The Breast Lump

The Breast Lump Rule:

In 1982 my sister felt a lump in her breast which she dismissed. But later at a routine doctors visit she showed her doc, and he dismissed it as probably fibroid. Fibroid lumps have no characteristics on exam that distinguish them from tumors. The doctor made his diagnosis based on probability. But he broke a cardinal rule -

All breast lumps must be biopsied.

One year later, she went again, as the "fibroid" had grown to considerable size...it was then that the doctor ordered a mammogram, and based on the findings, he did a needle biopsy. The diagnosis was made: Breast Cancer. The disease had spread to the lymphatic system as she had three positive lymph nodes (the mode of spread from local to systemic is lymphatic.) Within 6 months she had the disease in her hips. My sister didn't know the rule. Her doctor ignored the rule based on the probability that 2 out of 10 breast lumps are cancerous. But the rule is: BIOPSY of all breast lumps. If a woman learns two things it should be this rule and the breast self exam. Self exam should be as habitual as a daily shower. Malignant lumps detected early can lead to excision of all cancer cells.

After 11 years, with a course of chemo, several in fact, mastectomy and removal of the affected lymph nodes, my sister died of metastatic breast cancer at age 57.

With METS CA, living that long is unusual. But, my sister had estrogen sensitive tumors, and after chemo, she took Tamoxifen , and Toremifene (one was experimental at the time, I forget which.) These drugs deprived the tumors of the estrogen needed to grow at an aggressive rate. . My sister got to see her kids grow up. If she had known the rule, and her doc had not ignored it, most likely a lumpectomy would have solved her problem. She would be alive today. The rule again is:

Biopsy all breast lumps.

All breast lumps must be biopsied, also learn the breast self exam. Practice it daily in the shower. If you find a lump, and your doctor dismisses it, copy this story and hand it to him. If he disagrees, get another doctor quickly.

I met an expert who taught me the rule, and now I am teaching you! (Incidentally, I am not talking about obvious "pimples", unless they are pigmented and dimpling. Monitor any pimple for these changes. Lumps are visceral, deeper, and they have a palpable form, a pimple has a head on the surface, and usually people are prone to them, know what they are about, and they recognize them. It is still sensible to keep an eye on pimple, and other blemishes, especially ones that are pigmented )

When I was in nursing school I met a patient who followed the rule. She had a lump. I followed her through the course of her day in the hospital. I went with her to mammogram, and comforted her through the needle placement before the biopsy surgery.
This is no fun. It is initially very painful, but it is over very quickly, so if you have to experience it, take a buddy squeeze a hand. Focus your attention on that hand - and you will come through it just fine.

They literally stick a needle through the breast without anesthetic and later crush the breast between two mammogram plates..almost to the point of flattening it and then, using the mammogram;s x ray to map the location of the tumor by way of the needle placement. The needle lights up near the tumor.
Women are brave though, it's the men who are chickens here.

The needle placement didn't take long, but as a student i was shocked to see they took what looked like a needle that you skewer a turkey with to monitor temperature on Thanksgiving and plonked it through the breast. Then they take a picture. I wanted to run out of there myself. But, instead, I grabbed her hand, and asked her to squeeze during the placement. She did, and she tolerated the procedure better than I did. That focus helped.

(The mammography xray will highlight the needle on xray, and make locating the tumor easier on incision, as the needle will be near it.)

Next there was the surgery itself.

This woman decided she could not go on vacation worrying about this lump and got the lump investigated. This is what you should do if you encounter a lump on self exam.
The surgery lasted 1/2 hr or less. She was asleep. She felt nothing. The surgeon asked me as I watched him making his incision, peeling away layers of adipose tissue, while he was locating the lump, academic questions:

"how many of these lumps are cancerous:"
"Two out of ten," I said, a simple fact I'd remembered from reading.
The assisting nurse laughed. "Why are you laughing? He is right." He asked me how he knew where the lump was, and where to cut. :
I joked with him: "You mean you don't know how you know?"

He laughed and he explained the needle location, and showed me the lump on xray and peeled away the adipose tissue to reveal the needle. Then, there it was, just beneath the needle the lump. He excised it, and send it to pathology. The results were available in one hour, "Benign Fibroid." Luckily it was one of the 8 ":good lumps" out of 10 a benign fibroid mass. After the excision I wheeled the woman to recovery. And as she was coming out of the fog, the doc let me give her the good news. "You will have a great vacation; the lump was benign." She smiled from behind the anesthesia induced haze.

As I was leaving for the day, this doc saw me in the hall towing my books:

:"What's the rule?" he said...."There's a rule?" I said. "I dinno, what do you mean?"

"All breast lumps must be biopsied." I thought about my sister who was on Tamorafen at the time with metastatic cancer. And, if I learned nothing that day, I learned the rule. And so for you? Learn the breast self exam, and remember the biopsy rule too.
Even if you have to teach to your doc who is working probabilities, ensure that he follows the rule that you followed. This is the standard of care, and don't settle for less.
Here's two tools you can use from the web: The breast self exam: http://www.cancer.org/docroot/CRI/content/CRI_2_6x_How_to_perform_a_breast_self_exam_5.asp
Breast Biopsy Procedure: http://womenshealth.about.com/cs/breastlumps/a/brstlumpbiopsy.htm

© Toylanders Press International (Gary Stone.)  July 9, 2009

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