What Should Be Done When a Breast Lump Is Detected?

Steps to take when you notice a lump or change in your breast are listed below:

1. Physical breast examination

Your physician checks breasts, nipples and armpits for abnormalities. Providing your own and family medical history is important.

2. Mammography

Mammography images breast tissue and detects tumors too small to feel. Each breast is compressed between two plastic plates. Some discomfort is normal, but tell the technician if painful. The best time is after menstruation, when tenderness is less. Avoiding caffeine for several days beforehand reduces tenderness in some women.

• Mammography is used for screening and diagnosis.

Screening mammography is performed for most women to identify breast changes in those without breast cancer symptoms. If the latest screening mammogram detects a change or a swelling requiring examination, mammography is then used for diagnosis. Diagnostic mammography takes more images of breast tissue from different angles, and images of particular areas may also be magnified.

- Related topic: 12 Things Every Woman Should Know Before Her First Mammogram

Mammography and breast implants

Tell your physician about any breast implants (silicone) when attending a breast check. Ask whether specialists can assess mammograms with implants, which can obscure cancer and other changes. A special technique called “implant displacement imaging” will be used.

For cosmetic implants, screening or diagnostic mammography is performed; the choice depends on the testing facility.

For implants after mastectomy, ask your oncologist or breast surgeon which test is best.

3. Magnetic resonance imaging (MRI)

A strong magnet and radio waves create computer images of the breast interior. MRI can detect breast cancer but cannot replace mammography. It is added for high-risk women and has limitations; for example, breast microcalcifications (calcium hardening in tissue) cannot be shown. Its accuracy is also debated relative to other tests, meaning false positives may occur.

Doctors sometimes recommend MRI in high-risk women with:

• Harmful BRCA1 or BRCA2 mutations
• Family breast cancer history
• Personal medical history

Obtaining mammography results

• Normal results: no lump or calcification signs. Still consult promptly about any change before your next appointment.
• Abnormal results: a change may be benign, premalignant or cancerous. Complete all tests your physician requests.
• If results do not arrive, call your doctor. Most changes are not cancer, but all need assessment and further tests for certainty.

What can mammography show?

It shows lumps, calcifications and other changes. Radiologists examine abnormalities and differences between breasts, comparing previous images when possible. It does not detect every cancer, and many findings are not cancer. Consult promptly about any palpable lump absent from mammography or any breast change.

Lump (or mass)

Size, shape and margins provide important information. Noncancerous lumps are smooth and round, clear and well-defined; these are cysts. Irregular margins or shape require more tests.

Depending on size and shape, your physician may recommend:

• Another physical examination
• Another mammogram for closer inspection
• Ultrasound to determine whether solid or fluid-filled
• Biopsy collecting cells or the whole lump for laboratory cancer assessment

Calcification

Calcium accumulates in breast tissue. Too small to feel, deposits appear on mammograms and are common over 50. Macrocalcification is unrelated to cancer and usually needs no further tests. Microcalcifications look like tiny white spots and are not cancer signs, but when located in rapidly dividing tissue require clarification.

Depending on amount, size and location, another mammogram may be requested for closer examination. Biopsy is another option to check for cancer.

Tests after abnormal mammography

Additional tests may be needed for more information.

• Ultrasound: Sound waves produce images called sonograms, showing whether a lump is solid or fluid-filled. A fluid-filled lump is a cyst.
• MRI: Magnetic resonance imaging uses a strong magnet and radio waves for computer images. Sometimes physical or self-examination finds lumps or enlarged nodes absent from mammography or ultrasound. MRI can provide more information about these changes.

If these tests suggest malignancy, breast biopsy is performed.

Related Topics:

- What Is a Breast Biopsy, and How Is It Performed?

- What You Should Know Before Breast Biopsy