Oncology (General Cancer)/Breast Lump
QUESTION: Dear Dr Higby,
I wondered if I could please ask your advice.
I am 25 years of age and around 3 weeks ago I discovered a small lump in my right breast, just beneath the nipple. The lump is about the size of the end of a cotton bud / cotton swab. I wouldnít describe it as very hard, but itís not soft either.
When I discovered the lump, I thought there was a possibility it could be connected to my period. As a result, I thought it would be best to see if it shrunk / disappeared after my next period before going to the doctors.
I came to the end of my period a few days ago and the lump is still there. It is no smaller or bigger Ė just exactly the same as it was 3 weeks ago. The lump is not at all painful.
I do not know if this is connected, but the skin on my nipple area (both left and right) is very itchy (and has been like this on and off for over a year). It is also a little flaky. I assumed that this itchiness was just being caused by dry skin and nothing to worry about, but since discovering the lump, Iím now worried that there may be a connection.
I am planning on booking an appointment to see my Doctor in the next few days to have it checked out, but I am worried about going.
Will the doctor know just by examination what is causing the lump or do you think I will have to be referred for testing?
If the lump was just a cyst / connected to my period, do you think that it would have disappeared by now?
I have Endometriosis, could this be in any way connected to the breast lump?
Thank you very much for your time
ANSWER: At 25, with no risk factors (like a family history) the chances that this is breast cancer are very low. However, you do seem to have some sort of problem. The lump may very well be a "cyst" involving a milk duct if it is within the aereola; if it's under the normal skin it could be a follicle cyst. Another possibility is that it is a slightly enlarged lymph node. I think you are right in getting this looked at; if you were my patient I'd suggest treating the nipples with (initially) aloe vera solution or cream to improve moisture retention and I'd probably measure the nodule carefully and check it again in a month, assuming my inspection of it did not make me think it was serious. Obviously the definitive test would be to remove it, and that could be done as an outpatient. Sometimes that brings about "peace of mind" which is worth the minor surgery.
This is probably not related to your period. I don't think this has anything to do with endometriosis.
Hope this helps.
---------- FOLLOW-UP ----------
QUESTION: Dear Dr Higby,
I hope that you donít mind me asking you a follow-up question. I e-mailed you for advice a number of weeks ago regarding a firm, painless lump in my right breast and you agreed that I should have this checked out by my GP.
I have since been to my GP and saw the nurse practitioner there. Before examining me the nurse said that because of my age (26) and because I have a slim frame, she thought it was probably a rib I was feeling and mistaking it for a breast lump.
The nurse examined my breast and told me: ďThere is nothing untoward thereĒ and said there was no lump and it was probably just my rib I was feeling. I felt 100% certain that it was not my rib I was feeling, so asked if I could please lie down on the bed (as itís much easier to feel the lump when Iím lying flat) and see if she could feel it that way. The nurse felt again and said ďOh yes, there is a lump there, but itís so small!Ē She then told me it was up to me what I wanted to do and that she could refer me to a breast clinic if I wanted to.
I asked if she could please refer me as the lump had been there for around a month (at the time of the appointment) and hadnít gone away or changed with my period. As I was leaving the consultation room, the nurse said that the lump was ďprobably just a cystĒ.
Two weeks after my appointment with the nurse practitioner, I attended a breast clinic at my local hospital. The doctor I saw examined by breasts and underarms and said that he wanted me to have an ultrasound of the lump. He said that because the lump was small (about the size of the tip of a cotton bud) it may not show up on the ultrasound.
When I went for the ultrasound, the lady carrying out the procedure said that she could certainly feel the lump, but could not pick it up on the ultrasound. She said something to the effect of: ďIt might be a milk duct youíre feeling side on. I canít see anything on the ultrasound so Iím going to write down ĎnormalíĒ.
I always thought that the milk ducts were actually inside the nipple Ė if Iím right in thinking this I canít understand how the lump can be a milk duct Iím feeling because my breast lump is not within the areola / it is not on or behind my nipple Ė itís about 1.5cms BENEATH the edge of the nipple (please see diagram attached).
The lady did not say that she thought the milk ducts were swollen or anything Ė she seemed to be saying that the milk ducts were normal, but I might just feeling one of them side on. I remember thinking that surely if the lump was just a milk duct, it would ALWAYS have been there and I would be able to feel the same in my other breast too? The fact that the lump is new is something else which makes me feel certain that this canít be a milk duct Iím feeling?
After the ultrasound, I went back into the Doctorís office and he told me that my results were ďnormalĒ. He did not mention anything about the lump being related to my milk ducts (as the lady who had carried out the ultrasound did). 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 ďnodularityĒ 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 grows I can arrange another appointment.
I thought I would be able to breathe a sigh of relief after being told my results were ďnormalĒ but I just feel so full of doubt Ė mainly because different medical staff are telling me very different things. Iíve been told that the lump:
*isnít there (that itís my rib Iím feeling)
*is there but itís probably a cyst
*is not a cyst
*might be a milk duct Iím feeling side-on
*would just be nodularity being caused by my periods (even though the lump has remained the same before, during and after my period)
Since I havenít received a definitive diagnosis of the cause of the lump, Iím still quite worried Ė especially after reading all sorts on the internet about breast lumps not showing up on ultrasound but turning out to be cancer.
In your opinion, do you think that I should still be concerned about the lump?
If my lump is just down to nodularity, is it normal for a nodule to last 6+ weeks?
Do you feel that this could be a milk duct issue (the lump is around 1.5cms beneath the edge of my nipple)?
If the lump does not go away, how long should I leave it before returning to my GP?
Thank you very much in advance and apologies for such a lengthy question
First of all, I wouldn't worry about what the technician said, or the nurse practitioner. However it's obvious that whatever it is, it hasn't been diagnosed -- your doctor used a word (nodularity) that basically is latin for lump. It is true that under a certain size, a nodule might not be detected by ultrasound. However, for a very small cyst, it might not be detected either. So a cyst (which is my guess) hasn't been ruled out. I don't think it's a milk duct, because of the location. However, milk ducts can "pop up" because of some obstruction. Usually this is accompanied by some tenderness. Given the size, the fact that you've been to the doctor and had all the indicated tests, and the fact that it is painless and hasn't changed, plus your age, etc, I would recommend that you examine it on the first day of your period, making note of it's size. If it is stable, do nothing else. If it increases by 25% or more, then see the doctor again. Something that small either needs to be watched, or needs to be removed, and if it's removed, you might feel something there from scar tissue that forms, leaving you just as you are now, wondering. So please, make a measurement, write it down, and repeat only once a menstrual cycle. Hope this helps.