Breast Lumps

Every woman should be concerned about breast lumps. The reason is simple: Although most breast changes are harmless, they can be an indication of breast cancer - one of the leading causes of death in women.

Most breast lumps are benign, and if breast cancer is found early it is usually curable. The key to early detection is monthly breast self-examinations as well as periodic breast examinations by your doctor and periodic mammograms (breast x-rays).

Benign Lumps

Any noticeable change, thickening, or localized swelling in your breast that wasn't there before may be a lump. Most breast lumps are benign, and most women will experience a benign lump sometime in their lives. The following are common benign breast problems that appear as lumps.

Fibrocystic disease is the most common cause of breast lumps in women age 35 to 50, and is responsible for at least half of all breast operations performed. This condition, which is not an actual disease, is probably caused by the mammary glands, ducts, and fibrous tissue overreacting to normal hormonal changes. As a result, multiple pockets of fluid (called sacs or cysts) develop, and an increase in fibrous tissue may form. In some instances, a lump may consist only of fibrous, rubbery tissue (a condition called mammary dysplasia). Tenderness and lump size commonly increase during the week before menstruation and decrease the week after. Fibrocystic disease usually appears after menopause.

Simple cysts, a variety of fibrocystic disease, are either single or multiple fluid-filled sacs. With simple cysts, there is no significant increase in fibrous tissue. Tenderness and lump size often fluctuate with the menstrual cycle.

Fibroadenoma, a single solid tumor, is composed of fibrous and glandular tissue. It occurs most frequently in women between 18 and 35, and is usually moveable when felt. Although it is not usually tender, premenstrual tenderness can occur. Nearly all breast tumors in women under age 25 are fibroadenomas.

Papillomas are small, wart-like growths in the lining of a mammary duct near the nipple, which can produce clear or bloody discharge from the nipple.

Malignant Lumps

Malignant lumps are usually single, hard, and painless. They develop most often from mammary ducts or glands, and are most commonly found in the upper-outer portion of the breast. Unlike benign lumps, cancerous lumps continue to grow in an uncontrolled manner and in time will spread beyond the breast. The risk of developing breast cancer is greater 1) if you are over 30 - and the chances increase with age; 2) if you have a family history of the disease; 3) if you have had breast cancer before; or 4) if you give birth for the first time after age 30 or never give birth. Breast cancer is decidedly a woman's disease-only one percent of all breast cancers occur in males. Many authorities think that reducing fat intake can help reduce the chances of breast cancer.

Early breast cancer is a small tumor less than an inch in size, located in the breast only. It's important to realize that even an "early" cancer may have been growing for several years before becoming large enough to be felt. Women who examine their breasts each month, and go to their doctor for periodic breast examinations, are most likely to detect an early breast cancer. In the United States each year 130,000 women are diagnosed as having breast cancer. Early diagnosis and proper treatment give these women a better chance of being cured. Better than four out of five women who are treated for early breast cancer will be alive and well five years later.

Advanced breast cancer is a larger tumor that has spread from the breast to the lymph nodes. Once this has occurred, the chance for cure is reduced, even with the surgical removal of the breast and lymph nodes. Of the 410,000 American women who die each year from breast cancer, many could have been detected and treated earlier with regular examinations.

Disseminated breast cancer means that cancer cells may have spread not only to the lymph nodes but to other areas of the body as well, commonly the bones, lungs and liver. Cancer cells usually spread through the lymph system and bloodstream. Unfortunately, the cure rate is low.

Treatment Options:The three common types of surgery performed today include modified radical mastectomy, partial mastectomy, and simple mastectomy.

Modified radical mastectomy. This procedure is the most common breast cancer procedure today, and the majority of women who undergo mastectomy will have this operation. In the modified radical mastectomy, the entire breast is removed, and while most or all of the axillary (underarm) lymph nodes are removed, this procedure differs from the Halsted radical in that the chest muscles are left in place. This surgery is also known as total mastectomy with axillary dissection, or simple extended. Chemotherapy may be advised depending upon the evaluation of the lymph nodes during "staging."

Advantages and Disadvantages: Radiation therapy is not routinely prescribed following surgery. Another advantage of this procedure is that the chest muscles are retained and the strength of the arm is not affected. Hand and arm swelling are rare. Also, reconstructive surgery is possible. The disadvantage of this operation is that the breast is removed.

Simple mastectomy. If your doctor has determined that you are not a candidate for the other surgical procedures, a simple mastectomy may be recommended. This procedure, also known as total mastectomy, is less extensive than the modified radical. It removes only the breast. The chest muscles and the axillary lymph nodes are left in place.

Advantages and Disadvantages: One advantage of this procedure is that the chest muscles remain, and the strength of the arm is not affected. If you and your doctor have elected the simple mastectomy, your recovery time may be shorter, since this is a less extensive operation than the modified radical. A disadvantage of this operation is that the breast is removed.

Partial mastectomy. This procedure removes the tumor and a margin of surrounding healthy tissue. Most or all of the axillary lymph nodes are usually removed (axillary dissection), often through a separate incision, to determine whether the cancer has spread into those nodes. Sometimes a "lumpectomy" is performed rather than a partial mastectomy with axillary dissection. The two procedures are similar, but the margin of tissue surrounding the tumor is smaller with a "lumpectomy." With both procedures, radiation (x-ray) therapy is most always advised as an adjuvant (supplement) following surgery. Chemotherapy may be prescribed as well depending upon the evaluation of the axillary lymph nodes.

Advantages and Disadvantages: An advantage of this treatment is that most of the breast is left in place. The disadvantages of this procedure include multicentricity (cancer located in more than one area) and the necessity of radiation (x-ray) treatment following surgery.

Other treatments for breast cancer include radiation (x-ray) therapy, chemotherapy, and hormonal therapy.