I found a lump in my breast, what next?

University of Michigan oncologist, Shirish Gadgeel, MBBS, co-director of the Thoracic Oncology Research Program and the associate director for the Cancer Care Network and Affiliated Centers, discusses cancer care and how to choose a cancer center.

contributed by Susan L. Daron, R.N., BSN, OCN, Cancer AnswerLine™

Whether it was discovered during a breast self-exam or incidentally as you were putting on your deodorant, finding a breast lump can be terrifying. Somehow it seems human nature for us to think the worst when we find a mass or lump anywhere there should not be one. Both the National Cancer Institute and the American Cancer Society provide some peace of mind by noting that most breast lumps are not cancer. In fact, there are a whole host of more common and benign (non-cancerous) conditions that can cause lumps in the breast including collections of fluid, deposits of fat, and deposits of calcium.

But once found, do not wait, thinking the mass will go away on its own. Make sure to notify your healthcare provider. If you are having any difficulty moving your arms or have uncontrolled pain or redness/swelling in the breast, you should contact your care provider immediately. Next, write down answers to the following questions in a notebook or on your phone to bring to your appointment. These are many of the same questions your healthcare provider will ask, to gain a better understanding of the lump.

Having a ready answer will go a long way in assisting your provider with a diagnosis:

Note the size and location of the lump. It can be helpful to use common objects such as a grape, pencil eraser, or raisin to estimate the size. For the location, you can think of the breast as a clock face and use the hands to locate the lump at a position such as three o’clock or noon.
Have you noticed any other changes to the breast or nipple such as skin dimpling, skin color changes, nipple retraction, or nipple discharge?
Have you noticed any areas of swelling near the breast or armpit?
When did you first notice the lump?
Is the lump in one breast or both breasts?
Can you feel the lump if you change positions (such as going from lying down to standing or sitting to standing?)
What does the lump feel like (hard, tender, firm)?
Is the lump fixed in one place or does it move?
For pre-menopausal women, does the lump correlate with your menstrual cycle?
For women with children, provide a breastfeeding history if applicable.
Is the lump painful, if so describe the pain (sharp, stabbing, or throbbing) and the intensity of the pain?
Is there anything that seems to make it worse?
Is there anything that seems to make it better?
Do you have a personal or family history of cancer (especially anyone in the family who has been found to have either a BRCA1 or BRCA2 mutation)?

Cancer survivor Betsy de Parry shares her story of diagnosis, and advice for newly diagnosed cancer patients - including not what to ask at your diagnosis.

Diagnostic testing

In addition to your healthcare provider conducting a detailed health history and clinical breast exam, he or she may need to order additional tests to help diagnose the breast lump. Some of these tests may include a mammogram, ultrasound, or MRI. These tests will take detailed images of the mass inside your body. They provide additional diagnostic information to your clinician that he or she cannot obtain through feeling the lump. If there is a suspicion of cancer, a breast biopsy may be performed to remove a sample of breast cells for further examination by a pathologist.

If you do require additional testing, find out from your provider when you will get those results and what your follow-up plan will be. Waiting for the results on an uncertain diagnosis is often the most difficult part of the whole process. Do not let your mind wander during this anxious time to a worst case scenario. Rather take the time to congratulate yourself for not ignoring your body. No matter the outcome of testing you will not be facing it alone; your healthcare provider will be there to provide guidance and recommendations.