October is National Breast Cancer Awareness Month. Other than skin cancer, breast cancer is the most common cancer in American women. It also is the second leading cancer killer of women, after lung cancer. Every woman has a chance of getting breast cancer. About one in eight women will find out she has breast cancer at some point in her life. This might sound scary. But today, most women with breast cancer survive it. With breast cancer screening, doctors often can find cancer early when treatment has the best chance of success.
You may have received an abnormal mammogram result, or perhaps your health care provider found a breast lump or other breast change. Keep in mind that breast changes are very common. Most breast changes are not cancer, but it’s very important to get the follow-up tests that your health care provider recommends.
Breast and Lymphatic System Basics
To better understand breast changes, it helps to know what the breasts and lymphatic system are made of. Breasts are made of connective tissue, glandular tissue, and fatty tissue. Connective tissue and glandular tissue look dense, or white on a mammogram. Fatty tissue is non-dense, or black on a mammogram. Dense breasts can make mammograms harder to interpret. Breasts have lobes, lobules, ducts, an areola, and a nipple.
- Lobes are sections of the glandular tissue. Lobes have smaller sections called lobules that end in tiny bulbs that can make milk.
- Ducts are thin tubes that connect the lobes and lobules. Milk flows from the lobules through the ducts to the nipple.
- The nipple is the small raised area at the tip of the breast. Milk flows through the nipple. The areola is the area of darker-colored skin around the nipple. Each breast also has lymph vessels.
Check with your health care provider if you notice that your breast looks or feels different. The best time to call is when you first notice a breast change. Do not wait until your next mammogram.
Breast changes to have checked by your doctor include:
Normal Breast Changes
- A lump or firm feeling in or near your breast
- A lump under your arm
- Thick or firm tissue in or near your breast or under your arm
- Change in the size or shape of your breast
- Skin on your breast that is itchy, red, scaling, dimpled, or puckered
- Nipple discharge (fluid that is not breast milk) that comes out by itself
- Nipple changes (such as a nipple that points inward into the breast)
Before or during your menstrual periods, your breasts may feel swollen, tender, or painful. You may also feel one or more lumps during this time because of extra fluid in your breasts. These changes usually go away by the end of your menstrual cycle.
During pregnancy and breast-feeding, your breasts may feel lumpy. This is usually because the glands that produce milk are increasing in number and getting larger. Sometimes a milk duct becomes blocked, causing the breast to look red and feel lumpy, warm, and tender. It may be caused by an infection and is often treated with antibiotics.
As you approach menopause, your hormone levels change. This can make your breasts feel tender, even when you are not having your menstrual period. Your breasts may also feel more lumpy than usual.
Finding Breast Changes
A self-exam will help you learn how your breasts normally feel and make it easier to notice and find any changes early. Breast self-exams are not a substitute for mammograms.
Clinical breast exam:
During a clinical breast exam, your health care provider checks your breasts and nipples and under your arms for any abnormal changes. Ask your health care provider at what age and how often you should have a clinical breast exam. During the visit, it’s important to share your personal medical history and your family medical history. This includes problems or diseases that you or family members have had.
A mammogram is an x-ray picture of your breast tissue that can be used for both screening and diagnosis. This test may find tumors that are too small to feel. During a mammogram, each breast is pressed between two plastic plates. Some discomfort is normal, but if it’s painful, tell the mammography technician. The best time to get a mammogram is at the end of your menstrual period when your breasts are less tender.
If you have breast implants, be sure to inform the staff when you schedule your appointment so a specialist who is trained in taking and reading mammograms of women with breast implants is available. This is important because breast implants can make it harder to see abnormal changes on the mammogram. A special technique called implant displacement views is used.
If you have breast implant(s) after having a mastectomy for breast cancer, talk with your breast surgeon or oncologist to learn about the best screening test for you.
What can a mammogram show?
Mammograms can show lumps, calcifications, and other changes in your breast. The radiologist will study the mammogram for breast changes that do not look normal and for differences between your breasts. When possible, he or she will compare your most recent mammogram with past mammograms to check for changes. Mammography is a good tool to find breast changes in most women who have no signs of breast cancer. However, it does not detect all breast cancers, and many changes it finds are not cancer.
Most breast changes and conditions that are found by a woman or during a mammogram are not breast cancer. Conditions that are benign changes and do not increase your risk of breast cancer include:
Conditions that are considered risk factors for breast cancer include:
- Adenosis—enlarged breast lobules
- Cysts—lumps filled with fluid
- Fat necrosis—round firm lumps; usually without pain
- Fibro adenomas—hard round lump that moves easily
- Intraductal papilloma—a wart like growth; can cause pain and include discharge
Breast conditions that may become cancer:
- Atypical hyperplasia (ALH): abnormal cells in the breast lobules
- Atypical ductal hyperplasia (ADH): abnormal cells in the breast ducts
- Lobular carcinoma in situ (LCIS): Abnormal cells in the breast lobules, more than ALH but have not spread outside the breast lobules, it’s called “in situ,” meaning in place.
Breast cancer cells form in the tissue of the breast. Breast cancer cells:
- Ductal carcinoma in situ (DCIS): abnormal cells in the lining of the breast duct
Follow-up Testing After an Abnormal Mammogram
- Grow and divide without control
- Invade nearby breast tissue
- May form a mass called a tumor
- May metastasize, or spread, to the lymph nodes or other parts of the body
After an abnormal mammogram, additional follow-up tests may be needed to learn more.
An ultrasound exam uses sound waves to make a picture of breast tissue. This picture is called a sonogram. It helps radiologists to see if a lump or mass is solid or filled with fluid. A fluid-filled lump is called a cyst.
Magnetic resonance imaging uses a powerful magnet, radio waves, and a computer to take detailed pictures of areas inside the breast.
A breast biopsy is a procedure to remove a sample of breast cells or tissue, or an entire lump. A pathologist then looks at the sample under a microscope to check for signs of disease. A biopsy is the only way to find out if cells are cancer.
- Fine-needle aspiration biopsy: A fine-needle aspiration biopsy is a simple procedure that takes only a few minutes. Your health care provider inserts a thin needle into the breast to take out fluid and cells.
- Core biopsy: A core biopsy, also called a core needle biopsy, uses a needle to remove small pieces or cores of breast tissue. The samples are about the size of a grain of rice.
- Vacuum-assisted biopsy: A vacuum-assisted biopsy uses a probe, connected to a vacuum device, to remove a small sample of breast tissue. The small cut made in the breast is much smaller than with surgical biopsy.
- Surgical biopsy: A surgical biopsy is an operation to remove part, or all, of a lump so it can be looked at under a microscope to check for signs of disease.
It can be upsetting to notice a breast change, to get an abnormal test result, or to learn about a new condition or disease. Ask friends or loved ones for support and take someone with you while you are learning about your testing and treatment choices. Ask your health care provider to explain medical terms that are new or confusing. Have them share with you how other people have handled the types of feelings that you are having and tell you about specialists that you can talk with to learn more.
Most doctors welcome a second opinion, especially when treatment is involved. Getting a second opinion is often covered, or even required, by your health insurance. Talking with another doctor can give you peace of mind. It can also help you make the best choices about your health.
Do you know someone with breast cancer or would you like to volunteer some of your time to help women with breast cancer? Here’s several organizations that offer much needed support, resources, and free services to help women dealing with a breast cancer diagnosis. The women behind these organizations felt compelled to “do something” after they saw the need during their own cancer journey; so reach out to them—let them help.
My Hope Bag: www.myhopebag.org
or 480-987-0204, providing bags of hope and comfort, as well as resources and wellness education for those diagnosed with breast cancer in Arizona.
Cleaning for a Reason: www.cleaningforareason.org
or 877-337-3348, gives woman fighting cancer the amazing gift of free house cleaning.
Don’t be a Chump, Check for a Lump: www.checkforalump.org
or 602-688-5232, offers free wigs and mammograms.
Barbara’s Mastectomy Boutique: www.barbarasmastectomyboutique.com
or 602-234-9568, has a wide array of products available to purchase; designed to help women look and feel better after breast surgery.
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