In the fight against breast cancer, breast self-exams are an important line of defense. By doing a self-exam every month, women will get used to how their breasts look and feel and will notice any changes more quickly. But what happens when a lump is found?
“Although most lumps aren’t cancerous, we can detect the few that are,” says Colleen Hagen, MD, a general surgeon with Adventist La Grange Memorial Hospital. “That’s why it’s especially important to see your doctor about any changes you notice.” For women who do notice a lump, Dr. Hagen outlines the next three steps for diagnosis.
History and physical analysis. During a breast examination, the doctor will evaluate a woman’s breasts, including any skin changes or areas of thickening. The history includes how long the lump, or other abnormality, has been there. “Whether it’s something new, old or has changed over time makes a big difference in how suspicious a lump is,” Dr. Hagen says.
Imaging studies. A screening mammogram can often detect breast cancer in women at an early, more treatable stage, even if they have no signs or symptoms. However, if a lump or abnormality is found, technologists will perform a diagnostic mammogram, which takes images at a higher magnification and includes additional angles to pinpoint the location of the lump and determine its size and shape.
Next, a breast ultrasound will be performed to determine whether the mass is solid, indicating a benign or malignant tumor, or fluid-filled, indicating a benign cyst. A breast MRI may also be performed if further clarification is needed. “We tend to use this on high-risk patients, such as women with a strong family history or those who carry the breast cancer gene,” says Dr. Hagen. “However, this should be discussed on an individual basis between the patient and her physician.”
- Breast biopsy. A breast biopsy removes a small sample of breast tissue to find out what the lump is and whether or not it contains cancer. Benign breast conditions – such as cysts, non-cancerous tumors and mastitis – can often be the cause of a woman’s lump. Although going through a biopsy can be unnerving, four out of five biopsy results aren’t cancerous.
Dealing with a positive diagnosis
At Adventist La Grange Memorial Hospital, if a woman has an abnormal mammogram she is partnered with a patient navigator. Their job is to work as a liaison between the patient and her care team and schedule appointments and tests. “Patient navigators support and guide cancer patients during each step of their journey, from diagnosis through treatment and follow-up,” says Dr. Hagen. “And many of them are breast cancer survivors themselves.” Patient navigators are a big source of emotional support for patients, especially while they contemplate their treatment options.
If cancer is confirmed, Adventist La Grange Memorial Hospital offers patients a relatively new procedure, called sentinel lymph node biopsy. When cancer spreads from the tumor, the sentinel lymph node is the place where it’s most likely to go first. “With this procedure, instead of taking out a dozen lymph nodes to check for cancer, we now only take out two or three,” Dr. Hagen says. Based on the biopsy results, the surgeon can determine what stage the cancer is and suggest an appropriate treatment plan.
Although lumpectomy, which removes only the tumor and some surrounding tissue, is the standard of care, many women still choose a mastectomy, where one or both breasts are removed. “Many women choose mastectomy because they say, ‘I don’t want to go through this again,’” says Dr. Hagen. “However, lumpectomy – breast conservation surgery – needs to be followed by radiation, but we now have more options than ever.”
A breast cancer diagnosis is a life-changing event, no matter what the outcome. Dr. Hagen says it’s the support team that helps patients through this process. “At Adventist Midwest Health, patients aren’t numbers,” she says. “We give each woman the attention she deserves.”