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Breast Cancer

Breast lump

12/10/2007

Question:

I am 43 yr old. I have had 2 prior benign bx of my left breast ( fibroadenoma and cyst with suspicious shadowing). About 6 mos ago while doind a bse,I noticed a lump in the 10-11 o`clock position. I did not have it checked until about 3 weeks ago. My dr felt it also and sent me for a mammogram and ultrasound. But because of the density of my breasts, nothing showed up. I am scheduled to see a surgeon in December. What will the next likely step be? Is it common for lumps not to show up on mammograms and ultrasound? This lump feels completely different than the other 2 I have had. it is hard and can be felt with deep palpation and does not fluctuate in size with hormonal changes like I suspect fibrocystic disease does. Should I insist on a biopsy-at least a needle biopsy? Thanks!

Answer:

Dense breasts are difficult to evaluate with mammogram.  Density does not affect ultrasound, however.  If you have a significant problem, it really should be seen on ultrasound (if the person doing the ultrasound looked at the correct location and did the ultrasound properly).  MRI is another option for evaluating the breast but it is very expensive and would need to be approved by your insurance company.  Its accuracy is not affected by density, either. 

I would talk with your surgeon - a needle biopsy is always an option.  In this case, though, the needle biopsy could not be guided with either ultrasound or mammogram since no masses are seen with either xray.

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Response by:

Jean T Stevenson, MD, FACS Jean T Stevenson, MD, FACS
Associate Professor of Surgery
School of Medicine
Case Western Reserve University