American Medical Association Family Medical Guide - American Medical Association [575]
Fibrocystic breasts
Some women have a condition called fibrocystic breasts, in which they have several small lumps and cysts in one or, usually, both breasts. This is not a disease. However, women who have fibrocystic breasts should become familiar with the location and size of these lumps through regular breast self-examinations so they can recognize any changes and bring them to their doctor’s attention.
Fibroadenomas
Fibroadenomas are solid lumps that are firm and rubbery and can be moved around easily. Fibroadenomas seldom cause pain and don’t change in response to hormonal fluctuations during the menstrual cycle, although they can sometimes grow larger during pregnancy or breastfeeding. Doctors only remove them when they are unusually large, when they do not appear to be characteristic benign fibroadenomas on an image (such as a mammogram or ultrasound), or if cells taken in a needle biopsy look abnormal. If a needle biopsy confirms that a lump is a benign fibroadenoma, it is not removed but is monitored regularly for changes.
Diagnosis
If you still feel the lump after a menstrual cycle, see your doctor, whether or not the lump is painful. You should also see your doctor if a lump you have had for a long time becomes painful or feels different in some way (such as harder or bigger).
Your doctor will examine both breasts and, if the lump feels suspicious, recommend that you have a diagnostic mammogram to evaluate it. The radiologist who studies your mammogram may suggest that you have an ultrasound (see page 111) to determine if the lump is a harmless cyst or a solid mass of tissue that could be cancerous. The radiologist may also recommend taking a sample of tissue from the lump for examination under a microscope for cancer cells (biopsy).
Needle aspiration or biopsy
If you have a lump that looks like a cyst but the doctor is not absolutely sure is a cyst, he or she may recommend withdrawing fluid from the lump with a needle. The doctor locates the lump with his or her fingers and, often guided by ultrasound, inserts the needle into the lump. If fluid comes out, the lump is a cyst, and it will collapse as the fluid is removed. If no fluid comes out, the doctor may then use a larger needle to withdraw tissue from the lump to examine it for cancer cells.
Treatment
The treatment for a breast lump depends on the nature of the lump. If a lump is proven to be a cyst on an ultrasound, it does not need to be aspirated (unless it is causing pain). If a lump does not look like an obvious cyst on a mammogram or ultrasound, the doctor may try to withdraw fluid from the lump through a needle (called needle aspiration; see illustration below left). If it is a cyst, which contains fluid, the cyst usually collapses and disappears when the fluid is withdrawn.
If the cause of a lump (or lumps) is thickening of the glandular tissue in the breasts from fibrocystic changes, treatment is not necessary. However, if the lump feels tender or painful, wearing a bra that provides firm support can help reduce breast tenderness. For some people, limiting their intake of caffeine seems to reduce breast pain. If your breasts are very painful, your doctor may prescribe sex hormones or other medications to reduce the hormone fluctuations that are affecting the lumps.
If a mammogram or ultrasound suggests that the lump could be a cancerous or precancerous tumor, your doctor will recommend a needle biopsy (see illustration), in which a sample of tissue is removed from the tumor through a needle for examination under a microscope for cancer cells. If the cells are found to be cancerous, the lump will need to be removed. The type of surgery depends on the nature of the tumor. If the lump is found on a biopsy to be noncancerous, it does not need to be removed, but the doctor will want to examine it regularly