Next Step After Mammogram Shows Mass
So, there are typical steps that radiologists usually recommend when a mammogram shows a possiblemass. The radiologist might arrange for magnified mammogram views to look for microcalcifications.
Alternatively the radiologist might arrange for a breast ultrasound to see if the mass is actually a cyst, and not a solid mass. Furthermore, If multiplemasses or solid nodules are present, this increases the chances that there is not a cancer.
If cysts are present on mammogram, they are definitely not cancer.If the radiologist think the mass may be solid, because of the shape and the ultrasound results, then it might need a biopsy.
The breast mammogram in the image, certainly appears to have a nodule of some sort, but since it may or may not be a real nodule, one could label it as an asymmetric density or a developing asymmetry.
When a mass shows up on one mammogram view, the radiologists will ask himself, is it only one view? If so, it may be asymmetric density. The radiologist must look at both views,
Radiologist consider a mass seen in both orthogonal views to be a truemass.
Signs Of Benign Breast Masses
In contrast to breast cancer tumors, benign lumps are often squishy. They may feel like a soft rubber ball with well-defined margins. They’re often easy to move around and may be tender.
Infections in the breast can cause redness and swelling. Sometimes it can be difficult to tell the difference between mastitis and inflammatory breast cancer, but mastitis often causes symptoms of fever, chills, and body aches. Those symptoms aren’t associated with cancer.
Symptoms Of Breast Cancer
Although a lump in the breast is a common symptom of breast cancer, not all breast cancers have obvious symptoms. For example, some lumps may be too small to be felt, but can be detected with a screening mammogram or other tests. There are also some benign conditions that can cause lumps in the breast, such as cysts and fibroadenomas .
Most breast changes are not caused by cancer. However, it is important to see your doctor if you notice any new lumps or other unusual breast changes as soon as possible. Early detection gives the best chance of survival if you are diagnosed with breast cancer.
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Where Are Breast Cancer Lumps Usually Found
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Lymph Node Surgery For Breast Cancer
If breast cancer spreads, it typically goes first to nearby lymph nodes under the arm. It can also sometimes spread to lymph nodes near the collarbone or near the breastbone . Knowing if the cancer has spread to your lymph nodes helps doctors find the best way to treat your cancer.
If you have been diagnosed with breast cancer, its important to find out how far the cancer has spread. To help find out if the cancer has spread outside the breast, one or more of the lymph nodes under the arm are removed and checked in the lab. This is an important part of staging. If the lymph nodes have cancer cells, there is a higher chance that cancer cells have also spread to other parts of the body. More imaging tests might be done if this is the case.
Lymph node removal can be done in different ways, depending on whether any lymph nodes are enlarged, how big the breast tumor is, and other factors.
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Global Asymmetry Focal Asymmetry Developing Asymmetry
When there is asymmetric density on a mammogram image, it can mean that a mass is developing, but it is far more likely that it is something else.
There are different types of asymmetry global, focal, and developing, and the chances of malignancy, though low, tend to increase if there are new developments from previous mammograms, and if the lesion is, or becomes, palpable.
Global asymmetry
means that the area of density includes a significantly large portion of the breast. In most cases this is the result of normal variations in hormone levels.
However, if something is palpable, the possibility for malignancy is as high as 10%, and the lesion will require further evaluation. Now, if the lesion appears to be a solid mass, or has suspicious microcalcifications, or an architectural distortion, then a biopsy will be necessary.
Focal asymmetry
Means the suspect asymmetry-mass is much smaller, and has a similar shape on two views. It lacks the clear borders that we see in a true mass, and it usually appears as an island of normal , yet dense fibroglandular tissue. The likelihood of malignancy with focal asymmetry is less than 1%.
Follow-up procedures will, to some degree, depend upon whether or not this is a first or subsequent screening. If there are previous mammograms and the focal asymmetry seems to be stable, then a radiologist will consider this mass to be benign. However, yearly screenings may be necessary for monitoring purposes.
Developing Asymmetry
What Is Invasive Breast Cancer
Most breast cancers are diagnosed when a tumour has grown from within a duct or lobule into the surrounding breast tissue. These are called invasive breast cancers:
- Invasive ductal breast cancers begin in one of the ducts of the breast . They account for as many of 8 in 10 of breast cancer cases.
- Invasive lobular breast cancers begins in one of the lobes of the breast. They account for about 1 in 10 of invasive breast cancers.
Invasive breast cancers are also divided into those where cancer cells have invaded into local blood or lymphatic vessels and those that have not. Invasive breast cancer is able to spread outside the breast.
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Breast Lumps: Why Size Movability And Pain Matter
Your breasts are made up of fat, nerves, blood vessels, fibrous connective tissue, and glandular tissue, as well as an intricate system of milk-producing lobules , and ducts . This anatomy in and of itself creates a lumpy, uneven terrain.
A lump in the breast distinguishes itself from this background of normal irregularities. Harmless breast lumps can be solid and unmovable, like a dried bean or movable, soft, and fluid-filled you can roll it between your fingers like a grape. A lump may be pea-size, smaller than a pea, or even several inches across, although this larger size is rare.
What typically differentiates a benign breast lump from a cancerous breast lump is movement. That is, a fluid-filled lump that rolls between the fingers is less likely to be cancerous than a hard lump in your breast that feels rooted in place.
Another rule of thumb has to do with pain. Breast cancer does not usually cause pain. Benign conditions sometimes do, although there are exceptions to this rule as well. For instance, a rare form of breast cancer, inflammatory breast cancer, may cause symptoms such as aching, tenderness, pain, or burning in the breast.
The only way to know the status of a lump for sure is through medical tests, such as an ultrasound, a mammogram, or a fine needle aspiration , in which your doctor uses a tiny needle to extract a bit of the lump for laboratory examination.
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Which Lymph Nodes Are Involved In Breast Cancer Spread
Several groups of lymph nodes are near the breast, and these are the ones that breast cancer can spread to first. The nearest lymph node groups are:
-
Supraclavicular lymph nodes located above the collarbone, or clavicle.
When breast cancer spreads to lymph nodes, it can sometimes cause them to become fixed in position and stuck together . Lymph nodes that are matted generally have more cancer cells than those that are still mobile or movable.
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Other Types Of Breast Cancer
Other less common types of breast cancer include invasive lobular breast cancer, which develops in the cells that line the milk-producing lobules, inflammatory breast cancer and Pagetâs disease of the breast.
Itâs possible for breast cancer to spread to other parts of the body, usually through the lymph nodes or the bloodstream. If this happens, itâs known as âsecondaryâ or âmetastaticâ breast cancer.
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How Is Breast Cancer Diagnosed
During your regular physical examination, your doctor will take a thorough personal and family medical history. He or she will also perform and/or order one or more of the following:
- Breast examination: During the breast exam, the doctor will carefully feel the lump and the tissue around it. Breast cancer usually feels different than benign lumps.
- Digital mammography: An X-ray test of the breast can give important information about a breast lump. This is an X-ray image of the breast and is digitally recorded into a computer rather than on a film. This is generally the standard of care .
- Ultrasonography: This test uses sound waves to detect the character of a breast lump whether it is a fluid-filled cyst or a solid mass . This may be performed along with the mammogram.
Based on the results of these tests, your doctor may or may not request a biopsy to get a sample of the breast mass cells or tissue. Biopsies are performed using surgery or needles.
After the sample is removed, it is sent to a lab for testing. A pathologist a doctor who specializes in diagnosing abnormal tissue changes views the sample under a microscope and looks for abnormal cell shapes or growth patterns. When cancer is present, the pathologist can tell what kind of cancer it is and whether it has spread beyond the ducts or lobules .
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Types Of Breast Cancer
There are many different types of breast cancer. The type is determined by the specific kind of cells in the breast that are affected. Most breast cancers are carcinomas. The most common breast cancers such as ductal carcinoma in situ and invasive carcinoma are adenocarcinomas, since the cancers start in the gland cells in the milk ducts or the lobules . Other kinds of cancers can grow in the breast, like angiosarcoma or sarcoma, but are not considered breast cancer since they start in different cells of the breast.
Breast cancers are also classified by certain types of proteins or genes each cancer might make. After a biopsy is done, breast cancer cells are tested for proteins called estrogen receptors and progesterone receptors, and the HER2 gene or protein. The tumor cells are also closely looked at in the lab to find out what grade it is. The specific proteins found and the tumor grade can help decide the stage of the cancer and treatment options.
To learn more about the specific tests done on breast cancer cells, see Understanding a Breast Cancer Diagnosis.
What Is The Outlook
The outlook has greatly improved in recent years. Deaths from breast cancer are now at the lowest ever in 40 years. This is mainly due to the improvements in the treatment of breast cancer. The outlook is best in those who are diagnosed when the cancer is still small and has not spread. More breast cancers are also now being diagnosed and treated at an early stage. In general, the more advanced the cancer then the less chance that treatment will be curative.
The treatment of cancer is a developing area of medicine. New treatments continue to be developed and the information on outlook above is very general. The specialist who knows your case can give more accurate information about your particular outlook and how well your type and stage of cancer is likely to respond to treatment.
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How Can I Protect Myself From Breast Cancer
Follow these three steps for early detection:
- Get a mammogram. The American Cancer Society recommends having a baseline mammogram at age 35, and a screening mammogram every year after age 40. Mammograms are an important part of your health history. Recently, the US Preventive Services Task Force came out with new recommendations regarding when and how often one should have mammograms. These include starting at age 50 and having them every two years. We do not agree with this, but we are in agreement with the American Cancer Society and have not changed our guidelines, which recommend yearly mammograms starting at age 40.
- Examine your breasts each month after age 20. You will become familiar with the contours and feel of your breasts and will be more alert to changes.
- Have your breast examined by a healthcare provider at least once every three years after age 20, and every year after age 40. Clinical breast exams can detect lumps that may not be detected by mammogram.
Can Exercise Help Reduce My Risk Of Developing Breast Cancer
Exercise is a big part of a healthy lifestyle. It can also be a useful way to reduce your risk of developing breast cancer in your postmenopausal years. Women often gain weight and body fat during menopause. People with higher amounts of body fat can be at a higher risk of breast cancer. However, by reducing your body fat through exercise, you may be able to lower your risk of developing breast cancer.
The general recommendation for regular exercise is about 150 minutes each week. This would mean that you work out for about 30 minutes, five days each week. However, doubling the amount of weekly exercise to 300 minutes can greatly benefit postmenopausal women. The longer duration of exercise allows for you to burn more fat and improve your heart and lung function.
The type of exercise you do can vary the main goal is get your heart rate up as you exercise. Its recommended that your heart rate is raised about 65 to 75% of your maximum heart rate during exercise. You can figure out your maximum heart rate by subtracting your current age from 220. If you are 65, for example, your maximum heart rate is 155.
Aerobic exercise is a great way to improve your heart and lung function, as well as burn fat. Some aerobic exercises you can try include:
- Walking.
- Dancing.
- Hiking.
Remember, there are many benefits to working more exercise into your weekly routine. Some benefits of aerobic exercise can include:
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Common Causes Of Benign Breast Lumps
Most benign breast lumps and conditions are directly related to your menstrual cycle, to fluctuations in your hormones, and to the fluid buildup that comes with your monthly period. Other benign breast lumps and conditions may be related to plugged milk ducts, infections, or even breast injuries. The risk for benign breast conditions increases for women who have never had children and those who have a history of irregular menstrual cycles or a family history of breast cancer.
Here are some of the most common benign breast conditions.
Fibrocystic changes These changes cause a general lumpiness that can be described as ropy or granular, and affect at least half of all women. Symptoms of fibrocystic change include tender, fibrous, rubbery tissue a thickening of tissue or a round, fluid-filled cyst. These changes, which are related to hormonal fluctuation, may increase as you approach middle age and disappear with menopause. Sometimes doctors recommend limiting salt and caffeine consumption to ease fluid buildup. Birth control pills may also ease symptoms.
Mastitis An infection of the milk duct, mastitis can create a lumpy, red, and warm breast, accompanied by fever. It occurs most commonly in women who are breastfeeding, but can occur in non-breastfeeding women as well. Treatment involves warm compresses and antibiotics. Because these symptoms are similar to inflammatory breast cancer, if they occur in a non-breastfeeding woman a doctor may want to do a biopsy.
Kinds Of Breast Cancer
The most common kinds of breast cancer are
- Invasive ductal carcinoma. The cancer cells begin in the ducts and then grow outside the ducts into other parts of the breast tissue. Invasive cancer cells can also spread, or metastasize, to other parts of the body.
- Invasive lobular carcinoma. Cancer cells begin in the lobules and then spread from the lobules to the breast tissues that are close by. These invasive cancer cells can also spread to other parts of the body.
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Breast Area Dense Area And Percent Density In Four Quadrants
In this study , the mean overall PD in the contralateral normal breast was 20.2 ± 5.8%. Table shows the BA, DA, and PD measured within the four quadrants of the normal breast from the 110 women. The UO quadrant had the highest BA with a mean ± standard deviation of 37 ± 15 cm2 and the highest DA , with PD = 20.0 ± 5.8%. The order of BA in 4 quadrants was: UO > UI > LO > LI. The order of DA was exactly the same: UO > UI > LO > LI. The PD was calculated as the ratio of DA/BA, and the order was: LO > LI > UO > UI. The LO had the third ranking BA and DA , but had the highest PD = 22.8 ± 7.5%. For each of the 110 women, except for the comparison of BA for UO vs. UI, and PD for UO vs. LI, pair-wise comparisons were significantly different . Table shows the mean + SD of BA, DA, and PD in the four quadrants for the four groups of women with tumors in different quadrants. In each group, the order of means for BA and DA were the following: UO > UI > LO > LI. The means for PD had the order of LO > LI > UO > UI. For each of the three variables, there was no significant difference between the 4 groups of women . Figure shows a bar graph of BA in each of the 4 tumor groups and in the 110 cases. Figure shows the results of DA, and Fig. shows the results of PD.
Table 1 Breast area, dense area and percent density in the four quadrants and the whole breast