Dr. MJ Bazos MD,
A lump can be felt in my breast.What
should happen next?
First, be aware that finding a lump is common
and that most lumps are not due to cancer. However, any new lump must be
investigated to find out what it is. The investigation should start with your
doctor asking about your medical history, doing a complete physical examination
and usually also ordering a diagnostic mammogram. An ultrasound examination can
also be valuable, especially to distinguish between cysts (harmless fluid-filled
sacs) and other kinds of abnormalities. These steps may be all that is necessary
to rule out cancer, especially if your doctor is experienced in breast
What sort of questions will my doctor ask
You will be asked how long it has been since you
first noticed a lump, whether it has changed at all (for example, whether it has
grown bigger or changed in texture), and whether you’ve noticed any skin
changes or irritation. You will also be asked about possible risk factors. These
are things that might increase your chance of having breast cancer at some time
in your life.
Your risk is higher if:
- you are older. Risk increases with
- you have had breast cancer before;
- you have had a breast biopsy in the past that
showed some abnormality or
- you had radiation treatment for Hodgkin’s
disease in childhood.
Your family’s health history can also
contribute to your risk of getting breast cancer. The risk is higher if there is
a “strong” history of breast cancer in your family. You have a
strong history if the person with cancer was your mother, sister or daughter.
The risk rises if more than 1 person in your immediate family had breast cancer,
and if their cancer was found before menopause or before they were 50 years of
age. Although these factors are associated with an increased risk, don’t
be too concerned if some of them apply to you. It may reassure you to know that
most women with the common risk factors don’t get
What will my doctor look for during the
During the examination, the doctor is looking
for signs that the lump is either “benign” (non-cancerous) or
“malignant” (cancerous). The armpit and the area above your
collarbone will be examined to see if the lymph nodes are enlarged. These lymph
nodes are sometimes called “glands.” Swollen lymph nodes can be one
of the first signals of a spreading cancer. The skin of the breast and the
nipple will also be examined for any irritation, rash, dimpling or other
abnormality that cancer can sometimes cause. Fluid leaking from the nipples
unless it is bloodstained is usually not related to cancer, especially if it
occurs in both breasts. The lump itself will be felt to see if it can be moved
within the tissue and whether its edges seem smooth or rough. Smooth, rounded
lumps that move easily are much less likely to be cancerous. Lumps due to cancer
are usually, though not always, painless.
What is a diagnostic mammogram? Do I need
to have one?
A diagnostic mammogram is an x-ray of the breast
and is recommended when there is reason to suspect cancer. Because younger women
(generally less than 35 years old) have denser breast tissue, mammography is
less helpful in this situation. Diagnostic mammography is more thorough than
regular “screening” mammography. It includes extra compression to
“push” normal breast tissue out of the way and give a clearer image
of the suspicious area. If tiny flecks of calcium (microcalcifications) are
noticed, magnified views will be taken since these flecks are sometimes
associated with cancer. If there is any doubt about what the mammogram shows, it
is recommended that 2 individuals experienced in reading mammograms should
interpret the results. For an accurate diagnosis, a highquality mammogram is
important. To ensure high quality you should check that your centre is
accredited by the Canadian Association of Radiologists. However, even when all
the best procedures are followed, cancer is not always visible on a mammogram,
which means that a normal result is not absolute proof that there is no
I have gone through all these steps, but my
doctor still cannot rule out cancer. What is the next step?
More tests may be necessary. Your doctor may
suspect that the lump is actually a harmless cyst (a sac filled with fluid).
This is a common condition. If a cyst is suspected, an ultrasound examination or
a technique called “fine-needle aspiration” can help confirm the
presence of a cyst. In fine-needle aspiration, a very thin needle is inserted
into the lump. If the lump is fluid-filled, the needle will draw out the fluid.
If it is blood-stained it will be sent for testing. If not, you can be certain
that it is only a cyst, and no further testing or treatment will be required.
What if the lump is solid and contains no
If fine-needle aspiration doesn’t draw out
any fluid, the lump may still be a harmless, solid fibrous growth. The needle
can retrieve cells from the lump for further examination under the microscope.
Sometimes, this is enough to reach a clear diagnosis. If the answer is still
unclear, further investigation will be needed. Your doctor can use a larger
needle to draw out some tissue from the lump. This is then examined under the
microscope to see if there are any cancer cells. This procedure is called a
“core biopsy.” Your doctor may be able to locate the lump by feel;
if not, a mammographic or ultrasound “picture” of the lump is used
as a guide to make sure the needle goes to the right place. If cancer is still
suspected, a “surgical biopsy” is done, in which the whole lump is
removed for examination under the microscope. To make sure of getting it all,
some of the surrounding normal tissue is also taken.
What about other diagnostic techniques such
as thermography, light scanning and magnetic resonance imaging
Thermography, which detects the tumour’s
heat, and light scanning, which shows the tumour by shining a light through the
breast tissue, are inaccurate and not recommended for diagnosis. The value of
MRI is still being investigated. Right now, it is not a routine part of the
I have a breast implant. Should I not have
some of the tests?
You can and should have the same tests (and
treatments, if necessary) as everyone else. However, special techniques may be
necessary to get a good mammographic image of a breast with an
Will all these tests be
done by my doctor?
Reliable results depend on the skill and
experience of the people who do the tests and interpret the findings. Not all
doctors have the required experience and skills and not all tests are available
in every location. Depending on these factors, you may be referred to different
specialists for some or all of the tests you’ll need. No matter who does
the investigation, the goal is to reach a reliable diagnosis using the fewest
possible procedures as quickly as possible. While this goes on, you should
expect to be kept fully informed. Don’t hesitate to ask any questions you
Are any more follow-up tests needed if my
lump is found to have no cancer?
It depends on the type of lump you have. For
some lumps in which the diagnostic test results were difficult to interpret,
your doctor may wish to schedule follow-up tests to be on the safe side. When
the diagnosis is straightforward, however, no further tests are
What if my lump turns out to be
In this case, you will have more decisions to
make. Together, you and your doctors will decide which kind of surgery is best
for you and whether you need other treatment such as radiotherapy, chemotherapy
or hormonal therapy. Above all, don’t feel rushed into taking action.
This is a difficult time, and it is normal to feel anxious. A delay of 1 or 2
weeks will have no significant effect on the outcome and will give you time to
gather information and talk things over frankly and openly with your doctor.
Don’t be afraid to ask questions or to ask for any additional support you
need. Family and friends can be especially important at this time.