Breast lump: Early evaluation is essential
A breast lump deserves medical attention. Know what to expect during a clinical breast exam — and what happens when a lump needs further evaluation.By Mayo Clinic Staff
If you find a breast lump or other change in your breast, you might worry about breast cancer.
That's understandable. But breast lumps are common, and most often they're noncancerous (benign), particularly in younger women. Still, it's important to have any breast lump evaluated by a doctor, especially if it's new, feels different from your other breast or feels different from what you've felt before.
How breast tissue normally feels
Breasts contain tissues of varying consistency, including fatty, glandular and connective tissue. You might find that breast-related symptoms, such as tenderness or lumpiness, change with your menstrual cycle. Lumps during this time might be caused by extra fluid in your breasts. Breast tissue also changes as you age, typically becoming fattier and less dense.
When to consult your doctor
Breast and nipple changes can be a sign of breast cancer. Make an appointment with your doctor if you notice anything unusual.
Being familiar with how your breasts normally feel makes it easier to detect when there's a change in your breasts.
Consult your doctor if:
- You find a new breast lump or thickening that feels different from the surrounding tissue
- You notice a change in the size, shape or appearance of your breast
- Breast pain doesn't go away after your next period
- You notice skin changes on your breast, such as itchiness, redness, scaling, dimpling or puckering
- You have a newly inverted nipple
- You notice spontaneous nipple discharge
What to expect during a clinical breast exam
Evaluation of a breast lump typically begins with a clinical breast exam. During this exam, your doctor will likely:
- Ask about symptoms and your risk factors for breast cancer or benign breast conditions
- Examine your breasts and lymph nodes in your armpit, feeling for any lumps or other abnormalities
- Examine the skin on your breasts
- Check for nipple problems, such as inversion or discharge
If your doctor confirms that you have a breast lump or other area of concern, you'll likely need testing.
Procedures to evaluate a breast lump
During a breast MRI, you lie on your stomach on a padded scanning table. Your breasts fit into a hollow depression in the table, which contains coils that detect magnetic signals. The table slides into the large opening of the MRI machine.
During fine-needle aspiration, a special needle is inserted into a breast lump and any fluid is removed (aspirated). Ultrasound — a procedure that uses sound waves to create images of your breast on a monitor — might be used to help place the needle.
Core needle biopsy
Core needle biopsy
A core needle biopsy uses a long, hollow tube to extract a sample of tissue. Here, a biopsy of a suspicious breast lump is being done. The sample is sent to a laboratory for testing.
Stereotactic breast biopsy
Stereotactic breast biopsy
During a stereotactic breast biopsy, your breast will be firmly compressed between two plates. X-rays (mammograms) are used to produce stereo images — images of the same area from different angles — to determine the exact location for the biopsy. A sample of breast tissue in the area of concern is then removed with a needle.
To further evaluate a breast lump, your doctor might recommend a:
- Diagnostic mammogram. This specialized breast X-ray helps your doctor investigate suspicious breast changes. It takes X-ray pictures from several angles.
- Breast ultrasound. Sound waves create images of the inside of your breast on a monitor. Ultrasound imaging is helpful for determining whether a breast lump is solid or filled with fluid.
- Breast MRI. An MRI machine uses a magnet and radio waves to create pictures of the interior of your breast. A breast MRI usually is reserved for when the diagnosis is in question. Before a breast MRI, a dye might be injected through an intravenous (IV) line in your arm to enhance the appearance of tissues or blood vessels on the MRI pictures.
You might have a tissue sample removed and examined under a microscope (biopsy). Ultrasound or mammography might help guide the needle, and a local anesthetic might be used. Breast biopsy options include:
- Fine-needle aspiration biopsy. With a thin needle attached to a syringe, cells and fluid are removed from the suspicious area.
- Core needle biopsy. A larger needle with a special tip is used to remove a sample of breast tissue.
- Stereotactic biopsy. Mammography produces images of the area in question from several different angles (stereo images). Your doctor then removes a sample of breast tissue with a needle.
- Vacuum-assisted biopsy. A probe connected to a vacuum device removes a small sample of breast tissue.
- Surgical biopsy. A small cut is made in the skin and breast tissue to remove part or all of a lump.
After a biopsy, the tissue sample is sent to a lab for analysis. Your doctor will let you know when to expect the test results and will discuss them with you when they're available.
Follow-up after breast lump evaluation
If the breast lump isn't cancerous, your doctor will decide if you need short-term monitoring with clinical breast exams or repeat breast imaging. You may be asked to return in two to three months to see if there have been changes in your breast. Consult your doctor if you notice changes in the lump or develop new areas of concern.
If the diagnosis is in question — the clinical breast exam and the mammogram show areas of suspicion, for example, but the biopsy reveals benign tissue — you'll be referred to a surgeon or other specialist for further consultation.
If the breast lump is cancerous, you'll work with your doctor to create a treatment plan. The stage and type of breast cancer will influence your treatment options.
Oct. 31, 2018
See more In-depth
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