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Have a Breast Lump? Why You Shouldn’t Ignore Potential Signs of Cancer

Evaluating patients who feel a lump in their breasts is an important part of my practice as a breast radiologist.  Lumps in the breast may be due to many different causative factors.  Many times, the lump isn’t actually a mass at all; the patient or referring physician is feeling normal breast tissue.  Of course, the most serious cause of a lump in the breast is breast cancer, which is why we always take new lumps seriously in breast imaging.

Is a Lump Breast Cancer? 

All new lumps or masses in the breast should be evaluated by your primary care physician with a clinical breast examination.  After the clinical breast examination, your doctor will likely send you to an imaging center for a diagnostic mammogram and ultrasound evaluation.  The imaging evaluation of a lump in the breast is similar to the imaging performed when a woman is called back from an abnormal screening mammogram, with a few exceptions based on age.   I will outline how I evaluate a breast lump in my practice; however, please note that practices vary between imaging facilities, and this is only meant as a general guide.

Evaluation for Women Under 30

If you are female and younger than 30 years old, I will ask for a breast ultrasound first.  In this patient population, the mammogram is often not performed for several reasons.

  1. The breast tissue of young women tends to be very dense, limiting the usefulness of the examination.
  2. The most common causes of a breast lump in young women are not cancer.  The lump may be due to normal dense breast tissue, a fluid-filled cyst, or a fibroadenoma (a benign, non-cancerous, fibrous mass).  In this age group, all of these causes of a breast lump are best evaluated with ultrasound.
  3. Although the amount of radiation exposure during a mammogram is small, breast imagers are cognizant of the lifelong radiation exposure of obtaining yearly mammograms. Therefore, we attempt to avoid radiation exposure in younger women when the chance of the mammogram adding value to the examination is low.

However, if a mass suspicious of cancer is seen by ultrasound in this age group, mammography will then be performed in order to completely evaluate both breasts.

Evaluation for Women Aged 30-39

If you are female between the ages of 30 and 39, I will start the examination with a mammogram.  Both breasts are evaluated to provide a baseline mammogram which will serve as a comparison for future mammograms. Additional mammogram images, including 3D mammography and “spot compression” views, may also be obtained.

Spot Compression Views

Spot compression views use a smaller compression paddle in order to provide more concentrated compression of the breast at the site of the lump.  If a mass is present, these compression views can help make the mass more visible on the image, separating it from the normal breast tissue.  If 3D mammography is used, spot compression views are not always obtained.  I then have the ultrasound technologist evaluate the lump and surrounding tissue with a breast ultrasound.  Sometimes, the armpit area will also be evaluated to look for enlarged lymph nodes.

Evaluation for Women Over 40

If you are female over the age of 40, the following may be expected at my facilities.

  • > 12 months after your last screening mammogram, a mammogram of both breasts will be obtained to keep you on track for annual screening. However, additional mammogram views and breast ultrasounds will also be performed to specifically evaluate the lump.
  • < 12 months since your last screening mammogram, only the breast with the lump will be evaluated with a combination of mammography and breast ultrasound.

Evaluation for Men

Men of all ages who have a new lump in the breast will be evaluated with a mammogram of both breasts, and ultrasound of the lump and surrounding breast tissue.

Bottom line:  It is important to have all new lumps in the breast evaluated by your primary care physician followed by breast imaging.  When in doubt, have it checked out!  It’s always better to be safe….

Danielle M. Carroll, M.D. Danielle M. Carroll, M.D. Breast Imaging General Radiology

Written by Danielle Carroll, M.D.


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