Many women first identify fibrocystic breast changes when they perform their monthly breast self-examination. Other times, these changes are noticed during a bath or shower, or they are detected by a physician during a clinical breast examination. These changes may be due to:
- Menstrual cycle
- Birth control pills or other hormones
Any unusual changes in a woman’s breast, particularly lumps, cysts or nipple discharge, should be evaluated by a qualified physician.
The result may be a diagnosis of fibrocystic breast changes, a benign (noncancerous) breast condition. To rule out a more serious condition, such as breast cancer, the physician will take a detailed medical history of the patient and review the symptoms she is experiencing. A physical examination will be completed with focus on the breasts and surrounding areas, including the lymph nodes.
The clinical breast exam, which takes about five minutes, is performed by a physician who feels the breasts with the pads of the fingers. Using this method, the physician checks the entire breast area, including under the arms, around the collarbone area and nearby lymph nodes. To obtain more detailed information, the physician may order a mammogram.
If the results from the mammogram are inconclusive, a physician may send the patient for a breast ultrasound. The ultrasound test works by sending and receiving high-frequency sound waves to create images of internal organs or tissues. Sound waves pass through the tissues of the area being examined. These sound waves are recorded and displayed on a computer screen or television-type monitor or printed out for a physician to review. They are useful to help differentiate fluid-filled lumps from solid lumps
If the clinical breast exam, mammogram or ultrasound shows a simple, fluid-filled cyst, then a needle aspiration is performed. This procedure involves inserting a needle into the center of the lump or cyst and withdrawing the fluid contained inside of it. Once the fluid is withdrawn, the cyst typically disappears.
If the cyst does return following repeated aspirations, or if it does not seem normal in appearance, the physician may perform a biopsy to rule out cancer. This is particularly true for fibroadenomas because they appear as a firm lump. A biopsy is the removal of cells or tissues of concern so that they can be viewed under a microscope by a pathologist. The pathologist will determine whether or not the cells are benign, precancerous or cancerous.
However, breast masses shown on imaging tests that are diagnosed as “probably benign” may be safely managed with ultrasound follow-up rather than biopsy, according to a new study. The American Cancer Society reports that 80 percent of breast lesions biopsied are found to be benign.