You Found a Lump in Your Breast. Now What?

Take a deep breath—we show you what to do, who to call, and what it all means.

In 2009, Andrea Hutton was in the shower when she discovered a lump in her right breast, just above the nipple. "It seemed different from anything I'd ever felt before," recalled Andrea. "It was rounder, harder—like a pebble." Andrea's primary healthcare provider sent her for a diagnostic mammogram. After a few weeks and more tests, the mother of two and interior designer from Bellevue, Washington, had her fears confirmed: stage 4 breast cancer. She was 41 at the time.

The lead-up to Andrea's diagnosis isn't uncommon. Research published in a 2022 issue of the journal Cureus indicated that the majority of patients with breast cancer discovered the tumors themselves. This goes in line with previous research, including a 2019 study published in the Journal of Oncology which suggested that performing regular breast self-exams was associated with increased detection rates of breast cancer.

The good news: If you do 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. According to the American Cancer Society (ACS), most breast changes are benign—although some are linked with a higher risk of breast cancer later.

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

Check the Calendar

Is your period 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 you're postmenopausal, call your healthcare provider, even if you're due for a mammogram soon. While you wait for your appointment, take some notes, suggested Hollye Jacobs, RN, MS, a registered nurse and 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 for your exam.

See a Healthcare Professional

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 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 the choice, choose a 3D mammogram. According to a five-year study published in 2020 in the journal Radiology, 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're having. Interval cancers—tumors that appear within a year of a negative mammogram—tend to be more aggressive, so it's important to listen to that little voice.

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.

According to the Centers for Disease Control and Prevention (CDC), 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.

Get the Right Tests

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 both 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.

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, according to the ACS. 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 one, according to the ACS, is that mammograms expose the breasts to radiation. And 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.

Dr. Monticciolo recommended having your tests done at a facility that's been 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."

Find Out if the Lump Is Solid or Fluid-Filled

After the 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, 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, especially in women in their 30s and 40s, per the ACS.

Individuals who are plagued by cysts every month that are uncomfortable may want to avoid caffeine. The ACS says that while studies do not necessarily back this up, many people claim that avoiding caffeine seems to help with their breast symptoms. In addition, per the ACS, some herbal and vitamin supplements have been suggested to help, too.

Dr. Minkin is on board with these alternative suggestions and recommends the following: For 14 days, starting a week before your period, take 100 to 200 milligrams of vitamin B6, 200 IU of vitamin E, and 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.

If the imaging suggests a solid mass, you'll need more tests, including a biopsy of the lump.

Have a Biopsy

The radiologist may be able to do a biopsy on the spot with a needle—the most common method. After numbing the area, they'll 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.

How does it feel to get the biopsy? Andrea Hutton remembers feeling intense pressure, "like someone was pushing a pen into my breast." Afterward, there might be some soreness and bruising, 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, 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.

Receive the Results

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. According to the ACS, 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 mostly 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 is growing or becomes bothersome, Dr. Port said that 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), per the ACS.

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 higher your risk for breast cancer increases with atypical hyperplasia is varied. For example, a 2015 study published in the New England Journal of Medicine 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 2017 study published in the journal JAMA Oncology, researchers looked at people's risk of developing breast cancer after a diagnosis of atypical ductal hyperplasia and found that the risk was increased by 5.7% over 10 years—a big difference between the study showing a 25% increased risk. The authors of the JAMA Oncology study do note, 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 according to the ACS, 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, from lifestyle changes and genetic testing (if you have a family history) to taking the drug tamoxifen and getting more frequent screenings (usually alternating MRIs and mammograms every six months).

It Reveals Cancer

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

When Allison Boyanovski, a 36-year-old physician assistant from Fords, New Jersey, 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," recalled Boyanovski.

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," 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.

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

  1. Do they perform at least one or two breast cancer surgeries a week?
  2. If they've been practicing for less than a decade, have they completed a breast cancer fellowship?
  3. Do they 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 (for reconstruction), a genetic counselor, and a pathologist?

Ideally, all the doctors 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."

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," explained Andrea, who wrote about her experience in her breast cancer survivor's guide, Bald Is Better with Earrings. "I also wanted a surgeon whose office wouldn't put me on hold for 10 minutes every time I called."

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 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," explained Dr. Port.

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 a different treatment.

Regardless of the doctors you choose, take heart in knowing that breast cancer survival has been improving. In fact, according to the ACS, 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.

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