Changes In Your Breasts
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Early Detection – The Most Important Step
This is a guide to help you be aware of any changes in your breast and how the changes may be a warning sign of breast cancer. The key to finding breast cancer is early detection. The best available tool is a regular Screening Mammogram (an x-ray of the breasts) followed by a clinical breast exam by a doctor or nurse.
A mammogram is not foolproof. Some breast changes, including lumps that you may feel, are not visible on a mammogram. Changes can be especially difficult to detect in the dense, glandular breasts of young women.
Never ignore a lump because it does not show up on a mammogram.
Recommended guidelines are:
- All women in their forties or older who are at low to average risk for breast cancer should have screening mammograms every one to two years.
- All women who are at higher risk for breast cancer should ask their doctor about when and how often to schedule screening mammograms and the need for additional breast ultrasound or breast MRI exams.
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Reading a Mammogram
A diagnostic radiologist (a doctor who specializes in interpreting x-rays) reads the mammogram. The radiologist looks for unusual shadows, distortions, masses, calcifications, and the differences between the two breasts. The shape of a mass is important. A growth that is non-cancerous (benign) looks smooth and round and has a clearly defined edge. Breast cancer usually has an irregular outline with finger-like extensions. Only a very small number of cancers can present as a round mass.
- Benign growths look smooth and round and have clearly defined edges.
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- Breast Cancer has an irregular shape – with finger-like extensions.
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Many mammograms show white specks. These calcium deposits are calcifications.
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Macrocalifications
Macrocalcifications are course or chunky calcium deposits often seen in an area of prior surgery, scar, or trauma. They are usually not signs of cancer and are related to non-cancerous lesions such as fibroadenoma or fat necrosis.
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Microcalifications
Microcalifications are tiny flakes of calcium found in an area of rapidly dividing cells, usually within the milk ducts of the breast.
About one half of the cancers diagnosed by mammograms are detected as clusters of microcalcifications or branching microcalcifications that grow in a line like within a duct.
Your radiologist will report the results of your mammogram to your doctor, who will contact you. If you do not receive a report call your doctor. Do not assume that the mammogram is normal if you do not receive the results.
A woman who has breast implants should continue to have mammograms. Early detection of breast cancer is crucial for successful treatment. A mammogram is currently the best tool for early detection. Be sure to schedule a regular mammogram. It may save your life!
Breast Lumps and Other Changes
A lump is usually the size of a pea before it will be detected. Benign lumps (not cancer) tend to be round, soft, and smooth. A firm, hard lump with an irregular shape is more likely to be a cancer. The only way to be sure if a solid lump is cancer is to have a biopsy and examine the tissue under a microscope.
Types of Benign Breast Changes
80 per cent of the breast lumps that require a biopsy prove to be benign (non-cancerous).
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- General Breast Changes
Generalized breast lumpiness may become more obvious during pregnancy, one’s menstrual cycle or menopause.
- Solitary Lumps
If a single mass is identified in the breast, it can represent a number of different things.
Collapsed Types of Solitary Lumps
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Cysts
Cysts are fluid-filled sacs. Cysts are usually treated by observation, and less likely by fine needle aspiration.
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Fibroadenomas
Fibroadenomas are solid and round benign tissues that can easily be moved around and are painless. They are twice as common in African-American women. They can generally be managed with observation unless they are growing, in which case they should be removed.
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Fat necrosis
Fat necrosis is a round, firm lump formed by damaged or disintegrating fatty tissue and typically occurs in obese women with very large breasts or women with a history of breast surgery or trauma. If the core biopsy performed by the radiologist shows benign fat necrosis calcifications, then these lesions are not surgically removed or surgically biopsied. The patient is returned to a 1 year screening mammogram schedule.
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Sclerosing adenosis
Sclerosing adenosis is a benign condition where there is excessive growth tissue in the breast lobules. Discuss the follow-up management with your doctor. These lesions are not routinely removed surgically, but the doctor may recommend returning for annual follow-up examinations.
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Intraductal Papilloma
Intraductal papillomas are benign growths in the milk ducts of the breast. These growths may develop near the nipple and may cause nipple discharge, pain in the breast, or a lump in the breast that can be felt. Management may be simple observation or removal.
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Hyperplasia
Hyperplasia is an overgrowth of the cells in the breast. In “usual” hyperplasia, the excess cells look normal under a microscope. In “atypical” hyperplasia, the excess cells look abnormal. Women with hyperplasia should monitor their condition closely with mammograms and clinical breast examinations. If the hyperplasia is atypical, excision is generally recommended to exclude cancer.
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Breast Cancer
Four-fifths of all breast lumps are benign, but some solitary lumps may be cancerous. Contact your doctor immediately if you find any type of breast lump.
- Nipple Discharge accompanies some breast conditions. A discharge may be a sign of infection and require antibiotics. If the nipple discharge is bloody, then this condition may be related to a growth within a duct and you need to see your doctor for evaluation.
If you find a lump
If a lump is something new or unusual, then call your doctor immediately. Remember four-fifths of all breast lumps are benign (not cancer), but some lumps may be cancerous. The sooner any problem is diagnosed, the sooner you can have it treated.
A Word of Caution
If you find a lump, do not try to diagnose it yourself. There is no substitute for a doctor’s evaluation.
Reviewed by:
- Doreen M. Agnese, MD
Associate Professor of Surgery
James Cancer Center
The Ohio State University
- Naoto T. Ueno, MD, PhD, FACP
Professor of Medicine
Nylene Eckles Distinguished Professor in Breast Cancer Research
Executive Director of Morgan Welch Inflammatory Breast Cancer Research Program and Clinic
Chief, Section of Translational Breast Cancer Research
Department of Breast Medical Oncology
The University of Texas MD Anderson Cancer Center
- Huong Carisa Le-Petross, MD, FRCPC, FBSI
Professor
Department of Diagnostic Radiology
Section of Breast Imaging, Abdominal Imaging
Division of Diagnostic Imaging
The University of Texas MD Anderson Cancer Center
