Evaluating Breast Lumps

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Evaluating Breast Lumps

Question:

If a woman finds a nodule on her breast, does it have to be removed immediately? Does it matter if it is cystic?

Answer:

Anytime you discover a breast lump, you should see a doctor. But finding a lump does not always mean you will need a biopsy or surgery. This is especially true if the lump appears to be a simple cyst.

Breast lumps are common in women, especially during their reproductive years (between puberty and menopause). When there are multiple small lumps, they are almost always noncancerous (benign).

A single lump is a little more concerning. But most are benign. This is especially true when you are younger.

My approach is to examine the area where the woman feels the lump. I then do a full exam of both breasts and check the armpits for lymph node swelling. If I feel the lump, the next step often depends on the woman's age and when her next menstrual period is due.

The choices may include:

• Repeating the breast exam at the end of the next menstrual cycle

• Inserting a fine needle into the lump. If it is a cyst, fluid will come out.

• Sending the woman for an ultrasound or mammogram

If I don't feel the lump, I will have the woman return again next month, or order a mammogram or ultrasound during this visit.

Whenever a woman feels a persistent lump in the same spot in her breast, she should have it evaluated. This is true even if a prior exam suggested there was nothing to worry about.

Howard LeWine, M.D., is chief editor of Internet Publishing at Harvard Health Publications. He is recognized as an outstanding clinician and teacher and is a recipient of the Internal Medicine Teacher of the Year award at Brigham and Women's Hospital. Dr. LeWine continues to practice Internal Medicine; most recently he became a hospitalist after practicing primary care for over 20 years.

Last updated:	July 20, 2009