Leave diagnosis of lump in the breast to physician

ON CALL

November 24, 1992|By Dr. Simeon Margolis | Dr. Simeon Margolis,Contributing Writer

Q: I have just discovered a lump in my breast. How can I tell whether the lump is cancerous or not?

A: Lumps or masses are more likely to be cancerous (malignant) when they are firm, attached to underlying tissues and have indistinct borders. In contrast, benign masses generally are easily moved and have regular, discrete margins.

Other features that suggest malignancy include dimpling of the skin, bloody discharge from the nipple and retraction of the nipple. Malignant tumors are usually not tender, but this is not a dependable distinction. In fact, none of these differences is reliable in distinguishing between a benign and malignant breast mass.

Even experienced physicians have difficulty in using the findings of the examination alone to decide whether a breast lump is malignant. Various studies have shown that the conclusions based on physical examinations by physicians are correct only 60 percent to 85 percent of the time.

So the real answer to your question is that you should not try to decide whether the lump you discovered is cancerous or not. Rather, you and all women should see a doctor as soon as a breast lump is found.

In addition to examining the lump, your doctor may recommend a needle aspiration or open biopsy in order to make a definitive diagnosis.

Don't be surprised when mammography is ordered despite the presence of an obvious mass, and even if its features are strongly suggestive of cancer. Mammography in this situation is not done primarily to help determine whether the mass is malignant, it is done to evaluate the breasts for other masses that may not be apparent on examination. It is not unusual to find more than one cancer in the same breast, and about three in 100 women have cancers in both breasts at the same time. More than half of these are found only by mammography.

Dr. Margolis is professor of medicine and biological chemistry at the Johns Hopkins School of Medicine and associate dean for faculty affairs at the school.

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