Wednesday, June 03, 2009

Lovely Lady Lumps?

Dr. Kate,

I had a baseline mammogram, and two lumps were found in my left breast, so I was sent to get an ultrasound. The doctor did not really say too much. She asked me if I had an infection in my breast, I said no and that was that. She said that she really couldn't tell anything else because this was my baseline and that I needed to come back in 6 months to see if the lumps have grown. Is this a normal answer? Do I wait 6 months to see if it is cancer? I had one lump removed from my right breast in 1993 which was not cancer but is that what you do? Should I go see another doctor?

Leery About Lumps

Dear Leery,

Breast lumps can be tricky to manage. There are several features of a lump that doctors consider in trying to figure out if a lump is benign (not cancerous) or not:
  • Smooth or rough? A lump that's smooth like a marble is more likely to be benign thank one that is bumpy around the edges.
  • Mobile or fixed? A lump that you can squish around between your fingers is more likely to be benign than one that feels cemented in place.
  • Fluid-filled or solid? A cyst filled with fluid is 99% of the time benign.
Additionally, your medical history can provide clues. If you're a breast-feeding mom, a lump is more likely to be a blocked milk duct. Similarly, if you've got fibrocystic breast disease, a lump may be cyclical thickening of normal tissue. The radiologist, too, looks for features of the lump on the scan to give their best estimate of what the lump is.

But in the end, the only way to know that a lump is not cancer is to sample it--using a needle (with or without ultrasound or CT scan) to extract cells, then examine them under a microscope. No doctor can tell you with certainty that a lump is benign until you've had it biopsied. But if your doctor or the radiologist has a low suspicion that the lumps are cancer, waiting 3-6 months for another exam and mammo/ultrasound is reasonable.

Bottom line? Ask your doctor why she thinks it's okay to wait 6 months for another check. And if you're not reassured, seek a second opinion. It's your body, and you need to feel good about what's happening with it.

Have you ever had a breast lump? Did you have a biopsy, or did your doctor say it was okay to wait?

Photo credit: zpeckler

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