Medical Edge Newspaper Column

Breast Changes Should Be Checked Out,
Even With Normal Mammogram

June 26, 2006
DEAR MAYO CLINIC:
I have been experiencing changes in my left breast, some pain and thickening that is new. My mammogram was normal. I told my gynecologist about my situation. She said any irregularity is not normal, and I should see a surgeon. What does breast asymmetry like this mean, especially when the mammogram is normal? Should I seek further opinions? -- Lisle, Ill.

ANSWER:
You are right to seek more answers about your situation. While a mammogram is an invaluable diagnostic tool, it's not the only one. Some breast cancers don't show up on mammogram X-rays. That's especially the case for younger women -- those in their 40s or younger -- who have denser breasts.

Breast asymmetry can present as an area of thickening or fullness. The area feels different from the other breast and may feel more prominent than the surrounding breast tissue. In women with dense breast tissue, this thickening may be due to underlying benign fluid-filled cysts, also known as fibrocystic breast changes. However, a lump that develops in fibrous tissue may be much harder to detect by palpation and will present as breast asymmetry.

Any new change or irregularity of the breast tissue requires additional evaluation -- even though the mammogram is normal. First, I'd suggest a directed ultrasound exam of the area of concern. It will show if the changes in your breast are related to a cyst or a solid mass.

Cysts, which can fluctuate with the menstrual cycle, usually aren't cancerous. If the cyst isn't painful, the best approach could be to observe for change. If it's painful, the cyst can be drained with a needle to reduce the pain. Some "complex cysts" have "debris" in the fluid, which would be evident on the ultrasound. In this case, you'll want to talk with your physician about draining the cyst for further evaluation.

If the ultrasound shows a solid mass, you and your doctors will need to determine if it's benign or malignant, most likely with a core needle biopsy. A specialist uses a hollow needle to obtain tissue samples, each about the size of a grain of rice. Those samples are analyzed for malignant cells.

If nothing is evident on the ultrasound and the area of thickening has persisted and feels more prominent over one to two months, you should seek additional evaluation at a breast center or with a surgeon.

Additional studies may be recommended, such as diagnostic magnetic resonance imaging. It can reveal tumors that are too small to show up with other screening methods, especially in women with dense breast tissues. A biopsy is important to exclude cancer when the area of thickening or breast asymmetry is persistent even though the imaging studies are normal.

It's important for all women to be familiar with their breasts. When there are changes, such as a breast lump, dimpling, redness, pain, nipple retraction or asymmetry, it's a good idea to see a doctor to check it out.

-- Sandhya Pruthi, M.D., Breast Diagnostic Clinic, Mayo Clinic, Rochester, Minn.