Breast Health Care Frequently Asked Questions

Q: When I do an exam, I feel lumps everywhere! What is normal?

A: The breasts are composed of firm glandular tissue and soft fatty tissue. Together they make the breast tissue feel lumpy and bumpy with hills, valleys and ridges. That is normal.

If you feel a lump, check the opposite side and see if it has a matching area i.e. mirror image. Fortunately the breast tissue is rather symmetrical (one side matches the other). If you feel a lumpy area in the upper outer right breast, check the upper outer left breast for a corresponding area before you panic.

Q: When I do my exam, how do I know if there has been a change?

A: If you are normally quite lumpy, sometimes it is difficult to tell if the lumpiness is different. Here is what to do:

1. Do your examination early in your menstrual cycle when the breast is least lumpy and do it at the same point in the cycle each month, i.e., day 5-7 (the first day of your cycle is the first day of bleeding). If you no longer menstruate, pick the same day of each month.
2. Draw a map! Mark the hills, valleys, ridges, lumps and bumps. Put the map away and save it. The next month, repeat this process. Don’t cheat and look at your old map first. Compare maps. Usually after 3-4 months you will start feeling comfortable in recognizing what is normal for you.
3. Try not to routinely examine your breasts when they are the most lumpy and tender—ovulation time and prior to menstruation. At these times there is more fluid retention in the breast tissue making it feel lumpier, fuller and more tender.

Q: What if my breasts are different sizes?

A: Most of us are normally asymmetric (one breast may be slightly larger, just like one foot may be slightly larger). This may make the larger breast overall feel more prominent because there is more breast tissue on that side. This can be normal. Draw your maps to show it is not changing and if there is any concern, call your doctor.

If you have had breast surgery that changes the size or contour of the breast, now is a good time to do a map to establish a new baseline of normal. The diagram is also helpful if you have had one breast removed, since it is no longer possible to compare from side to side.

Q: How can I tell the difference between breast tissue, ribs and muscle?

A: Compare one side to the other. The tissue, ribs and muscles should all match up.

Q: What should I do if I feel a lump?

A: First, compare it to the other side to see if there is a matching lump. Next look at your maps — is it old or new, stable or changing? If it is new or increasing in size, see your doctor immediately (even if you had a normal mammogram recently). Remember many lumps, including most new lumps, are benign but they need to be checked.

Q: Why do I need to do a breast self-examination if I see my doctor and have my mammograms regularly?

A: Unfortunately, some tumors can grow rather quickly between your visits to the doctor, and even after a relatively recent mammogram. Breast cancer, when small, will often not be real hard or immobile on a physical examination. Therefore, it is very important to find them early when the disease is potentially curable.

10 to 15% of cancers grow in a way that may make them imperceptible on the mammogram. If you feel a lump— even if your mammogram is normal — don’t ignore it. See your doctor.

Q: Why have a mammogram at all?

A: Mammography saves lives! The trick is trying to find the cancer when it is so small it can’t be felt. These small cancers can be found by mammography, which could save your life!

Q: I have gained weight recently and now my breasts feel different. Is this normal?

A: Recent weight gain or loss changes the amount of fat in the breast, which changes the contour and texture of the breasts. This should happen on both sides, so it is important to compare from side to side.

Q: Does an injury cause breast cancer?

A: No. However, sometimes after an injury a woman may be performing more breast examinations and find a cancer.

Q: Does breast pain mean I have cancer?

A: Usually no. Most women have breast pain sometime in their lives. It is often related to menstrual cycles or fluid retention and it is a very common complaint. I would be concerned if the pain was only in one particular area and did not come and go as it may with your cycle. If that happens, see your doctor.

Q: Sometimes my breasts stay tender for months. Is this common and what can I do about it?

A: Yes. If too much fluid builds up in the breast tissue during one cycle then the next month the fluid retention is even worse and may cause more pressure. This may persist for several months, and can be aggravated by emotional stress, foods (i.e. caffeine) and certain medications. Sometimes it is helpful to reduce caffeine intake at this time until the body can clear the fluids. Some doctors also prescribe vitamin E to help reduce fluid retention. The buildup of fluid is uncomfortable but not harmful.

Q: What are fibrocystic changes?

A: Some women develop balloon-like pockets of fluid in the breast tissue called cysts. They feel like lumpy water balloons under the skin. There seems to be a genetic predisposition to this type of breast tissue but it does not predispose you to cancer. However, it is very important to do a good breast self-examination and find these lumps so they can be evaluated to make sure they are only cysts. Cystic breasts are often very difficult to evaluate on breast self-examinations and mammography because they are so lumpy. Therefore, it is essential to have a good baseline and know what is normal for you.

Q: Can cysts become cancerous?

A: This is very rare. Cysts will often be evaluated by sonography (to show they are clear fluid with no solid parts) or by needle aspiration (draining the fluid out through a needle) to prove they are benign. Otherwise,we leave them alone. They do not turn into cancer nor do they predispose you to cancer.

Q: What is breast ultrasound (sonography)?

A: This is a non x-ray examination using sound waves to determine if a mass seen on the mammogram or felt on a physical examination is filled with fluid (benign) or is solid (indeterminate). The solid nodules need further evaluation, either close follow-up or biopsy.

Q: Why not just do an ultrasound instead of the mammogram?

A: An ultrasound exam helps answer questions raised by mammography or physical exam but it is not as efficient or effective as a means of screening the entire breast. Ultrasound (sonography) does not replace mammography but can be used in complement to the mammogram to determine whether a mass visualized on the mammogram is solid or filled with fluid.

Q: What if I have a nipple discharge?

A: Most discharges are not worrisome—especially if it looks like milk. Report any nipple discharge, especially if bloody, to your physician for further evaluation. The most common tumor that causes a bloody discharge is a non-cancerous papilloma which would be removed by a surgeon.

Q: What if my nipples are inverted (retracted, pulled-in)?

A: When the condition is old (chronic) and unchanged, it is considered normal. If the condition is something new on your physical exam, you should consult your doctor.

Q: Who should have a mammogram and when?

A: If you are a woman, you need a mammogram! The American Cancer Society guidelines recommend:

• Baseline examination – before age 40
• Every year – age 40 and up

These guidelines may change depending on your clinical needs. If there is a strong family history of breast cancer (i.e., mother, sister, daughter) your doctor may recommend a mammogram more frequently. Although your risk of getting breast cancer increases from one out of nine to approximately one out of five—if you have a significant family history—most women who do get breast cancer do not have a family history. A negative history does not protect you!

Q: Does mammography find all breast cancers?

A: No! As mentioned before, 10-15% of cancers do not show up on mammography. Other imaging modalities, i.e. sonography and/or MRI may be utilized to further evaluate the breast if clinically indicated. This makes breast self-examination even more important. Please do your examinations and don’t be afraid to ask us or call your doctor with any questions. The way to find breast cancer early when it is curable is a combination approach: breast self-examination, a physical examination by your doctor, and a mammogram.

Q: Do mammograms hurt?

A: Usually not, but you will feel pressure. The breast is compressed firmly between two plastic plates for about 5-8 seconds to allow good penetration of the x-rays. Most women notice little to no pain but do feel pressure. If you have experienced pain in the past try this to make it easier:

• Have your exam done early in your menstrual cycle i.e. days 5-10.
• Take 2 aspirin or 600 mg of ibuprofen one hour prior to the exam.

Q: Are mammograms safe?

A: Yes. The amount of radiation has been significantly reduced over the years. The benefits of the mammogram far outweigh the risks.

Q: Where should I go for my mammogram?

A: You should go to an FDA/ACR (American College of Radiology) accredited facility. These facilities must routinely comply with strict regulations regarding the equipment, technical staff and physicians. Just ask when you call for your appointment.