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 your period.
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 amammogram 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 order an ultrasound or 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.
- Excisional biopsy: 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 breast cancer.
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 you.
- 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.
- It is also 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 physical examination.
- 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.
Medically Reviewed by a Doctor on 8/4/2015
M Ruby Alvi, MD, CCFP, MHSc
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