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Dear Alice,
My doctor found a lump in my breast recently. She told me not to worry, but have it checked out soon, by another doctor. She said that it did not feel cancerous, but may be a cyst or fibroadenoma. Can you tell me about what these are exactly, and does this mean a greater chance for breast cancer later in life? What should I expect? Thanks for your help.
—Concerned
Dear Concerned,
Finding a breast lump or mass may be a worrisome experience, but rest assured not all lumps are cancerous. Fibrocystic changes occur in one quarter to three quarters of all women, and their cause is unclear.
A benign cyst is the most common type of breast lump. A cyst develops in the breast when small sacs fill with fluid or semi-fluid material. The size of the cyst may fluctuate during the course of a menstrual cycle. During ovulation and before menstruation, hormone levels change, causing breast cells to retain fluid. If a woman examines her breasts during these times, she may find a series of cysts in one or both breasts — especially in the areas near the underarms. These lumps may be present from a woman's very first period, or may develop in her twenties or thirties, but they are more commonly found in women nearing menopause. Sometimes, the lumps feel a little sore or tender due to pressure, but they are harmless. Cysts usually resolve on their own. If they don't, a health care provider may drain the fluid using a fine needle. For recurrent cysts, other options, such as surgery, are considered. The presence of multiple cysts in the breast makes examination and differentiation between normal and abnormal lumps more difficult.
A fibroadenoma is the second most common breast lump. A fibroadenoma, a benign, fibrous tumor, does not fluctuate with menstruation. Fibroadenomas are painless, firm, round mobile lumps that are usually solitary. They occur most often in adolescent and young women under thirty and are more common in black women. Infrequently, multiple fibroadenomas may develop in one or both breasts. These lumps do not disappear and will continue to grow slowly. Rapid growth may occur under the influence of estrogen during adolescence or pregnancy. The average size is one inch in diameter. Surgical removal is generally recommended, though conservative management is appropriate in some cases. If removed, it may be done with either a local or a general anesthetic. After removal, the lump is examined by a pathologist to confirm the diagnosis of fibroadenoma as well as to rule out the small chance of a precancerous breast tumor.
Scientific consensus indicates that benign fibroadenomas and breast cysts are not associated with an increased risk of developing breast cancer. However, studies have demonstrated an association between increased breast cancer risk and multiple breast biopsies.
To effectively monitor any changes in your breasts, the American Cancer Society (ACS) recommends that, whether or not you menstruate regularly, a breast self-examination (BSE) be done at the same time every month, preferably one week after your period ends when your breasts are not swollen or tender. For instructions on how to perform a BSE, check out the ACS website.
If you are concerned about any changes in your breasts, a clinical examination is warranted. At that time, you can talk with your primary care provider about your personal risk for breast cancer. Columbia students can make an appointment with Primary Medical Care Services online through Open Communicator or by calling x4-2284. Your provider can make necessary referrals, offer support, and hopefully put your breast concerns at ease.
