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.
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.
More Diagnostic Advances
As successful as needle biopsy is, it does have some limitations.
"The needle is very small and thin, and getting a sample can be difficult.
Or on occasion sampling is inconclusive," says Lehman. This, she says,
sometimes results in an unnecessary surgical biopsy.
By the late 1990s however, doctors had another tool -- vacuum-assisted
biopsy. Instead of just removing cells, the addition of suction and a larger
needle allowed for the removal of actual tissue fragments.
"This enabled us to get a better sampling in less time and in some
instances, have a better, more accurate diagnosis," says Gail Starr, MD,
director of breast imaging at Hackensack University Medical Center.
Moreover, two very recent advances further improved the technology. The
first is the MRI-guided vacuum-assisted biopsy.
"This is the really big advance because before this, we did not have the
ability to biopsy things we could only see on an MRI. But now we can, without
having to resort to surgery," says Sumkin.
Even more recently researchers developed BLES -- short for breast lesion
excision system. This removes not just fragments, but larger pieces of tissue.
Some believe this may be a more accurate biopsy for women diagnosed with
atypical ductal hyperplasia (ADH) -- abnormal cells in the breast that increase
their risk of cancer.
"The reason this kind of technology is particularly exciting is because it
is moving us closer towards the goal of removing an entire cancer without
fragmenting, which in turn would give us the ability to move breast cancer
treatment from the surgical [operating room] to the doctor's office," says
But even with the technologies available now, Lehman tells WebMD, she is
concerned that too many American women are still being led to believe surgical
biopsy is their only option.
"It's important that women understand that in all but a few rare instances,
diagnosing breast cancer should not have to involve surgery," says Lehman.