Women’s Health: Breast Lumps, Cancer & Self-Exam

Breast Lumps

Feeling a lump or lumps in your breast(s) can be scary. For a lot of women, the first thought is cancer. The good news is that most breast lumps, 80-90%, are not cancerous. They are usually benign tumors or cysts that do not invade and destroy body tissue or spread to other parts of the body. Examples of these breast lumps are:

Fibroadenomas:

• Occur mostly in women under 30.
  
• Are made of fibrous and glandular tissue.
  
• Are painless, firm or rubbery to the touch.
  
• Often move freely under the breast tissue.
  
• Can be removed easily if necessary.
  
• Are not linked to an increased risk for cancer.
  

Cysts (sometimes called fibrocystic breast disease):

• Are normal benign growths that occur in the breasts of some women.
  
• Are fluid-filled sacs.
  
• Are painful and feel lumpy or tender, especially during the week before the menstrual period.
  
• Can occur near the surface of the skin of the breast and/or be deep within the breast. Fluid-filled breast lumps can be aspirated with a needle. If fluid is obtained, the cyst goes away. Breast lumps that don’t go away should be tested with a biopsy.
  

Nipple-duct tumors:

• Occur within the part of the nipple that milk flows through.
  
• Cause a discharge from the nipple.
  
• Should be evaluated by a surgeon with a breast biopsy if there is any bloody discharge from the nipple.
  
• May need to be surgically removed.
  
  [Note: In rare instances, there can be a bloody discharge from the nipple which could indicate cancer.]
  
• Breast lumps may go away if you breast-feed for many months or take a low-dose birth control pill. Prescription drugs Danazol, Gestrinone and Tamoxifen can get rid of severe breast lumps, but all have side effects.
  

Tests can be done to tell whether or not a breast lump is benign:

• Ultrasound – to tell whether the lump is fluid-filled (usually harmless) or solid. This test is 80% accurate.
  
• Needle aspiration – a needle is put into the lump to remove fluid or cells. This test is 90% accurate.
  
• Biopsy – a sample of breast tissue is taken and examined. This test is 100% accurate.
  
• Mammogram – X-ray of breasts to detect breast abnormalities. This test is 70% accurate.
  

Breast Cancer

Breast cancer is the most common form of cancer among women, accounting for 30% of cancers women get. Each year, there are approximately 180,000 new cases of breast cancer and 45,000 deaths from it. Only lung cancer causes more cancer deaths among women.

The chance of breast cancer increases dramatically with age. The National Cancer Institute (NCI) has given the following statistics for a woman’s chances of developing breast cancer:

By Age:	25	30	35	40	45	50	55	60	65	70	75	80	85	Ever
Chances:	1 in 19,608	1 in 2,525	1 in 622	1 in 217	1 in 93	1 in 50	1 in 33	1 in 24	1 in 17	1 in 14	1 in 11	1 in 10	1 in 9	1 in 8

Men can also develop breast cancer, but it is very unusual. About 300 men die each year from the disease. Breast cancer results from malignant tumors which invade and destroy normal tissue. When these tumors break away and spread to other parts of the body, it is called metastasis. Breast cancers can spread to the lymph nodes, lungs, liver, bone and brain.

The risk of breast cancer increases above the normal risk with these factors:

• Having had cancer in one breast increases the risk for cancer in the other breast.
  
• Never giving birth or giving birth after age 30
  
• Early onset of menstruation (before age 12).
  
• Late menopause (after age 55).
  
• Family history of breast cancer, especially for mothers, daughters and sisters of women with breast cancer prior to menopause.
  
• Exposure to radiation.
  
• Diet high in fat.
  
• Diabetes.
  
• Recent Trauma.
  

Detection

Recommendations for mammograms vary among government and health organizations. Some favor screening before age 50. All suggest a mammogram every year or at least every two years after age 50. Any women who notices a lump in her breast or any of the other symptoms mentioned previously should see her doctor as soon as possible. Tests can be done to tell if cancerous cells are present. Also, make sure you have mammograms at facilities that are accredited by the American College of Radiology (ACR). Call The National Cancer Institute Hotline at 1-800-4-CANCER to find ones in your area.

s
Treatment

There are a variety of treatments for breast cancer. The main treatment is surgery. The removal of the cancerous area is most often recommended along with taking a sample of the lymph nodes in the armpit to see if the cancer has spread there. Other treatments are radiation therapy, chemotherapy and hormonal therapy. It is important to find out the type of cancer cell that is involved. If the cancer is a type which spreads quickly, a more extensive surgical treatment may be chosen.

Types of Surgical Procedures:

• Lumpectomy – the lump and a border of surrounding tissue are removed.
  
• Partial or segmental mastectomy – the tumor and up to one quarter of the breast tissue are removed.
  
• Simple or total mastectomy – the entire breast is removed.
  
• Modified radial mastectomy – the entire breast, the underarm lymph nodes and the lining covering the chest muscles, but not the muscles themselves, are removed.
  
• Radical mastectomy – the breast, lymph nodes in the armpit and the chest muscles under the breast are removed. Ask your doctor about the benefits and risks for each surgical option and decide together which option is best for you.
  

Question to ask

Do you see or feel any lumps, thickening or changes of any kind when you examine your breasts? For example, is there dimpling, puckering, retraction of the skin or change in the shape or contour of the breast?.
Do you have breast pain or a constant tenderness that lasts throughout the menstrual cycle? If you normally have lumpy breasts (already diagnosed as being benign by your doctor), do you notice any new lumps or have any lumps changed in size or are you concerned about having benign lumps?
Do the nipples become drawn into the chest or are they inverted totally, change shape or become crusty from a discharge?
Is there any non-milky discharge when you squeeze the nipple of either breast or both breasts?
Do you have a family history of breast cancer which leads you to be concerned, even if you don’t notice any problems when you examine your breasts?
Have you had recent trauma which resulted in a breast lump being formed?

How to Examine Your Breasts

It is normal to have some lumpiness or thickening in the breasts. By examining your breasts once each month, you will learn what is normal for you and notice when any changes do occur. Some women find that doing a daily or weekly self-exam works better for them. They learn their breasts at all phases of their menstrual cycle. The more you can examine your breasts, the better you can learn what is normal for you. Your job isn’t just to find lumps, but to notice if there are any changes.

In the shower – With your fingers flat, move gently over every part of each breast. Use your right hand to examine the left breast and your left hand to examine the right breast. Check for any thickening, hard lump or knot.

In front of a mirror– Check your breasts with your arms at your sides. Then raise your arms overhead. Look for any changes in the shape of each breast, swelling, dimpling or changes in the nipples.

Lying down – To examine your right breast, put a pillow under your right shoulder. Place your right hand behind your head. Then with the flat fingers of your left hand, press gently in small circular motions around an imaginary clock face. Begin at the outermost top of your right breast for 12 o’clock, then move to 10 o’clock, etc. until you get back to 12 o’clock. Each breast will have a normal ridge of firm tissue. Then move in one inch toward the nipple, including the nipple. Keep circling to examine every part of your breast including the nipple. Repeat the procedure on the left breast with a pillow under the left shoulder and your left hand behind your head. Finally, squeeze the nipple of each breast gently between the thumb and index finger. Any discharge, clear or bloody, should be reported to your physician immediately.

Self-Care/Prevention Procedures

For Cystic Breasts:

• Avoid caffeine in: Beverages such as coffee, tea, colas and ones with chocolate; chocolate; medicines such as appetite suppressants, and some pain relievers such as Extra Strength Excedrin, etc.
  
• Breast-feed your baby unless you have a medical reason not to do so. Do this for at least a year if possible.
  
• Exercise regularly. This can stimulate circulation to your breasts.
  
• Maintain a healthy body weight.
  
• Eat a low fat diet. If possible, your diet should be less than 25% of total calories as fat.
  
• Limit salt and sodium intake to prevent fluid buildup in the breasts.
  
• Don’t smoke and don’t use nicotine gum or patches.
  
• Take pain relievers such as aspirin, acetaminophen, ibuprofen or naproxen sodium.
  
  
  
  • [Note: Do not give aspirin or any medication containing salicylates to anyone 19 years of age or younger unless directed by a physician, due to its association with Reye’s Syndrome, a potentially fatal condition.]
    
  
  
• Wear a bra that provides good support. You may want to wear it while you sleep.
  
• For severe discomfort, apply ice packs to your breasts two to three times a day.
  

To help prevent breast cancer:

• Eat a low fat diet of 25% or less of total calories as fat. Focus on fresh fruits and vegetables, whole grains, etc.
  
• Eat vegetables that contain a substance called sulforaphane which may help protect against breast cancer.
  
  
  
  • Examples: Broccoli, cabbage, cauliflower and brussels sprouts.
    
  
  
• Avoid unnecessary X-rays. Wear a lead apron when you get dental X-rays and other X-rays not of the chest.
  
• Don’t smoke. Stop smoking if you do.
  
• Breast-feed your babies. This may reduce your risk for breast cancer, especially before menopause.
  
• Limit foods that are salt-cured, smoked and preserved with nitrites and nitrates.
  
  
  
  • Examples: Hot dogs, bacon, smoked sausage, ham.
    
  
  
• Limit alcohol.