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The breast is a lumpy organ to begin with.
It's just very lumpy particularly in the upper outer
quadrants, which is what we call the area of the breast that's
closest to the armpit.
So often very lumpy in that location,
it can be lumpy throughout the breast.
So that's part of the normal features of breast tissue.
What you're looking for
is something that's a lump within that lumpy breast tissue.
And so sometimes it can be very hard to tell because the breast
is so lumpy.
And there are cycles of lumpiness that happen with
the menstrual cycle also.
The breast can be more lumpy right before you cycle and
then get better afterwards, and that's completely normal.
If you feel something that you feel before your period and
it goes away then that's just normal for breast tissue.
So it's constantly making more tissue during the cycle to get
ready to produce milk for a baby, and
that can be very lumpy.
It can be sore and tender also.
If you feel something that you feel after your period is over,
it persists then you should pay attention to that.
That's something to pay attention too.
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It can be very difficult to distinguish cancer from normal
tissue, but cancer typically is very hard.
Feels like a rock in something like tapioca.
The breast is lumpy to start with but
if you feel something that just doesn't feel like it belongs,
it feels different than all the other lumpiness,
then that's something to pay attention to.
If it does go away then it can't be cancer.
Cancer just doesn't come and go, it just stays there,
it can get larger and it may not hurt at all.
So that's something that's very unusual I think.
We're used to paying attention to things that hurt.
Cancer usually doesn't hurt, so
if you have a firm mass in the breast that doesn't hurt
than that's something definitely pay attention to.
If you're still having periods, you can wait until after your
cycle and see if it's still there.
If you're no longer having periods,
if you're past the menopausal age and
you feel a lump you should pay attention to that.
Bring that to your doctor's attention.
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So what you would do if you feel a lump that is persistent
through your cycle or
if you're past having menstrual cycles and you feel something.
Give your doctor a call and go in and
what the doctor would do is a clinical breast exam or
a physical exam of the breast to check out the lump.
And then they usually,
the next step is to go to an imaging center.
The imaging center then would do imaging mammogram,
ultrasound typically are what's used.
The other alternative course, instead of an imaging center
would go straight to the breast surgeon and
some gynecologists or your family doctor,
whoever is your health care provider might say to you,
I would like you to go to the breast surgeon first.
But typically and especially here at Johns Hopkins, we do
start with imaging first before recommending breast surgery.
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So when you come to the imaging center with a lump, we'll start
with doing a mammogram if you're over 30 years old.
So the mammogram is our first line of choice for
an imaging study to evaluate a lump.
We put a little marker on the lump.
We do a standard mammogram and maybe some additional views.
If you're under 30 we actually start with ultrasound first.
We know that mammogram uses radiation dose,
it's small and it's actually less than the background dose
that we get from the sun.
So we know it's a small does, but still we know that the young
breast is more sensitive and so if you're under 30 years old,
we do start with an ultrasound first.
And typically women under 30, it's a very low chance that
that mass or lump is a cancer, that's a relatively low chance.
So we start with an ultrasound first and we'll determine
whether it's a solid a mass or a cyst, and then what we should do
from there based on what that information is.
And then if we start with the mammogram first,
if the mammogram is completely normal then we'll go on to
an ultrasound and see if we can identify if it's a cyst or
a solid mass.
If we see a mass on a mammogram we also do an ultrasound.
Same thing again, we wanna see if it's cystic of a solid mass.
And then the solid mass may very well be benign.
Most solid masses are.
Most solid masses are not cancer.
If we can feel based on looking at the ultrasound and
the mammogram that it's a 98% chance
that it is not cancer then we may follow it.
The most common thing we find is what's called a fibroadenoma.
And those are not cancer, they don't turn to cancer.
They can grow and you were born with it.
You developed it.
That doesn't necessarily have to be removed.
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The most common lump that we find is actually normal tissue.
Most women who come in with a lump that they are feeling,
it turns out to be normal.
Just normal lumpy breast tissue.
I would say the next most common thing is probably
the breast cyst.
So what the cysts is it's just an envelope of
water in the breast.
It's a thin rim of cells that has made fluid and
that is sitting in the breast tissue.
The breast basically is an organism that makes fluid
for a living.
That's what it's there for, and so for it to make fluid and
it form into a cyst is really completely normal.
But of course it feels like a lump or it can feel like a lump.
And they can get quite big, the size of a golf ball or
they may be very small.
So a cyst is just water.
It's not cancer.
It won't turn to cancer.
The only thing we can use to be sure about that actually is
the ultrasound.
So ultrasound very, very useful for the definition of a cyst to
find and make sure that it's just a simple cyst.
The solid mass is the third thing.
So it's either normal tissue, a cyst or
it could be a solid mass.
Most solid masses are actually not cancer.
So most are what we call the fibroadenoma.
It's got a lot of cousins, but a lot of these benign masses
that don't really need to be removed.
We sometimes will do a needle biopsy to prove that it's
a fibroadenoma, that it's not a cancer and again,
doesn't turn to cancer.
Then of course,
the next most worrisome thing is the actual cancer.
That's also a possibility when you feel a lump.
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So the next step if we confirm that it looks suspicious to us.
So that would be greater than 2% chance that it could be cancer,
then we'll want to find out what it is for sure.
We can do a needle biopsy in the imaging center
to make that diagnosis.
In the old days again the old days, not that long ago you
would go to a surgeon, and the surgeon would remove it and
that's what's called an open biopsy.
But right now,
what we do is what we call an image guided needle biopsy.
Where we numb your skin, and then put a needle inside to just
get a little bit of cells or a little core of tissue or
several cores of tissue from inside the mass.
The pathologists then can interpret that tissue as
if they had the whole mass under the microscope.
So they can make a rock solid diagnosis just from a few
cores of tissue from inside the mass.
So that's very valuable, because most masses even the ones that
we're concerned about on an imaging basis are not cancer.
Most are benign and would not need surgery.
So if we can spare you from going to the operating room and
having that mass removed when it didn't need to be removed,
we'd like to do that.
So the image guided biopsy is the next step.
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