Last updated: Sep 14, 2015
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Six years ago, Andrea Hutton was in the shower, going through the motions of her habitual self-exam, when she discovered a lump in her right breast, just above the nipple. "It seemed different from anything I'd ever felt before," she recalls. "It was rounder, harder—like a pebble." Andrea's primary care doctor sent her for a diagnostic mammogram, and after a few weeks (and more tests), the mother of two and interior designer from Bellevue, Wash., had her fears confirmed: stage 4 breast cancer. She was 41.


The lead-up to Andrea's diagnosis isn't uncommon. Research indicates that about 40 percent of breast cancer patients discover their tumors themselves, either by accident or during a self-exam. The good news: If you do find a mass, the odds are in your favor, says Elisa Port, MD, chief of breast surgery and co-director of the Dubin Breast Center at Mount Sinai Hospital in New York City. An estimated 80 percent of breast lumps turn out to be benign.

RELATED: 25 Breast Cancer Myths Busted

This happened to Aleisha Gore—twice. The 40-year-old writer and filmmaker from Woodland Hills, Calif., felt a lump at age 30, then went through the ordeal again a decade later. In both cases testing revealed the masses weren't cancer. But even situations that end happily can be stressful to navigate.

That's why we talked to some of the country's leading experts to help take the mystery out of the process. After all, the more you know, the more empowered you'll feel to be your own best advocate.

Here's exactly what you should do—and what happens next—when you feel something suspicious in your breast.

Step 1: Check the calendar
Is your period due within a week? The lump may just be a cyst—a small, fluid-filled sac. For some women, premenstrual hormone surges can cause cysts to grow. Chances are your gyno will ask you to wait to see if it goes away on its own after your period, says Mary Jane Minkin, MD, clinical professor of obstetrics and gynecology at Yale School of Medicine.

However, if you're in the middle of your cycle (or you're postmenopausal), call your gynecologist, even if you're due for a mammogram soon. While you wait for your appointment, take some notes, suggests Hollye Jacobs, RN, a breast cancer survivor who wrote a patient guide called The Silver Lining. How long has the lump been there? Is it getting bigger or smaller? Is it painful? Does it move when you push it? Those details can be helpful at your exam.

Step 2: See your doctor
Your gynecologist will feel the lump herself, and there are a few things she'll check for. "Breast cancers are typically hard, similar to the consistency of a frozen pea," says Holly J. Pederson, MD, director of breast services at the Cleveland Clinic. But tumors come in all shapes and sizes, so if your lump persists, no matter what it feels like, you'll need further testing. Don't let a doc tell you it's nothing, urges Dr. Pederson: "Insist on further evaluation."

RELATED: 12 Things That Probably Don't Increase Breast Cancer Risk

When Cathy White found a lump at age 22, her primary doc brushed it off as "probably just extra fat." Still concerned, the administrative assistant from La Mirada, Calif., booked regular follow-ups with a breast specialist. Three months later, she finally got a referral for further tests. The diagnosis: stage 2 breast cancer.

"Even in this day and age, many women aren't taken seriously by providers, who will say, 'You're too young,' or 'You just had a mammogram,'" says Dr. Pederson. But mammograms don't pick up all tumors, and interval cancers—tumors that appear within a year of a negative mammogram—tend to be more aggressive. Bottom line: If you're worried, always seek a second opinion.



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Step 3: Get the right tests
You'll start with imaging tests, which give your doctor a look at the lump. If you're over 30, your doc will likely recommend both a focused ultrasound and a diagnostic mammogram. "The ultrasound provides information about the lump—such as whether it's solid or a cyst," says Debra Monticciolo, MD, chair of the Commission on Breast Imaging at the American College of Radiology. "A mammogram may reveal other suspicious findings, like calcifications, and can help characterize the borders and density of the mass."

For the ultrasound, a technologist will apply gel to the area of your breast where the lump is located, then place a device against your skin that uses sound waves to create a picture of the tissue inside. The mammogram will be similar to the screening mammos you may have had in the past (in which your breast is compressed between two plates to spread the tissue), except the X-rays focus on the area of the lump. Make sure you get both tests. "When I discovered a lump, it was only visible on the ultrasound. It didn't show up on the mammogram," says Barbara Medile of South Salem, N.Y., who was diagnosed with stage 2 cancer in 2010 at age 46.

Women under 30 will typically just get a focused ultrasound. That's in part because a mammogram is less likely to detect abnormalities in younger breast tissue, which tends to be denser.

RELATED: 19 Medical Tests Everyone Needs

Dr. Monticciolo recommends having your tests done at a facility that's been designated a Breast Imaging Center of Excellence (look for one at acr.org). If you've had screening mammos elsewhere, bring copies of your most recent images. And don't panic if you can't get an immediate appointment. "It may feel as if waiting a few days is too long," says Dr. Port, whose book, The New Generation Breast Cancer Book, came out in September. "It's safe to wait for up to a few weeks."

Step 4: Find out if the lump is solid or a cyst
After the ultrasound, the radiologist or your gyno will tell you if your lump is a simple cyst, in which case you don't need to do anything else. (Though if the lump is tender, the radiologist or a breast surgeon can drain it with a superfine needle.) Cysts are quite common, found by ultrasound in 30 percent of premenopausal and 7 percent of postmenopausal women, according to one study. Women who are plagued by cysts every month (to the point where it feels uncomfortable to exercise) may want to try this regimen, courtesy of Dr. Minkin: For 14 days, starting a week before your period, take 100 to 200 milligrams of vitamin B, 200 IU of vitamin E and 1,000 milligrams of evening primrose oil, while cutting back on caffeine.

If, on the other hand, the imaging suggests a solid mass, you'll need more tests.

RELATED: What You Must Know if You Find a Lump in Your Breast

Step 5: Have a biopsy
The radiologist may be able to do it on the spot with a needle—the most common method. After numbing the area, she'll likely use ultrasound to guide a needle to the mass and extract a small piece of tissue to be examined by a pathologist. (Andrea Hutton remembers feeling intense pressure, "like someone was pushing a pen into my breast.") Generally, several samples will be taken from the mass. There might be some soreness and bruising afterward, and possibly a small scar.

In some cases, you may need to schedule a surgical biopsy with a breast surgeon. While you're sedated or under general anesthesia, she will use a scalpel to remove part or all of the lump. You'll leave with stitches and may notice a change in the shape of your breast if a lot of tissue was removed.

Step 6: Receive the results
You'll get a call within a week. There are a few possibilities.

It's negative.
Great news! This means your lump is a benign tumor. One prevalent type: fibroadenomas, which are probably influenced by your reproductive hormones, since they sometimes grow during pregnancy. If you plan to have a baby in the future, your doc may suggest removing it now. ("The last thing you want is to have to get a mammogram or biopsy during pregnancy," notes Dr. Port.) Otherwise, book a follow-up with a breast surgeon in three to six months. "If the tumor has gotten bigger, we usually opt to remove it," says Dr. Port.

RELATED: 15 Disease Doctors Often Get Wrong

It's abnormal.
One of the most common findings in this category is atypical hyperplasia, a growth of abnormal cells inside a milk duct (ductal hyperplasia) or one of the sacs that produce milk (lobular hyperplasia). It's not cancerous, but your doc will likely want you to have it removed by a breast surgeon: "In about 10 to 15 percent of cases, we'll find cancer in the surrounding tissue, and it turns out that the atypical cells were just the tip of the iceberg," says Dr. Port.

You'll also discuss risk management with your surgeon, or she'll refer you to a specialist (often a breast cancer oncologist), explains Deborah Axelrod, MD, director of clinical breast programs and services at Perlmutter Cancer Center at NYU Langone Medical Center. A recent Mayo Clinic study discovered that 30 percent of women with atypical hyperplasia go on to develop breast cancer over a period of 25 years. An expert can recommend risk-reduction strategies, from lifestyle changes (see Beat the Odds, opposite page) and genetic testing (if you have a family history) to taking the drug tamoxifen and getting more frequent screenings (usually alternating MRIs and mammos every six months).



It reveals cancer.
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Your doctor—either your gynecologist or your breast surgeon, depending on the kind of biopsy you had—will call you in to discuss the result and next steps.

When Allison Boyanovski, a 36-year-old physician assistant from Fords, N.J., learned that her lump was malignant, her first instinct was to get it removed, stat. "It was like having a bug in my shirt. I wanted it out," she recalls. But ultimately she decided not to rush and to educate herself on what the process would entail, which experts say is wise. "It's worth taking a few days to research the right doctors," says Dr. Port.

You'll need to find a surgeon who specializes in breast cancer to remove the mass. If you have a very large tumor or you're diagnosed with certain types of breast cancer, you might undergo chemotherapy first. In that case, your surgeon will likely work with a medical oncologist to manage your treatment.

Your gynecologist may give you some names. You can tap your own network, too. Seek referrals from co-workers, neighbors, friends of friends—anyone who has been down this path before.

RELATED: 22 Ways to Help a Friend With Breast Cancer

When you interview a surgeon, try to have a partner or friend with you for support. Dr. Port suggests getting answers to these three questions:

1) Does she perform at least one or two breast cancer surgeries a week?

2) If she's been practicing for less than a decade, has she completed a breast cancer fellowship?

3) Does she collaborate with a team including a medical oncologist (who can oversee any needed chemotherapy, hormone therapy, immunotherapy or other nonsurgical treatments), a radiation oncologist (who would manage your radiation treatments), a plastic surgeon, a genetic counselor and a pathologist?

Ideally, all the doctors you might need would work at the same center, says Dr. Port. "One benefit is that they can meet regularly to put their heads together to develop the best possible treatment."

When Andrea Hutton was interviewing doctors, she decided against her city's "rock star" surgeon in part for that reason. "I thought it was more important to go with someone who had a good relationship with the oncologist I wanted," she explains. "I also wanted a surgeon whose office wouldn't put me on hold for 10 minutes every time I called." (Andrea, who is now cancer-free, wrote about her experience in her new survivor's guide, Bald Is Better with Earrings.)

Dr. Pederson says that it's also worth asking if the center participates in clinical trials, and if a trial that fits your profile might be available.

RELATED: 15 Worst Things You Can Say to Someone Battling Breast Cancer

If you click with the first surgeon you meet, there's no rule that you need to get another opinion. "But if it will make you feel better, then do it," says Dr. Port. When you visit the second doctor, avoid explaining the first doctor's plan; let him do his own review and assessment of your radiology images and pathology slides. "That way you'll be sure you're getting an unbiased opinion," she explains.

It's possible that the recommendations you hear will be different from what you expected based on a friend's or relative's fight against breast cancer. Keep in mind that there's no universal cancer experience. Every case requires different treatment.

Regardless of the doctors you choose, take heart in knowing that breast cancer survival has been improving. In fact, between 1990 and 2010, the death rate dropped by 34 percent. "We've made huge strides in advanced treatments specifically targeted to a woman's cancer," says Dr. Pederson. "And as always, the earlier a tumor is found, the better the prognosis." Finding that lump may be your worst nightmare. But it can also mean saving your own life.



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3 Big Myths About Breast Lumps

"A little lump is less worrisome than a large one."
Size doesn't always predict prognosis. Even a small lump can harbor a potentially lethal cancer, says Elisa Port, MD, so get it checked out.

"A lump in a breast-feeding mom means a clogged milk duct."
Yes, chances are that's true. But while it's unusual, you can still get cancer while nursing, says Mary Jane Minkin, MD. Try applying a warm compress before each feeding for three to five days. Lump still there? See your gyno. All types of diagnostic imaging and tests, including surgical biopsies, can be done on a nursing woman if needed.

"If a lump is sore, it can't be cancer."
While a tender lump (especially around your period) is often a cyst, some breast cancers do present with pain. It could be that the mass is irritating nearby nerves. Or it might be a type known as inflammatory breast cancer, which can block lymph vessels in the skin.

RELATED: 10 Celebrities Who Battled Breast Cancer

Symptoms You Shouldn't Ignore
Lump or no lump, if you notice any of these other changes in your breasts, alert your gynecologist ASAP.
• A change in skin texture, or an enlargement of the skin pores
• Redness or scaling of the skin or a nipple
• Nipple tenderness that doesn't coincide with your period
• Dimpling anywhere on your breast
• Swelling or shrinking on one side
• A nipple that indents or seems to turn inward
• Spontaneous nipple discharge (especially if you aren't breast-feeding or pregnant)

Beat the Odds
There are certain breast cancer risk factors you can't control (like your family history and getting older). But here are four things you can do to boost your chances of staying healthy.

1. Keep your weight down
British research from 2014 suggested that going up a skirt size every decade starting at age 25 is associated with a 33 percent higher risk of developing breast cancer after menopause. And a large study published in August found that the most obese postmenopausal women (those with a BMI of 35 or higher) had a 58 percent greater risk of the disease than women at a normal weight.

RELATED: Products That May Reduce Your Risk of Breast Cancer

2. Stick with your exercise routine
It doesn't have to be extreme to help. According to a 2014 study from France, postmenopausal women who walk the equivalent of about four hours a week have a 10 percent lower risk of developing breast cancer than those who are less active.

3. Get your insulin levels under control
After menopause, high insulin levels and insulin resistance can raise your risk of breast cancer even if you're not overweight, found a 2015 study published in Cancer Research. Your doc can check your blood glucose levels, which are linked to insulin resistance, with a blood test at your annual checkup. If your blood sugar is high, dietary and lifestyle changes can help bring it down.

4. Be careful with alcohol
An analysis of 53 studies showed that women who consumed about three drinks or more per day had a nearly 1.5 times greater risk of developing breast cancer than nondrinkers. If you imbibe, cap it at one per day. (Though even having one a day increases risk by a small amount.)

Should You Do a Self-Exam?
It wasn't long ago that a breast self-exam was like paying your credit card bill: Once a month, you forced yourself to do it. But these days it's considered optional, after the U.S. Preventive Services Task Force recommended in 2009 against teaching formal self-exams. What's more important, doctors say, is developing general breast awareness. "That means becoming familiar with the normal feel of your breasts," says Holly J. Pederson, MD. You don't need to follow any prescribed procedure. Just massaging your breasts in the shower on a regular basis will help you detect changes, she explains.

RELATED: A Complete Guide to Breast Cancer Screening

If you're in the habit of doing a regular self-exam, however, that's perfectly fine, too. "I tell my patients, 'Do whatever makes you comfortable,'" says Elisa Port, MD. The idea is to know your body, and if setting aside time on the calendar helps you make that a priority, go for it.