(February 27, 2009 - Insidermedicine) In this video, Dr. Sarah A. McLaughlin MD, discusses what she would do if she discovered a new lump in her breast. Dr. McLaughlin is Assistant Professor of Surgery at the Mayo Clinic in Jacksonville, Florida.
At the 2008 San Antonio Breast Cancer Symposium, we spoke with Dr. Sarah McLaughlin, Assistant Professor of Surgery at the Mayo Clinic in Jacksonville, Florida.
If I had a new lump in my breast…
Dr. McLaughlin: If you find a new lump in your breast, I think it's important to quickly call your primary care physician or to call a physician and to let them know that you have found this and then they will direct you in terms of what needs to be done. It's probably important that you call them within a week or so a few days of finding it, just so that you can start the ball rolling getting down the path of trying to determine what it is.
What does the evaluation consist of?
Dr. McLaughlin: When you go and see the physician, they're going to want to know what you feel. Many times they are going to ask you to point exactly what you're feeling and then they will confirm with you whether they feel the same thing, whether or not it's considered suspicious or not. In general when a woman has a breast exam, the physician is going to examine the patient in two positions, both sitting up and lying down, because the shape of the breast changes as we change positions.
What can a lump represent?
Dr. McLaughlin: A lump can represent many things. It's possible to have benign tumours of the breast but of course when we have a new mass in the breast our biggest concern is that this is a new breast cancer and we need to prove that it's not, until we proceed down the path of looking at benign lesions. Not only will that entail a physical exam but it will also ultimately require some type of imaging technique, a mammogram with or without an ultrasound as well.
What imaging tests should be ordered?
Dr. McLaughlin: In terms of imaging you're going to end up having a mammogram, the mammogram is going to be two views of each breast. In general the area where the mass is palpated, you might have additional views, additions mammogram pictures in that area. Ideally if it is not seen by mammogram or if additional information is need, then a targeted ultrasound of the area where the mass is palpated will be performed, and that will give us more information in terms of the mass consistency. Is it Solid, is it Cystic, is it filled with fluid, are their multiple septations or divisions within the mass or is it one unit? That will also help us to determine if there is blood flow coming to or from the mass and then how suspicious it is, and then based on that, those characteristics; the determination for a biopsy can be made.
What happens during a biopsy?
Dr. McLaughlin: If you do a biopsy, that's generally performed under image guidance, meaning that the mass is seen under mammogram or under ultrasound and then a small needle is inserted into the mass under that guidance to make sure that the appropriate mass is sampled. This is generally performed by either the radiologist or a surgeon, a little bit of numbing medicine will be given in the beast in that area and then a needle will be inserted a couple of times taking several cores of samples or cores of the mass that are then sent to the pathologist for diagnosis.
What is the biopsy comes back positive?
Dr. McLaughlin: If the biopsy comes back positive for breast cancer then the patient should have a consultation with a surgeon. At that point in time then further diagnostic studies, additional images, either by ultrasound or whether or not an MRI needs to be performed would be determined at that point in time and then ultimately the patient would require surgery to have the area removed.
What are the risks of having a biopsy?
Dr. McLaughlin: The risks of having a needle biopsy are relatively low. The needle that is inserted is quite small, it takes several cores, I would say the biggest risk is that patients face the possibility for hematoma or bleeding at the biopsy site which then can cause some bruising in the breast itself and then some associated pain in that area after the biopsy. The risk of infection is extremely small, and there is no risk at this point of dispersing the cancer elsewhere which I think it a common question that patients ask.
Are there adverse effects of a biopsy?
Dr. McLaughlin: The biggest thing after the biopsy is whether or not you have some bleeding. Some woman can have very significant bleeding after a biopsy, although it's rare it does happen occasionally where they get significant bruising over the breast. So after the biopsy, I would recommend that you wear a nice supportive bra, and keep the bandages on from the biopsy itself, and just some Tylenol is probably enough that you'll need for pain control from that stand point. A surgical biopsy is a little bit different. It's very rare that we actually have to do surgical biopsies with such good imaging techniques and image localization techniques these days. Surgical biopsy is rare but that's more of an incision in the breast, a little bit of anaesthesia and the risk of bleeding and infection is also with that; infection more so then bleeding.
How reliable is the biopsy?
Dr. McLaughlin: The test is pretty accurate. I don't know numbers off the top of my head but if you have a biopsy that demonstrates cancer I would consider that to be accurate. Generally what's going to happen is if you go to a different institution to seek another opinion they're going to recommend that you bring with you the slide of the biopsy that the pathologist looked at and then their pathologist is also going to review that information as well to make sure everyone agrees, yes this is cancer or this is not cancer.
Dr. McLaughlin: If I had a breast lump I would notify my physician fairly quickly. I would undergo additional tests as recommended, mammogram or possibly an ultrasound, and certainly have a physical exam to confirm that the mass is there. If a biopsy is recommended, ideally an imaged guided biopsy under mammogram guidance or ultrasound guidance would be recommended and performed. It's a relatively low risk procedure where the highest risk would be of bleeding after the biopsy and even that is seen infrequently.