Breast Cancer/Breast lump 7 months after hospital referral
Dear Dr Nordquist,
I emailed you for advice in November of last year after discovering a small, firm, painless lump in my right breast, just beneath the nipple (about the size of the end of a cotton bud).
You kindly took the time to write back to me with the advice to have this checked out by my GP.
I followed your advice and made an appointment to see my GP and was referred to the breast clinic at my local hospital. The Doctor at the hospital examined the lump and arranged for me to have an ultrasound.
When I went for the ultrasound, the technician carrying out the procedure said that she could certainly feel the lump, but could not pick it up on the ultrasound. She said something like “I can’t see anything on the ultrasound so I’m going to write down ‘normal’”.
After the ultrasound, I went back into the Doctor’s office and he told me that my results were “normal”. I asked if there was any possibility that the lump could be a cyst and the doctor told me no because a cyst would have showed up on the ultrasound.
I asked what he thought had caused the lump. He told me that it would just be “nodularity” caused by my periods. But during my first meeting with him (before the ultrasound) I had specifically explained that I had had 2 periods since discovering the lump and the lump had stayed the same before during and after my period. (e.g. it did not appear to be hormone related).
Before I left, the Doctor told me that if the lump increases in size I can arrange another appointment.
It is now seven months since my hospital referral. I had hoped that the lump would have disappeared by now, but it is still there. While I do not feel that it has grown in size, I do feel that it is harder than it was.
I wondered if I could please ask your advice on what I should do (if anything). Would you have this checked out again, or do you feel that it is safe to leave and monitor?
I am 26 years of age and the lump is completely painless.
Thank you very much in advance.
At your age the risk of breast cancer is very low. It is not 0 but low. Furthermore your lump does not seem to have grown. It is therefore very probable that it is NOT a cancer. A cancer would also - like a cyst - have shown up on the ultrasound scan. Whatever else it may be I can not explain why it was not seen on your ultrasound scan. Based on all this I think I can safely say that your risk of breast cancer at present is VERY low. But I can still not tell you what it is you feel. And that is frustrating. For me and probably also for you. There are 2 ways of finding out what it is. But since you live in the UK at the "mercy" of the NHS where it is difficult or impossible to decide on your own which specialist or procedure you want, that has to be supported by your GP, it is most probably hard for you to have it done. You may have it done privately though at a cost I can in no way predict. I am not even sure that one of these options is available to you in the UK at all. The 2 options are 1. A fine/thin needle aspiration biopsy of the lump guided by touch alone since it can not be seen on ultrasound. That is a cytologic biopsy which means there are certain limitations in what it can tell us but sufficient for telling us if there are cancer cells there or not. It is also the quickest, cheapest, simplest & easiest option. Not even local anesthesia is necessary since that too would be injected. But I am not sure if it at all is available in the UK. The other 2nd option is a surgical biopsy. That has to be done at least with local anesthesia. It has the advantage that we would obtain a histopathology specimen for microscopy not just a cytology smear. But in all and every other aspect it would be more complicated. It would probably also be more expensive. But I can not even guess the cost. These are the 2 possible options available. You can discuss with your GP if you can get support from there to have any of these done in the "official" system. If not only the private road remains. There is one more option. You can go to another EU country where patients can decide on their own which specialist they want to go to (Sweden is such a country) within the local national health insurance program and go to a private breast clinic for examination. In Sweden the cytology biopsies are done routinely. I have to stress that I am retired and do not work so you can not ask my help and I have no financial gain from this advice! Which option you choose - if any - is your choice and yours alone. Good luck!
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