Medical Progress

Breast Lumps: 7 Myths and Facts

About 40% of women will discover a breast lump at some point in their lives. Although a lump doesn’t necessarily mean cancer, what women do immediately after that discovery can mean the difference between survival or not.

So what do you need to know if you find a breast lump? Four experts interviewed by WebMD help separate myths from facts.

1. A Breast Lump Is Almost Always Cancer

This is a myth, thankfully, but a widespread one, says Stephen Sener, MD, past president of the American Cancer Society and professor of surgery at the University of Southern California’s Keck School of Medicine in Los Angeles.

“Every woman [with a breast lump] thinks it’s cancer until proven otherwise,” Sener says. “The older a woman is, the more petrified she is that she is the one in seven or eight to getbreast cancer,” says Sener, referring to a woman’s lifetime risk of the cancer.

But some women shift  to denial, says Laura Kruper, MD, a breast cancer surgeon at the City of Hope Comprehensive Cancer Center in Duarte, Calif. They will think cancer can’t possibly be happening to them, she says. “Or they will think they are too young.”

The lump is more likely to be cancerous in older women who have gone through menopause than in younger women, says Susan Love, MD, president of the Susan Love Foundation, clinical professor of surgery at the University of California Los Angeles David Geffen School of Medicine, and author of Dr. Susan Love’sBreast Book.

When a lump turns out not to be cancer, what else might it be? It could be a cyst (a fluid-filled sac that can be drained), an abnormal noncancerous growth such as a fibroadenoma or, much less often, a blood clot that causes lumpiness. It could also be a “pseudo lump,” caused by hormonal changes that isn’t a lump at all, says Love.

Whatever the cause, it’s important to get any lump evaluated. Sener recommends a physical examination, a mammogram, and perhaps anultrasound. “Most of the time you have a reasonable idea what is happening after that,” he says. Some women will need to get abiopsy.

2. Breast Cancer Is Always Accompanied by a Lump You Can Feel

Not necessarily, says Jennifer Eng-Wong, MD, a medical oncologist at Georgetown University’s Lombardi Comprehensive Cancer Center in Washington, D.C.

“Sometimes you pick up a cancer on a mammogram before you can feel [the lump] she says. That’s the norm. “Most cancers are picked up on screening mammograms.”

3. A Cancerous Lump Feels Different From a Benign Lump

Not always, says Eng-Wong. Cancerous lumps and noncancerous, or benign, lumps, can overlap. When a lump is cancer, she says, women often assume it will be a single lesion that feels hard and doesn’t move around. That could be, she says, but a cancerous breast lump could also feel smooth and be mobile, she says.

3. A Cancerous Lump Feels Different From a Benign Lump continued…

”You can’t always tell by how it feels,” says Love. ” Cysts, if they are deep, will feel scary. If they are near the surface, they often feel round and smooth. But if they are deep, they can push the breast tissue forward. Something that feels fairly benign and smooth and movable can be a cancer. Something that feels very scary can be benign.”

The best advice? “Anything that feels different to you should get checked out,” Love says.

These days, Love says, checking out breast lumps is easier for several reasons. Breast surgeons and breast clinics are common and ultrasound is often available right in the office.

4. A Small Lump Is Typically Nothing to Worry About

This is definitely not so, says Kruper. “Cancer can be very small when it first presents,” she says. “Size is never a good way to decide whether a lump is something to worry about.”

Kruper says she has seen women whose breast lumps have ranged in size from a pea to a grapefruit. The lumps found on mammograms, she says, can be extremely small. “When women actually feel a mass, it’s usually less than an inch in diameter, the size of a small cherry,” she says.

5. It’s OK to Watch a Lump and Call the Doctor Later

It’s not OK, and the older you are, the more this advice applies, doctors say. “You should always be evaluated by a health care practitioner,”  Eng-Wong says. “Sometimes they will recommend watching it for a couple months in women who are still menstruating,” she says. “You can have cysts [that feel like lumps], and they can change with the menses.”

Older women who have gone through menopause aren’t likely to have lumps change from hormonal influence, so watchful waiting isn’t typically considered an option.

Bottom line for older and younger women: “Get evaluated,” Eng-Wong says.

How soon should you seek medical help? Doctors vary somewhat in their answers. Eng-Wong advises: “Take care of it within two to four weeks,” whatever your age.

Sener prefers a faster timeline. “Call a physician within a day or two of identifying the lump and get advice about what to do,” he says. A doctor may decide watchful waiting is acceptable, but a woman should not decide that on her own, Sener says.

The worst approach? To go into denial and wish away the lump. “I still see women who have had a lump for two, three months,” Sener says. “They think that because physicians tell patients that cysts come and go,” it may go away on its own.  “If it turns out to be a cancer, two or three months can make a difference, especially in a younger person.”

6. A Lump Can Be Cancer Even in a Woman With No Family History

Absolutely, says Love. “Only 5% or 10% of breast cancer is hereditary. The majority of women who get breast cancer have no risk factors.”

But women often believe otherwise, Kruper says. They tell her: “If I don’t have a family history of cancer, a lump is not likely to be cancer.”

7. A Lump Can’t Be Cancer in Women with a History of Cysts

Not so, but some women are lulled into this false sense of security.  Women who have been told for years they have cysts often assume a new lump is nothing to worry about, Kruper says.

She tells women: “Whenever something new appears, we [physicians] need to know about it.” She cautions them not to assume that just because previous lumps turned out to be cysts — or nothing at all to worry about — that the new lump is the same story.

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