Understanding Breast Changes, Part 3

by National Cancer Institute

(Page 3 of 4)

As you age, other breast changes are more common, such as:

Intraductal papilloma. This is a growth inside the nipple that looks like a wart. It can be removed by surgery without changing the way the breast looks.

Mammary duct ectasia. As you near menopause, ducts beneath the nipple can become swollen and clogged. This can be painful and cause nipple discharge. The problem is treated with warm packs, antibiotics, and sometimes surgery to remove the duct.

If you are taking hormones, such as hormone replacement therapy (HRT), birth control pills, or injections, when getting your mammogram be sure to let your doctor know. Hormones may cause your breasts to be more dense. This can limit your doctor's ability to read a mammogram.

When you stop having periods (menopause), your hormone levels drop, and your breast tissue becomes less dense and more fatty. You may stop having the lumps, pain, or nipple discharge you used to have. And because your breast tissue is less dense, mammograms can be easier to read. This means doctors are more likely to find breast changes or early breast cancer.

Getting a Second Opinion

After seeing your health care provider, you may want to get a second opinion from another health care provider. Sometimes, a second opinion may be covered by your health insurance. Many women feel uneasy about asking for a second opinion, but it is very common. Your health care provider will not be surprised or offended if you seek a second opinion. A second opinion might help you feel more confident that you are making the best choices about your health.

Follow-Up Tests to Tell You More

Doctors often use ultrasound or biopsies to follow up after finding signs of a breast change.

Ultrasound

An ultrasound uses sound waves to make a picture of breast tissue. This picture is called a sonogram. It helps doctors look more closely at lumps. An ultrasound shows if a lump is solid or filled with fluid (cyst). (See Chart 1: Possible Cysts are usually not cancer. Mammogram Results and Follow-Up Care 2.) An ultrasound also can help your doctor decide if more tests are needed.

It is important to know that an ultrasound may not find all abnormal changes.

A Cyst: The Most Common Breast Change

A cyst is a lump filled with fluid.

If a cyst is found, your doctor may decide to:

• Remove fluid in the cyst to make it go away
• Look at it with an ultrasound
• Watch it closely over time

Biopsies

During a biopsy, the doctor removes some cells or tissue, an area of small calcium deposits, or the whole lump. The tissue is sent to a lab where a doctor called a pathologist will look at the cells. He or she checks the cells for cancer or other diseases. Biopsies are usually done on an outpatient basis, meaning you can go home the same day as your test. Biopsies are the only way to find out if cells are cancer.

Questions you might want to ask if your health care provider suggests a biopsy:

• What type of biopsy will I have? Why? How much tissue will be removed?
• Will only part of the lump or the whole lump be removed?
• Will the shape of my breast change?
• Will I have a scar?
• Where will the biopsy be done? How long will it take?
• Will I be awake?
• Will it hurt?
• Will there be any side effects?
• What tests will be done on the tissue?
• When will I know the results?
• Will I be able to go back to work the same day?

After the biopsy, you might want to ask:

• What do the results mean?
• Do I need to have other tests?
• Will I need follow-up tests or treatment?
• How do I care for the biopsy site?
• Is it okay if I exercise?
• Does my result mean I am at higher risk for breast cancer?

Sometimes it's hard — even for the experts — to tell benign breast changes from cancer. If you have any questions about your biopsy results, have more than one doctor look at the results.

Types of Biopsies

The most common types of biopsies are:

• Fine-needle aspiration
• Core needle biopsy
• Surgical biopsy

Fine-Needle Aspiration

Fine-needle aspiration only takes a few minutes and can be done in the doctor's office. It is often done when a doctor finds a lump that appears to be a cyst. The doctor tries to remove fluid from the lump using a thin needle and a syringe. If the lump is a cyst, removing the fluid will make it go away. If the cyst returns, it can be drained again. Because cysts are rarely cancer, doctors test the fluid only if it is bloody or if there are other reasons to be concerned. If the lump is solid, cells can be taken out with the needle. These cells are checked for cancer.

Core Needle Biopsy

This type of biopsy can be done in the doctor's office or hospital. A core needle biopsy is a type of biopsy that uses a needle with a special cutting edge. The core needle is inserted through a small cut in the skin. A small core of tissue is removed. More than one tissue sample can be taken through the same small cut in the skin. This test may cause a bruise but rarely leaves a scar.

During the biopsy, the doctor may insert a guided probe into the area of the breast change. The probe gently vacuums tissue samples from the area.

Sometimes the doctor uses other methods to guide the core needle or probe to the breast change.

About the Author

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