Breast lumps and cancerImages (Click to view larger image)
breast masses and cancer
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Breast cancer is the most common cancer faced by women and the second most common reason for cancer deaths among women. A woman's best defence is early detection of breast cancer through: These techniques are most effective when combined. When used alone, mammography finds about 35% to 50% of breast cancers. Cancers not found by mammography are most often found by women who examine their breasts.
Women should become familiar with how their breasts look and feel. Beginning in the late teens or early twenties, a woman can start to perform monthly breast self-examinations. If a woman does BSE regularly, she is likely to notice early changes in the size, structure, and texture of her breasts.
Doctors do a clinical breast examination as part of a regular check-up. The goal is to recognise breast abnormalities at the earliest stage possible. There is a clear link between early detection of breast cancer and survival rates.
Mammography is the most useful technique for detecting early breast cancer. It can find cancer years before a mass can be felt. Mammograms may be used as a diagnostic tool to see if a lump or abnormality is cancer or done to screen women for cancer.
Current recommendations for screening mammography include:
A woman has a higher than normal risk for breast cancer if:
- Women 40 to 50 years old should have this examination every 1 to 2 years. Many doctors recommend yearly mammograms for this age group.
- Women older than 50 should have mammograms every year if there is a family history of breast cancer or if they have breast pathology. Mammograms clearly saves lives in this age group.
- Women who have a higher than normal risk for breast cancer should decide with their doctors when to start having mammograms. This examination is often not useful for women younger than 35 years old because their breast tissue is too dense to allow accurate interpretation of X-rays taken with current mammography techniques. Younger women can be screened by ultrasound
Most breast masses are not cancer. Many benign, or non-cancerous, breast conditions cause masses or lumps that can be felt. These include:
- her immediate relatives have had breast cancer, especially before menopause or in both breasts. Immediate relatives include mothers, sisters, daughters, aunts and grandmother.
- certain genes that predispose women to breast cancer, such as BRCA1 or BRCA2, have been found in her family.
- she has had an episode of breast cancer or cancer of the lining of the uterus or ovaries.
- she started menstruating before age 12.
- she started menopause after age 55.
- she has never been pregnant or she had her first pregnancy after age 35.
Once a breast mass is found, it is important to learn if it is benign or cancerous. Doctors generally evaluate lumps or masses as follows:
- fibrocystic changes, the most common benign breast condition, that can cause both breasts to become lumpy and often painful
- fibroadenoma, a common benign breast tumour, that is usually round, rubbery in texture, and movable
- cysts, or fluid-filled sacs
- fat necrosis, a condition often caused by trauma to the breast that can result in a breast lump
- breast abscess, an infection that often occurs in women who are nursing
- milk duct abnormalities
If any mass or lump is thought to be suspicious, a mammogram is usually performed.
If the mammogram suggests the possibility of cancer, a fine needle aspiration is done, followed if necessary by a biopsy. During a biopsy, a tissue sample is taken and checked for cancer.
If the mammogram shows a solid area that does not suggest cancer, the woman and her doctor will decide whether an ultrasound or biopsy should be done. One to 3 months later, the woman may have a second mammogram. If a biopsy is done, a diagnosis can be made at the time. If a biopsy was not done, but the second mammogram shows that the mass has disappeared or become smaller, only routine follow-up is needed. The woman should continue to follow recommendations for routing screening by mammogram. If the second mammogram shows that the mass has not changed or has become larger, a biopsy is often recommended.
If the mammogram shows a fluid-filled cyst, it can be drained with a needle. This procedure is called fine-needle aspiration. Depending on its results i.e. analysis of cyst fluid by a pathologist further steps may be taken:
- If the fluid in a cyst is clear and the mass completely goes away, the woman is normally examined again in 1 to 3 months. If the cyst recurs, the woman and her doctor must decide if repeat aspiration or biopsy should be done. If the cyst does not recur, only routine follow-up is needed. The woman should continue to follow recommendations for routine screening by mammogram and ultrasound.
- If the fluid in a cyst is clear but a mass remains, a biopsy is often done to remove the mass and have it examined pathologically.
- If the fluid in a cyst is bloody, a biopsy may be recommended even if the mass goes away.
- If a new finding is made or a thickening of breast tissue or a questionable area is discovered through an examination, a diagnostic mammogram is often recommended.
These general guidelines for managing breast lumps may not fit every case. Together, a woman and her doctor should consider the specific issues of her case to make decisions that suit her best. A woman's emotional and physical health as well as her medical details are key to making these decisions.
Reviewer: eknowhow Medical Review Panel
Editor: Dr John Hearne
Last Updated: 8/11/2004
Potential conflict of interest information for reviewers available on request