So you’ve found a lump. What now?

Posted on 7 October 2014

During your own monthly breast lump self-exam, you may feel a lump under the skin. At this stage, it’s important not to panic – it may not be breast cancer but you’ll need to get it checked out by a doctor immediately. Here’s what to expect…

Step 1: See your doctor
Early detection saves lives, so as soon as you feel a lump in your breast – even if it’s tiny and you have no family history – seek medical attention as soon as you can. Your GP will not only ask you questions about your family history but also see if any of the other symptoms of breast cancer are present. According to CANSA’s Breast Cancer Fact Sheet, authored by Professor Michael Herbst, these are:
• General pain in or on any part of the breast.
• Irritated or itchy breasts.
• Presence of a lump in or near the breast or in the under-arm area.
• Thickening in or near the breast or in the under-arm area.
• A change in the size or shape of the breast.
• A dimple or puckering in the skin of the breast.
• A nipple turned inward into the breast.
• Fluid, other than breast milk, coming from the nipple, especially if it is bloody.
• Scaly, red, or swollen skin on the breast, nipple, or areola (the dark area of skin that is around the nipple).
• A change in breast colour.
• Changes in touch – the breast may feel hard, tender or warm.
• Changes in the appearance of one or both nipples.
• Dimples in the breast that look like the skin of an orange.
• Skin changes, such as swelling, redness, or other visible differences in one or both breasts.

Your GP will also do a breast exam to see if she can feel the same mass that you do. If she does, in combination with the rest of your symptoms, he/she will refer you to your nearest radiography department for a specialist to conduct a mammogram.

Step 2: The mammogram and other diagnostic tools
A mammogram is basically an x-ray of your breast tissue to see if there are any lumps or nodes present within the tissue. If your diagnostic mammogram reveals a dark mass, then you’ll need to undergo further tests to confirm diagnosis. These may involve the following: a breast ultrasound, magnetic resonance imaging (MRI), blood tests to check hormones and genetic markers, and a surgical biopsies of the lump/skin/affected tissue. Results of the mammogram are available immediately and, if the mass is worrying to the specialist who assesses your results, she’ll recommend a combination of these other diagnostic interventions to investigate further.

Step 3: Sampling the lump
It’s vital to remember that not all breast lumps are cancerous – but they do all need to be checked out! According to the American Cancer Association website, ‘non-cancerous breast conditions are very common, and they are never life threatening. The two main types are fibrosis and/or cysts, and other non-cancerous or benign breast tumors.’ Fibrosis is a thickening of the connective tissue of the breast, cysts are fluid-filled sacs and tumors are abnormal cells that gave grown into a solid lump/s.

According to CANSA’s Breast Cancer Fact Sheet, surgical biopsies that are useful in the diagnosis of breast cancer can include:
• Fine needle aspiration biopsy: using a thin needle to remove cells or fluid from a breast lump.
• Core biopsy: using a wide needle to remove a sample of breast tissue.
• Skin biopsy: in the case of skin changes, a small sample of skin is removed.
• Surgical biopsy: removing only a sample of tissue.
• Incisional biopsy: taking out a part of the lump or abnormal area.
• Excisional biopsy: taking out the entire lump or abnormal area.
The samples taken during any one of these procedures will be sent away to a laboratory for testing so the results may not be immediately available.

Step 4: Diagnosis and treatment plan
If it’s not malignant: Continue doing your monthly breast self-exams and get regular mammograms done as a precaution. You may require surgery to remove non-cancerous tumors but your doctor will advise you on the next steps.
If it is malignant: You’ll most likely be referred to a breast cancer specialist or an oncologist so they can work out the best treatment plan for you – and your type of breast cancer.

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The information provided in this article was correct at the time of publishing. At Mediclinic we endeavour to provide our patients and readers with accurate and reliable information, which is why we continually review and update our content. However, due to the dynamic nature of clinical information and medicine, some information may from time to time become outdated prior to revision.