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You Found a Breast Lump: What Happens Now?

It’s every woman’s worst fear: finding a lump in your breast. Before you panic, get advice from experts on the next steps to take.

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One reason is that for many women -- particularly young women -- the next step won't be a mammogram at all, but an ultrasound exam; it's a painless, radiation-free way of determining if the lump is a mass or a harmless, fluid-filled cyst.

"If it's a cyst, testing stops here; there is nothing to fear," says Lehman.

Moreover, if a mammogram does become necessary, and particularly if it's been a year or more since your last one, Lehman says an ordinary screening mammogram won't do.

"It takes only four pictures, two of each breast. A diagnostic mammogram uses the same equipment and technique but focuses intently on the area of concern, compressing tissue and magnifying the images so that we can get a much more detailed look," says Lehman.

With the advent of digital mammography -- which, much like your digital camera, uses electronic imaging rather than film -- pictures can be computer-manipulated, making them even cleaner, clearer, and some say easier to read.

"In the area of screening, but particularly in diagnosis of breast abnormalities, digital is one of the exciting and very promising new technologies," says Perkins.

Is It Cancer? How to Know for Sure

Once it's established that your lump is not a cyst, the next step is to rule out other noncancerous lesions, such as fibroadenoma (benign tumor) or intraductal papilloma (small, wart-like growth in a milk duct).

This is frequently accomplished by testing the suspicious area for the presence of cancer cells.

For many years, this routinely meant surgery -- which, when cancer wasn't found, became a harshly unnecessary procedure.

Today, however, the advent of minimally invasive biopsy is changing the way breast cancer is diagnosed. It began with the development of ultrasound guided core needle biopsy -- an in-office procedure that can diagnose cancer.

"Using the real-time ultrasound image as a guide we insert a slender needle into the breast and suck out a small sampling of cells which we test for cancer," says Jules Sumkin, DO, professor of radiology and chief of radiology at Magee Women's Hospital in Pittsburgh.

In the event that the lesions can't be seen on ultrasound -- which Sumkin says occurs about a third of the time -- a similar procedure known as a "stereotactic needle biopsy" uses a mammogram to guide the procedure.

"In this instance we insert the needle and then scan the breast with the mammography equipment to ensure accuracy," says Sumkin.

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