by Lora L. Burke, MD

As a breast surgery specialist at St. Luke’s, I see many patients every day who are concerned about breast cancer. While each case is unique, many of the questions posed are similar. If you have reason to be concerned about your own risks for developing breast cancer, see your doctor without delay. In the meantime, here are some answers to frequently asked questions about breast health.

“I have a new lump in my breast. What should I do first? See my primary care doctor, or go get a mammogram?”

Finding a new lump or something “different” in your breast can send you into a panic, but you should remember that the vast majority of breast lumps are not cancerous. Monthly fluctuations in hormone levels can cause changes in breast tissue, making even normal areas feel more prominent. Still, it’s important to have new lumps checked out.

First, see your primary-care physician as soon as possible. If your physician cannot see you within a couple of days, find someone who will. After examining your breasts, your primary-care physician may refer you to a surgeon who specializes in breast problems. You most likely will have a mammogram (unless you’ve had one fairly recently) and possibly an ultrasound to further evaluate any suspicious areas. Based on this further testing, the doctor can then make recommendations as to whether you need a biopsy.

Biopsies usually can be done with a small needle, and surgery is often unnecessary. A good rule of thumb is that all new breast masses need some kind of biopsy, even if you have a normal mammogram and ultrasound. Most importantly, find a doctor you can trust, and don’t be afraid to get a second opinion if what the doctor says doesn’t make sense to you, or if you still have a nagging sense that something is wrong.

“I’m 28, and my doctor says my breasts are fibrocystic. What does that mean, and does it mean I have a higher chance of getting breast cancer?”

“Fibrocystic” is a catchall phrase that is hard to interpret. To doctors it usually means that the breasts are “lumpy and bumpy,” making examination of the breast more difficult. In truth, the term “fibrocystic” encompasses a diverse group of processes in the breast, some of which are normal body changes while others verge on being pathologic.

It’s important to remember that the breast is made up basically of two components: duct tissue (the cells that make the milk) and the other supporting tissues of the breast (the “stroma”). Stroma includes fat, blood vessels, ligaments to hold the breast up, and connective tissue to hold the breast together. Monthly hormonal fluctuations can act on all these components, causing the breast to feel “lumpy and bumpy.” Such lumps and bumps are usually cysts or fibroadenomas, both of which are non-cancerous.

Cysts are fluid-filled structures that originate from the milk-producing part of the breast. They can get bigger and smaller, not surprisingly, paralleling the monthly menstrual cycle. Cysts are not pre-cancerous, and having cysts does not make you more likely to get breast cancer. Having cysts, however, can make examination of your breasts slightly more difficult and, if significant, may warrant yearly exams by a breast specialist.

Fibroadenomas, on the other hand, contain both ductal and stromal elements that get “heaped up” and form a mass-like structure that can be felt. Fibroadenomas are not pre-cancerous and do not turn into cancer, but having fibroadenomas does put a woman at a slightly increased risk of developing breast cancer. Again, fibroadenomas do not transform into breast cancers – they are just a “marker” for slightly increased risk.

Once an ultrasound or a needle biopsy proves that a breast mass is a non-cancerous simple cyst or fibroadenoma, it does not need surgical removal unless it is growing, painful, or particularly large.

“My aunt had breast cancer. Does this mean I have a higher chance of getting breast cancer, too?”

Family history is a significant component in determining a woman’s risk for breast cancer. You must remember, however, that only about 5-10% of breast cancers are familial or genetically based. The vast majority of breast cancers are sporadic, meaning they are random and do not follow a familial pattern.

When a woman has one or more women on the same side of the family – usually a mother or sister – with breast or ovarian cancer, physicians often perk up their ears and wonder if there if a genetic reason for the cancer. .Presently, there are only two known genetic abnormalities associated with an inherited susceptibility to breast and ovarian cancer, BRCA 1 and BRCA 2. These two account for a small minority of breast cancers. Luckily, we can test for these genes in the blood. If the blood test is positive, we can take numerous steps to reduce a woman’s risk of developing cancer.

Most importantly, if you have a strong family history of breast cancer and you think you are at increased risk, you should see your primary doctor and discuss your concerns. If your family history is suspicious enough, you will need to be referred to a genetic counseling specialist who can get all the details about your family history of cancer and decide whether or not you need a blood test or other special screening.

Dr. Burke’s office is located adjacent to St. Luke’s Hospital at 1580 Valencia Street, Suite 604, telephone: (415) 285-3049.

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