Dear Concerned,

When a lump is found in a young woman, the health care provider initially suspects fibrocystic changes and not cancer. Fibrocystic changes occur in one quarter to three quarters of all women, and their cause is unknown. Conversely, breast cancer is extremely rare in young women.

The most common type of breast lump is a benign cyst. 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.

The second most common breast lump is a fibroadenoma. A fibroadenoma is a benign, fibrous tumor that 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 can 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 can 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.

The consensus is 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. Further investigation will clarify this finding.

If a woman is concerned about any changes in her breasts, a clinical examination is warranted. At that time, she can talk with her primary care provider about her personal risk for breast cancer. She can be prepared with information, resources, referrals, and support, to take any next steps, if they are needed.

Alice

P.S.:

Breast Self-Exam (BSE)

To effectively monitor any changes in your breasts, the American Cancer Society (ACS) recommends that, whether or not you menstruate regularly, a BSE be done at the same time every month, preferably one week after your period ends. This is when your breasts are not swollen or tender.

TO DO A BSE:

First, lie on your back with a pillow under your right shoulder, and your right arm behind your head. For your right breast, use the top one-third of the three middle fingers of your left hand and press firmly to feel for any lumps. Move your fingers in a circular motion. Switch pillow and arm position to check your left breast. Squeeze each nipple to check for any discharge.

Then, in the shower, raise your right arm and carefully examine your right breast using your left hand. Start at the top, outer edge of your breast and press your fingers firmly in a circular motion, feeling for any abnormal lumps in the underlying tissue. Once you've finished with the outer edge, move in an inch toward the nipple and repeat. Repeat this with your left breast. Also, check the area above your breasts and your underarms for any lumps or knots.

Lastly, stand in front of a mirror with your arms at your sides. Check your breasts for any color, size, and/or shape changes. Also, check for any dimpling or scaling on the skin. Do this check again with your hands on your hips, flexing your chest muscles (by pressing your shoulders and elbows forward). Then, do the check one last time with your hands raised above your head.

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