A breast lump felt by a patient or on a clinical exam should always be further evaluated. A breast lump ignored or allowed to grow can lead to late diagnosis of breast cancer with consequent poorer outcome. About 5% of all breast lumps are cancerous, this percentage is higher in women over the age of 50 years and lower in women under 35 years of age. A breast ultrasound and a diagnostic mammogram is needed to fully evaluate the cause of any type of a palpable abnormality in the breast. In women under the age of 30 years a breast ultrasound is the initial test performed based on current practice guidelines, in women over the age of 30 years a diagnostic mammogram is followed by a breast ultrasound.
What causes palpable lumps in the breast?
Common causes of palpable lumps include fluid filled cysts, fibrocystic changes, benign solid tumors of the breast such as a fibroadenoma, a normal ridge of tissue, and an enlarged lymph node. In addition, based on certain underlying conditions, trauma or an infection can also present as a painful lump. These common causes are readily diagnosable by ultrasound. In combination with a diagnostic mammogram an ultrasound can accurately rule out cancer as the cause of a lump in greater than 98% of cases.
https://www.ncbi.nlm.nih.gov/pubmed/12418762?dopt=Abstract
J Ultrasound Med. 2002 Nov;21(11):1211-6 Prospective evaluation of the value of negative sonographic and mammographic findings in patients with palpable abnormalities of the breast. Shetty MK, Shah YP
I feel a lump in my breast, not sure it is real, what next?
When you feel a lump, or think you feel a lump, call your doctor and get tested. You will need to be evaluated by a diagnostic mammogram and an ultrasound, it is nearly impossible to determine if a true palpable lump is non-cancerous based on a physical examination, an ultrasound is a must, Potential small curable cancers can be missed or diagnosed late if attention is not promptly sought when a breast lump is discovered. Self-referral to a breast center is not an option as it is for a screening mammogram. Diagnostic mammogram and a breast ultrasound requires a Physicians order. A breast lump is a sign that should never be ignored or delayed in reporting.
What if my lump shows up as a solid tumor on an Ultrasound?
Based on the features of the tumor on ultrasound, the breast imaging specialist will determine the need for an outpatient needle biopsy. Tumors that appear benign will be managed by follow up ultrasound every 6-12 months for up to 3 years.
A small palpable lump investigated by a breast ultrasound shows a 4-mm cancerous tumor.
