Most women had the importance of breast health drilled into their heads from an early age. They grew up understanding that they should call the doctor at the first sign of a lump in their breast. But many women were never told how to identify such a mass: What would it feel like? How big would it have to be to warrant attention? Would it move under the touch of a finger? The truth is that if you feel a lump in your breast, the characteristics don’t matter. The only thing that matters is that a mass is there.
Any swelling in the breast is worrisome, no matter what it looks or feels like, although only tumors that are at least a half-inch in diameter can be felt by hand.
“ If you notice an area of your breast that feels different from the surrounding tissue or corresponding tissue on the opposite breast, that is a concern.” - Dennis Citrin, MD, PhD, Medical Oncologist at our hospital in Suburban Chicago
Typically, a breast mass occurs for one of three reasons: tissue changes related to the hormonal fluctuations common before and during a woman’s menstrual cycle, a benign tumor or a cancerous tumor. “There aren’t a hundred different things it could be,” Dr. Citrin says. That’s why women who are premenopausal are advised to wait a cycle or two before calling their doctor, to see whether the lump goes away, and women who are postmenopausal are urged to call immediately. “In postmenopausal women, hormone fluctuations related to menstruation aren’t at play, so it eliminates one of the three options,” Dr. Citrin says.
Although your doctor will likely perform a physical examination of the area, he or she cannot tell whether a lump is cancerous just by feeling it. Your doctor may order a mammogram if cancer is suspected, but the screening tool isn’t considered the most reliable in diagnosing breast cancer because the test may not detect an abnormality, and because the test may report a false positive. If you notice a mass in your breast, it’s important to have an ultrasound, which should determine whether a biopsy is necessary, Dr. Citrin says.
If breast cancer isn’t caught early, the lump will typically grow larger before spreading to multiple areas. “That doesn’t happen overnight, though,” Dr. Citrin says. “Most breast cancers grow relatively slowly.” And there is no basis to the common misperception that breast tumors are more likely to be cancerous if they don’t move under the touch of a finger. A cancerous breast tumor that doesn’t move is likely so large that it’s grown into the chest wall, Dr. Citrin says. “The more typical case is a patient who notices a moveable lump in her breast, which means it’s not attached to the chest wall and not attached to the skin,” he says. “If a lump in the breast is immobile, meaning it can’t be moved, or the skin over the lump contains small nodules or is bleeding or inflamed, then this almost certainly represents advanced breast cancer, and has to be addressed by your doctor immediately.”
Being familiar with your breasts and understanding how they change is important to recognizing changes that deserve further testing. That’s how breast cancer is most often caught and diagnosed early. Although the American Cancer Society has moved away from encouraging women to perform regular breast self-exams, the organization does encourage women to be familiar with the way their breasts look and feel, and to report any changes to their doctor immediately. “Your breasts probably feel differently at different times of the month,” Dr. Citrin says. “Women should know those differences so they can tell if something changes. The worst thing that could happen is that you may go to the doctor once or twice unnecessarily, but I’d much rather see that happen than have a woman ignore a cancerous mass.”
Learn more about the signs of breast cancer.