, but they’re not always cause for panic.
According to Dr. Jesse Casaubon, a Breast Surgical Oncologist at Baystate Health, “While breast cancer is the second-most common cancer found in women, most breast lumps are NOT cancerous.” However, he adds, “if you find something out of the ordinary, by all means, get it checked.”
What Do Breast Lumps Feel Like?
Like breasts, breast lumps come in all shapes and sizes. “Sometimes they’re round, sometimes they’re irregularly shaped. They can be the size of a pea or larger. Sometimes they move a bit and sometimes they’re fixed in place,” says Casaubon. “The one consistent thing about breast lumps is they feel different than normal breast tissue. Anything that feels out of the ordinary—firm, hard, or just solid—is noteworthy.”
What Causes Breast Lumps?
Breast lumps can appear for a variety of reasons at different ages and stages of a woman’s life.
Casaubon notes that breast lumps are often related to hormone levels. “It’s not uncommon for lumps to come and go with menstrual cycles or for them to occur in relationship to pregnancy or breastfeeding.”
Possible causes include:
- Breast cysts (soft, fluid-filled sacs)
- Milk cysts (sacs filled with milk that can occur during breastfeeding)
- Lipomas (a slow-growing, noncancerous, fatty lump)
- Fibrocystic breasts (lumpy or rope-like tissue sometimes accompanied by pain)
- Fibroadenomas (noncancerous rubbery lumps most often occurring in young women)
- Non-cancerous tumors that may still need to be removed
- Breast cancer
How to Prepare for a Breast Evaluation
Given the number of possible causes of breast lumps, a key part of any evaluation is fact-finding.
“Asking questions is helpful in eliminating and narrowing down potential causes,” says Casaubon. “It’s important to be prepared to discuss the specific mass including when you first noticed it and whether it has changed in that time period. It’s also important to review your personal and family history of breast-related issues, including cancer.”
Be prepared to discuss the following questions:
- How long has the mass been there?
- Has it changed at all in that time?
- Have you noticed any nipple discharge?
- Has the appearance of the skin changed in any way?
- Is there just one or multiple areas of concern?
- Have you had previous issues with your breasts (cancer, fibroadenoma, etc.)?
- Is there a family history of breast issues, including cancer?
- Is there a family history of ovarian cancer?
In addition, your provider will examine both breasts and your lymph nodes.
“A physical exam provides additional information that helps us better understand the characteristics and thus, the possible cause of the mass,” says Casaubon. “For example, redness, swelling, and a collection of fluid suggest an infection. The exam is extremely important as it will steer us in one direction while other clues may send us a different direction in terms of what tests to conduct.”
How is a Breast Lump Diagnosed?
Casaubon says that information and physical exams only tell part of the story, which is why imaging is so important.
“Imaging provides an inside look at what’s occurring in the breast,” he says. “For example, a mammogram provides multiple views of the breast and reveals any abnormalities in the tissue. In some cases, we’ll also perform an ultrasound which can reveal whether a lump is solid or filled with fluid. Again, we’re just trying to get more of the story about what’s going on in the breast.”
When Do You Need a Breast Biopsy?
If, after the physical exam and imaging, a doctor is not certain a breast lump is non-cancerous, a needle biopsy will be recommended.
“The biopsy allows us to extract a bit of tissue from the mass with a small needle and analyze it in the lab,” says Casaubon. “It provides the definitive answer to whether or not a lump is benign (non-cancerous) or not.”
A biopsy is performed by first numbing the area where the tissue will be extracted with an injected medication. A second needle is then inserted into the concerning area to draw out the tissue. “Though there are needles involved, we really do everything we can to make patients as comfortable as possible as we know this can be an anxiety provoking procedure,” says Casaubon.
The good news, according to the National Breast Cancer Foundation, is that 80% of women who have a breast biopsy do not have breast cancer.
“If You Feel Something, Say Something.”
Casaubon urges all women to not dismiss changes in their breasts. “If you feel something, say something.” Learn how to do a breast self-exam.
He adds, “Last year, Baystate Health Breast Specialist performed 10,000 diagnostic breast images in response to unusual mammograms and the identification of a lump by a patient. Of those, only 1,500 ended up having a needle biopsy. Of the 10,000 diagnostic imaging tests, less than 1% ended up cancer. So 99% of the time were are relieved by knowing there is no cancer, and 1% of the time we are relieved that we did the biopsy, diagnosed the cancer, and can treat it.”
If you have questions or concerns about your breast health, call the Baystate Breast & Wellness Center at 413-794-8899. The Baystate team can schedule an appointment for you as well as help you navigate any challenges related to referrals for insurance.