Wed | Sep 28, 2022

Dear Doc | Not all breast problems caused by cancer

Published:Sunday | October 6, 2019 | 12:00 AM

Q Dear Doc, I am very concerned and need a second opinion. So I went to the doctor for what I thought was a very big problem, but I think he didn’t take me or my concern seriously enough. I had breast tenderness, very tender – and I felt lumps. I panicked and went to the doctor like everybody says you should. But all he did was ask me some questions and told me to re-examine them after two weeks and return if it is still there. I want a scan of my breasts to make sure everything is OK! Shouldn’t that have been done?! Where can I go to get a scan without a doctor.


A I know exactly what your concern is and I also understand why your doctor did what he did.

Breast problems, such as breast lumps, breast pain or tenderness, and even nipple discharge, nipple inversion, and changes to the skin of the breast are quite common in women of all ages, from adolescents to older women. While it is very frightening to discover a breast problem, most breast problems are not caused by breast cancer.

A lump is the breast problem associated with the most concern for patients, and the cause of much panic. You or your doctor may find a breast lump by examining your breast, but it is difficult to determine by examination alone if a lump is caused by breast cancer.

Although most breast lumps in women age 20 to 50 are not cancerous, all breast lumps should be evaluated by a healthcare provider to determine if further testing is needed.

This is because the best test for evaluating a breast lump depends, in part, upon your age, and your menstrual cycle.

If you are under 30 years of age and you find a lump, especially before your menstrual period, you may be advised to have a repeat breast examination after your period has ended.

The reason for this is that in this age group, breast lumps are often caused by hormonal changes and will resolve after your menstrual cycle.

If the lump does not go away when your period is over, you are likely to need further testing, starting with a breast ultrasound, which if abnormal. This may be followed up with what is called a needle aspiration biopsy, to determine whether the lump is fluid-filled or solid.

Mammograms are not usually performed in women under 30 years old.

If you are over the age of 30 and find a breast lump, you will need a diagnostic mammogram, and usually an ultrasound as well. If the lump appears suspicious on the mammogram and or the ultrasound, a breast biopsy is usually recommended.

So the questions you were asked by your doctor was likely to determine which category you were in, and determine what would be next for you.

Hormonal Changes

Regarding your breast pain and tenderness, again, the most common type of breast pain is caused by the hormones that control the menstrual period. These hormonal changes can cause pain in both breasts several days before the menstrual period begins. Because the pain can come and go with the menstrual cycle, it is called ‘cyclical’ breast pain. Cyclical breast pain is not usually caused by breast cancer or other serious breast problems.

Less commonly, a woman can have breast pain that does not come and go with the menstrual cycle and thus is called non-cyclical breast pain. This type of pain is not related to the menstrual cycle and may occur only in one breast or in a particular area of the breast. Non-cyclical breast pain is caused by breast cancer in only a very small percentage of women. It is more commonly caused by a problem outside the breast, such as a muscle strain, skin injury, spinal conditions, or problems in another organ system (e.g., heart burn).

If you believe your pain and tenderness may be due to your menstrual cycle, pain relief medicines, such as acetaminophen (Tylenol) or ibuprofen (Advil), can provide relief. Women with very severe breast pain are sometimes treated with prescription medicine.

You can also try wearing a well-fitted support or sports bra.

If you do find that your breast problems persist after your menses, you should return to your doctor within a few weeks, as he recommended. The re-evaluation may be all that is needed, and you can be set at ease. However, you may be referred for further testing or evaluation with a breast surgeon, depending on what is found.

If your re-evaluation shows no sign of a problem, but you remain concerned, talk to your doctor about your concern. Further testing and follow-up, over time, may be planned to ensure that your breast complaints are truly cyclical, or not; or referral to a specialist may be recommended.