Breast Lumps and Pain (cont.)
Breast Lumps and Pain Diagnosis
If you find a breast mass or lump, you should schedule an appointment with
your health care professional who will do a breast examination to check your breasts
for irregularities, dimpling, tightened skin, lumps, inflamed or tender areas,
and nipple discharge. The areas of each breast and underarms will be examined.
If your doctor finds a lump at this time, you may have a re-examination
in two to three weeks. If it is still present, then your doctor may recommend some
further testing. The ideal time for the breast examination is seven to nine days after
If the physical examination is normal and no mass is
found, laboratory and
imaging tests are not usually necessary in women younger than 35 years. Women
older than 35 years should probably still have a
mammogram unless they have had
a mammogram in the past 12 months.
- Mammography is an
X-ray technique that looks for changes in the breast.
These appear as changes in the shape of the breast or calcifications. Mammograms
can see abnormalities that you may not be aware of or that the doctor cannot
feel or identify by physical exam.
- Mammograms are the best tool for the early detection
of breast cancer.
- The test is more sensitive in women over the age
of 30. Mammograms detect 85% of cancers, but up to 15% can be missed.
Thus, if a suspicious lump is found, and mammography is normal or the
doctor cannot distinguish the lesion as having a cancerous appearance, then the doctor may
fine-needle aspiration to be performed. An alternative
would be to repeat the mammogram in another 6 to 12 months.
- Ultrasound: If a lump is found, ultrasound scanning
helps to distinguish between a fluid-filled sac (cyst) in the breast and a
solid lump. This distinction is important because cysts are usually not
treated, but a solid lump must be biopsied to rule out cancer. In a breast
biopsy, a piece of the lump is
taken out and tested for cancer.
- Aspiration: If a cyst-like lump is found, fluid may
be drawn out of it by suction (aspiration) with a syringe and needle. Examination of the fluid and
repeat exams will help your doctor decide what other tests to do.
Fine needle aspiration: Special techniques of aspiration (drawing out a
sample of fluid or tissue with a needle) may be used on certain masses.
Occasionally, the surgeon may prefer to remove the whole lump and send it
for analysis in a lab. In this case, you will be scheduled for
surgery to remove the lump.
- If you have a family history of breast cancer, your doctor may also suggest
genetic testing to see if you have any genes known to put you at higher risk for
Your doctor will be able to classify your breast pain as cyclic or noncyclic by taking a thorough history. After performing a physical examination,
the different causes of noncyclic breast pain can be found. Both components of
your visit to the doctor will determine an appropriate management strategy for
- Questions that your doctor will ask you to help decide if you have cyclic
or noncyclic breast pain include your age, the position of the pain, the
character of the pain, and the relation of the pain to your menstrual cycle.
- You should inform your doctor if you have a history of taking hormone
replacement therapy or oral contraceptives, previous history of breast problems,
breast surgery, or a family history of breast cancer.
- Also it is important to tell your doctor if you have any other breast
symptoms such as nipple discharge or a lump that you can feel.
The diagnosis of mastitis and breast abscess can usually be made based on
- If it is unclear whether a mass is due to a
fluid-filled abscess or to a solid mass such as a tumor, a test such as an
ultrasound may be done. An ultrasound may also be helpful in distinguishing
between simple mastitis and abscess or in diagnosing an abscess deep in the
breast. This noninvasive test allows your doctor to directly visualize the
abscess by placing an ultrasound probe over your breast. If an abscess is
confirmed, aspiration or surgical drainage, and IV antibiotics, are often required.
- Cultures may be taken, either of breast milk or of
material aspirated (taken out through a syringe) from an abscess, to
determine the type of organism causing the infection. This information can
help your doctor decide what kind of antibiotic to use.
- Non-breastfeeding women with mastitis, or those who do not respond to
treatment, may have a mammogram or
breast biopsy. This is a precautionary
measure because a rare type of breast cancer can produce symptoms of mastitis.
M Ruby Alvi, MD, CCFP, MHSc
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