I have a lump in my breast, now what?

For the Gazette
Published: 10/18/2018 2:15:46 PM

 When you find a lump in your breast, it’s normal to be concerned. In fact, some people are so distressed that they choose to ignore a lump assuming that it will go away.

Fear of breast cancer can cause inaction. But don’t jump to conclusions. Instead, take action and call your health care provider to find out what it is.

Eighty percent of breast lumps that women find in their breasts are not cancer. Breast lumps are more commonly benign, meaning not cancerous. But they still need to be vigilant.

It is important to know your own body and to perform monthly self-breast exams to detect any changes that may need to be evaluated. If the lump turns out to be breast cancer, early detection saves lives.

Benign breast lumps usually have smooth edges and can be moved when you push against them. They are often found in both breasts. There are several factors that can cause benign breast lumps, including normal changes in breast tissue, breast infection, fibroadenoma, intraductal papilloma and traumatic fat necrosis. I highlight some of these factors below:

Normal changes in breast tissue: Breast tissue responds to hormone changes particularly around the menstrual cycle. During normal monthly menstrual cycles some women have fibrocystic breast changes. This means that they have lumps in both breasts that increase in size and tenderness just before their periods. These lumps are normal breast tissue or cysts which have become enlarged or irritated in response to cyclic hormone changes. They usually become less prominent and tender after the period.

Breast infection: Sometimes a painful lump, with or without redness, is the first sign of infection. Infection tends to occur in small pockets that are warm and tender to touch. Symptoms usually worsen quickly. Applying warm compresses can be helpful, but your doctor may prescribe antibiotics.

Breast injury: A bump to the breast can cause bruising or an underlying blood clot (hematoma). These lumps tend to occur in response to a known injury and are usually associated with the “black and blue” color changes associated with bruising. Hematomas can take a long time to heal.

Simple cysts: Simple cysts are fluid-filled sacks that are usually found in both breasts. They can vary in size and tenderness particularly around the menstrual cycle. There can be one or many.

Fibroadenomas: These lumps tend to occur in women between the ages of 20 and 30. They are more common in African-American women. A fibroadenoma forms when the breast makes extra milk-making glands. This causes development of a solid, round, rubbery lump in the breast that freely moves when touched. There can be one or many of them.

Cancer is the most concerning cause of a breast lump. A cancerous mass in the breast will continue to get bigger and ultimately can cause disfigurement of the breast. Breast cancer can also spread to other vital organs making it life threatening.

The good news is that breast cancer can be found in the early stages when treatment and cure are possible. For this reason, it is vitally important for you to watch for the warning signs of breast cancer and report them immediately to your health care provider.

In general, be aware of a change in the look or feel of the breast, a change in the look or feel of the nipple, or development of nipple discharge. The warning signs of breast cancer include:

<sbull value="sbull"><text xmlns="urn:schemas-teradp-com:gn4tera"></text></sbull>A lump, hard knot or thickening of the breast or underarm area.

■Swelling, warmth, redness or darkening of the breast.

<sbull value="sbull"><text xmlns="urn:schemas-teradp-com:gn4tera"></text></sbull>Change in the size or shape of the breast.

■Dimpling or puckering of the skin.

■Itchy, scaly sore or rash on the nipple.

■Pulling in of the nipple or other parts of the breast.

■Nipple discharge that starts suddenly.

■New pain in one spot of the breast that does not go away.

If you have any of these breast changes, seek care immediately.

During Breast Cancer Awareness Month let’s think about the things that can be done to keep our breasts healthy. Once you turn 20, you should check your breasts every month, usually the week after your period. This will allow you to become familiar with your breast tissue so that you can more easily recognize any changes that occur. Your health care provider may also recommend a clinical breast exam (done by your provider) every 1-3 years starting at 20.

As you get older, get a mammogram. Expert organizations disagree on the timing and frequency of mammograms, so it is best to discuss with your health care provider when you should start having mammograms and how frequently they should be repeated.

In general, I recommend having a first mammogram at the age of 40 (or earlier if you have a family history or breast cancer in a first-degree relative at a young age), mammograms every 1-2 years between the ages of 40 and 50, and annual mammograms between the ages of 50 and 75.

 Glenda Flynn is an Advanced Oncology Nurse Practitioner with The Mass General Cancer Center at Cooley Dickinson Hospital 

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