What To Do if You Find a Lump in Your Breast

It's good to be familiar with how your breasts look and feel so you can be aware of any changes and contact a healthcare provider. One of those changes could be finding a lump in your breast.

There can be a number of reasons why a lump has appeared, and most breast changes are benign—although some are linked with a higher risk of breast cancer later.

The good news is if you find a mass, the odds are in your favor, said Elisa Port, MD, a surgeon specializing in breast cancer at the Dubin Breast Center at Mount Sinai Hospital in New York City.

Here are some steps and guidelines on what you should do—and what happens next—when you feel something suspicious in your breast.

What To Do if You Feel a Lump In Your Breast

Assess What Could Be Causing the Lump

If you feel a lump and your period is due within a week, the lump may be a cyst—a small, fluid-filled sac. For some people, premenstrual hormone surges can cause cysts to grow.

Chances are your healthcare provider will ask you to wait to see if it goes away on its own after your period, said Mary Jane Minkin, MD, clinical professor of obstetrics, gynecology, and reproductive sciences at Yale University School of Medicine.

However, if you're in the middle of your cycle or postmenopausal, call a healthcare provider, even if you're due for a mammogram soon.

While you wait for your appointment, take some notes, suggested Hollye Jacobs, RN, a registered nurse and breast cancer survivor who wrote a patient guide called The Silver Lining. You'll want to have information to answer questions like:

• How long has the lump been there?
• Is it getting bigger or smaller?
• Is it painful?
• Does it move when you push it?

Knowing those details can be helpful for the healthcare provider during your exam.

Have the Lump Examined

A healthcare professional will feel the lump and will check for several things. "Breast cancers are typically hard, similar to the consistency of a frozen pea," said Holly J. Pederson, MD, director of medical 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. Even a small lump can harbor a potentially lethal cancer, said Dr. Port.

And don't let a healthcare professional tell you that it's nothing, urged Dr. Pederson. "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,'" said Dr. Pederson.

But mammograms don't pick up all tumors, especially traditional 2D mammograms. If given a choice, choose a 3D mammogram. Compared to traditional 2D mammograms, 3D mammograms pick up more breast cancers and have lower false-positive rates.

And even if you had a mammogram within the past year, don't allow your healthcare provider to dismiss you and any symptoms you have. Interval cancers—tumors that appear within a year of a negative mammogram—tend to be more aggressive, so it's important to be persistent if you feel something is wrong.

Different types of breast cancer can also present in different ways. While a lump is the most common symptom of breast cancer, it isn't the only one. Other symptoms of breast cancer include:

• Thickening or swelling in parts of the breast
• Irritation or dimpling of breast skin
• Redness or flaky skin on the breast or nipple area
• Inverted nipple or nipple pain
• Nipple discharge (including blood, but not including breast milk)
• A change in the size or shape of the breast
• Pain in any area of the breast

The bottom line is: If you're worried, always seek a second opinion and "insist on further evaluation," said Dr. Pederson.

What Tests Are Used?

Testing for Individuals Over 30

You'll start with imaging tests, which give your medical team a look at the lump. If you're over 30, your healthcare provider will likely recommend a focused ultrasound and a diagnostic mammogram.

"The ultrasound provides information about the lump—such as whether it's solid or a cyst," said Debra Monticciolo, MD, a diagnostic radiologist for Baylor Scott & White Health in Texas. "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 mammograms you may have had in the past, in which your breast is compressed between two plates to spread the tissue; in this case, the X-rays will focus on the area of the lump.

Testing for Individuals Under 30

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

The density of the breasts makes it more difficult to see a lump with a mammogram. This is also one reason annual screening mammograms are not recommended for low-risk people under 40.

Another reason is that mammograms expose the breasts to radiation. While the amount of radiation exposure is low, starting annual mammograms in your 20s or 30s would expose your breasts to more radiation over your life than it would if you waited until your 40s to start having your annual screenings.

When a Biopsy May Be Necessary

If the imaging suggests a solid mass, you'll need more tests, including a biopsy of the lump. The radiologist (a provider that specializes in the diagnosis and treatment of health conditions with medical imaging) may be able to do a biopsy on the spot with a needle—the most common method.

After numbing the area, the radiologist will likely use ultrasound to guide a needle to the mass and extract a small piece of tissue to be examined by a pathologist. Generally, several samples will be taken from the mass. Afterward, there might be some soreness, bruising, and possibly a small scar.

Sometimes, you may need to schedule a surgical biopsy with a breast surgeon. While you're sedated or under general anesthesia, they 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.

How To Go About Getting Testing Done

Dr. Monticciolo recommended having your tests done at a facility designated a Breast Imaging Center of Excellence. If you've had screening mammograms 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," said Dr. Port, who also wrote The New Generation Breast Cancer Book. "It's safe to wait for up to a few weeks."

What Else To Know About Testing for Breast Lumps

After an ultrasound, the radiologist or your healthcare provider will tell you if your lump is solid or filled with fluid.

A simple cyst is fluid-filled, so 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, especially in individuals in their 30s and 40s.

Individuals who are plagued by cysts every month that are uncomfortable may want to avoid caffeine. Studies do not necessarily back this up, but many people claim avoiding caffeine seems to help with breast symptoms. In addition, some herbal and vitamin supplements have been suggested to help.

Dr. Minkin was on board with these alternative suggestions and recommended the following regimen for 14 days, starting a week before your period:

• 100 to 200 milligrams of vitamin B6
• 200 IU of vitamin E
• 1,000 milligrams of evening primrose oil (while cutting back on caffeine)

Note that more does not mean better and could harm. Only take the recommended amount of each supplement.

What Results Might You Receive?

You'll most likely get a call with your biopsy results within a week. From here, there are a few possibilities.

It's Negative

This means your lump has been determined to be a benign tumor. One prevalent type of benign breast tumor is fibroadenomas. They're made up of glandular tissue and connective tissue and are most common in people in their 20s ad 30s but can be found at any age.

Fibroadenomas can grow, stop growing or shrink. For simple fibroadenomas (as opposed to complex fibroadenomas, which tend to be bigger and are primarily found in older people), it's common to leave them as is, especially if they aren't bothersome and aren't changing the shape of the breast.

But if the lump grows or becomes bothersome, Dr. Port said they "usually opt to remove it."

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).

While atypical hyperplasia is not typically cancerous, your healthcare provider will likely want you to have it removed by a breast surgeon since it is linked with an increased risk of breast cancer. "In about 10-15% 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," said Dr. Port.

You'll also discuss risk management with your surgeon, or they'll refer you to a specialist—often a breast cancer oncologist, explained Deborah Axelrod, MD, director of clinical breast programs and services at Perlmutter Cancer Center at NYU Langone Medical Center.

How much your risk for breast cancer increases with atypical hyperplasia is varied. One study suggested that a diagnosis of atypical hyperplasia has a 25% increased chance of developing into breast cancer over 10 years. This cohort study included people who had ductal or lobular atypical hyperplasia.

In a JAMA Oncology study, researchers looked at people's risk of developing breast cancer after an atypical ductal hyperplasia diagnosis, They found that the risk was increased by 5.7% over 10 years—a big difference between the study showing a 25% increased risk.

The JAMA Oncology study authors noted, however, that they only looked at people with atypical ductal hyperplasia, not atypical lobular hyperplasia like earlier studies had, and that this may account for their lower risk findings.

What might also have contributed to the lower rate of potential breast cancer in the latter study was that atypical lobular hyperplasia is more closely linked to breast cancer than atypical ductal hyperplasia is—so it makes sense that the study showed a lower risk since it only looked at atypical ductal hyperplasia.

To reduce your risk of developing breast cancer following an atypical hyperplasia diagnosis, a breast specialist can recommend risk-reduction strategies such as:

• Lifestyle changes
• Taking medications
• Getting more frequent screenings (usually alternating MRIs and mammograms every six months).

It Reveals Cancer

Your healthcare provider will call you to discuss the result and the next steps.

However, if you plan to get the lump removed, you'll want to make sure you educate yourself on what the process would entail, which experts say is wise. "It's worth taking a few days to research the right doctors," said 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 healthcare provider may give you some names. You can tap into your network, too. Seek referrals from family members and friends who have been down this path before. Often, the ones who have real-life experience are good sources to go by.

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

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

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," said Dr. Port.

When you visit the second provider, avoid explaining the first provider's plan; let them review and assess your radiology images and pathology slides. "That way, you'll be sure you're getting an unbiased opinion," explained Dr. Port.

The recommendations you hear may differ 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 a different treatment.

Regardless of the healthcare providers you choose, take heart in knowing that breast cancer survival has been improving. In fact, between 1989 and 2017, the death rate from breast cancer dropped by 40%.

"We've made huge strides in advanced treatments specifically targeted to a woman's cancer," said 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.

A Quick Review

It can be worrisome to discover a lump in your breast. However, there are some steps to take if you find a breast lump, including seeing a healthcare provider to assess the lump to explain and determine its type.

Depending on your age and the consistency of the lump, healthcare providers might complete certain types of testing to find out more about the lump. The steps you'll take after testing will be based on if the test results come back negative or abnormal or if they indicate cancer.