Breast Lumps

WHEN TO SEE YOUR DOCTOR

* You find any unusual lump, swelling, bulge or dimpling in one of your breasts.

What Your Symptom Is Telling You

When it comes to breasts, there's a lot that fits under the umbrella of "normal"—big, little, pear-shaped, downward drooping. Women's breasts look different, and they can feel different.

In a lot of women, the tissue at the base of each breast is thick and ridgy, giving it a bumpy or lumpy feel. For many women a certain amount of lumpiness is perfectly normal. In fact, it's quite common for women beyond age 40 to complain of lumpy breasts.

A woman's breasts can feel lumpier just before her menstrual period. At this time of the month, she experiences a surge in female hormones—estrogen, progesterone and prolactin. These hormones stimulate fibrous breast tissue to grow and retain fluid. Once her period starts, her body reabsorbs the excess tissue and fluid. But as a woman ages, a certain amount of excess fibrous tissue remains behind, making breasts feel lumpy. This lumpiness is often called fibrocystic breast disease, but many doctors are now saying it's wrong to refer to these lumps as a disease. They may, after all, simply be a natural part of an older woman's breasts.

Why all this talk about normal lumps? The answer is simple. Because breast cancer first announces itself in the form of a lump (unless it's detected early by mammography), women tend to panic when they find one. In fact, the vast majority of lumps are not cancerous.

A squishy, movable lump that feels like a grape and stands out from the general lumpiness is probably a cyst. These fluid-filled sacs are caused when milk ducts become plugged and do not drain. Cysts may be painful, but they do not cause cancer. And they usually disappear when your period arrives.

A lump that doesn't move and feels hard like a dried bean or pea is cause for concern. Hard, nonmovable lumps can (but don't always) contain cancerous cells.

Movable, marblelike lumps are probably noncancerous swellings known as fibroadenomas. Firm, irregular clumps of breast tissue are probably caused by a breast injury or a boil near the breast's surface. And a swollen wedge-shaped area near the nipple is probably an infected milk duct.

Symptom Relief

When it comes to lumps, don't second-guess yourself. If you find a lump that concerns you—or anything else about your breasts doesn't feel right—ask your doctor to examine it. Here are some things you should be aware of.

Have an expert educate your fingers.The best way to become familiar with the normal terrain of your breasts is to have a health professional examine your breasts along with you the first time, says Kerry McGinn, R.N., nurse coordinator at the Breast Care Center of the University of California, San Francisco, and author of The Informed Woman's Guide to Breast Health.

"Guidance from a doctor or nurse has saved many a woman from panicking when she discovers a large, hard lump—which happens to be a tip of a rib," she says.

Stick to a monthly schedule. This makes it easier to remember what your breasts felt like last month. The best time to perform a breast self-exam is a week to ten days from the first day of your period when your breasts are less tender and feel less lumpy, according to Rosalind Benedet, R.N., nurse practitioner with the Breast Health Center at the California Pacific Medical Center in San Francisco. If you no longer menstruate or you're taking hormone replacement therapy, do your breast exam on the first day of the month. No matter which method of self-examination you choose, it's a good idea to use it consistently. That way you'll be able to recognize any changes that occur.

Get flat on your back. Smaller lumps may be easier to detect—especially in large breasts—if you're lying down with one arm raised above your head. Using the pads of your fingers of the other hand, press firmly on your breast following a pattern of concentric circles outward from the nipple until you've examined the entire breast including the nipple and areola. You should also examine the area above the breast up to the collarbone and the underarm area. If you've gained or lost weight, you may encounter lumpiness that you never felt before. (A firm ridge in the lower curve of each breast is normal.)

Schedule a mammogram. Breast x-rays can find a lump two years sooner than you or your doctor can, studies show. Three-fourths of lumps that show up on mammograms turn out to be cysts, clumps of tissue or calcium deposits. The American Cancer Society recommends having the first mammogram at age 40, then having one every one to two years until age 50. After that you should have one annually.

Try the needle test. If you have a blisterlike cyst, your doctor may want to drain it with a needle in a simple office procedure. If it deflates—as is most likely—then you know that it's not cancerous, according to Robinson Baker, M.D., professor of surgery and oncology at Johns Hopkins University School of Medicine in Baltimore.

Prepare for further diagnostic tests. If the cyst doesn't drain, you may be sent for a mammogram or ultrasound, which will help determine the shape and size of the lump. Your doctor may then perform a needle biopsy—surgical removal of a tissue sample—to analyze your breast cells for any abnormalities.

"A biopsy is the only definitive way to diagnose a lump," says Dr. Baker. If the lump is small, the surgeon may remove the whole thing during a biopsy. If it's a large lump, only a section is removed for analysis. If cancer is found, then you and your doctor can decide between a lumpectomy—which removes the lump plus the surrounding margins of healthy tissue and underarm lymph nodes—or a mastectomy—removal of all or part of the breast.

Plan to Stay Lump-Free

By limiting factors that influence excess estrogen production, you may be able to prevent lumpiness. Here are some tips.

Swear off high-fat foods. Fats promote breast growth and fluid retention, according to Susan Lark, M.D., director of the PMS and Menopause Self-Help Clinic in Los Altos, California, and author of Premenstrual Syndrome Self-Help Book and Menopause Self-Help Book. "Fat converts to estrogen, a tissue promoter in the breast and also increases fluid and salt retention, worsening cysts," she notes. She recommends adopting a diet based on whole grains, fruits and vegetables to help prevent lumpiness.

Make friends with bran flakes. Boosting your intake of fiber-rich foods can help absorb excess estrogen and move it out of the body. "If estrogen is not eliminated and remains in high levels in the body, it will promote fluid retention and stimulate the development of breast lumps," explains Dr. Lark. Again, the ideal diet consists mainly of whole grains, fruits and vegetables.

Lose excess pounds. "Try to maintain your ideal weight for your height," says Robert London, M.D., assistant clinical professor of obstetrics and gynecology at Johns Hopkins University School of Medicine in Baltimore. Obesity is linked with higher blood estrogen levels, he says, and also places you at a greater vulnerability to breast cancer.