What To Think About

Breast lumps

• Ultrasound is used to guide the placement of the needle during a fine-needle aspiration biopsy or core needle biopsy if the lump shows up on an ultrasound scan. For more information, see the medical test Breast Ultrasound.
• Some lumpiness of breast tissue is normal. The fibrous tissue in the breast often feels lumpy or bumpy, especially before your menstrual period. This lumpiness (fibrocystic changes) is so common in women that doctors now think it is a normal change. These changes usually go away after menopause, but they also may be found in women who are taking hormone replacement following menopause.
• Most breast lumps are not cancer. But the chance of having a cancerous breast lump is higher after menopause than before menopause.
• If you cannot feel the lump, the most accurate type of biopsy is an open biopsy done after a needle has been placed in the suspicious area of the breast using mammography, ultrasound, or MRI.

Biopsy samples

• A mammogram and clinical breast examination may be needed after needle or stereotactic biopsy shows the biopsy sample is not cancer (benign). This is done to make sure that the biopsy sample was taken from the correct area. If more tissue needs to be taken, an open biopsy may be done.
• The biopsy sample may be looked at immediately. This method is called a frozen section because the sample is frozen and then sliced into very thin sections to be looked at under a microscope. Your doctor may give you the results right away. A frozen section is more likely to be done after an open biopsy. A more careful look of the biopsy is done with a permanent section to check the results of the frozen section. The results of a permanent section are available in about 3 to 5 days.
• Sentinel node biopsy may be done instead of an axillary lymph node dissection. Sentinel node biopsy takes out less tissue, and it does not cause as many problems with lymphedema. For more information, see the medical test Sentinel Lymph Node Biopsy.

When breast cancer is found

• Additional tests will be done if breast cancer is found. These tests may include:
  • Flow cytometry, which checks the types of cells in the biopsy sample. This helps find cells that are growing quickly. Fast-growing cells are more likely to be cancer.
  • Hormone receptor tests, which check to see if the hormones estrogen and progesterone affect the way the cancer grows. They also may give information about the chances of the cancer returning. The results help your doctor decide whether to use hormone therapy, such as tamoxifen ( Nolvadex), as part of your treatment.
  • Tumor marker testing, which checks for the protein HER-2/neu on the cells taken during the biopsy. This marker may help your doctor choose the best medication to treat breast cancer.
• If breast cancer is found, surgery called axillary lymph node dissection may be done next to see if the cancer has spread to the lymph nodes. Axillary lymph node dissection is done by taking some or all of the lymph nodes in the armpit . Removal of the axillary lymph nodes to treat cancer that has spread may cause significant, long-term swelling (lymphedema) of the arm in some women.