Breast Lump

Dave and Susan were anxiously waiting for me.

Since her last visit, Susan has practiced breast self examination. She found a breast lump.

Susan is aware that breast cancer is the most common cancer diagnosed in Alberta women. It also accounts for about 21% of all cancer deaths in women (Breast Cancer – The Picture in Alberta: 1998).

Susan came straight to the point. She told me about her breast lump.

“Dr B, do you think it is cancer?”

“Susan, I will have to do some investigations before I can answer your question.”

I started with clinical history. How long the lump has been present? Has any change been noted? Is there a previous history of breast biopsy or breast cancer?

Age is the most significant risk factor for breast cancer in women. At age thirty, the probability of developing breast cancer in the next five years is 1 in 667. At seventy, it is 1 in 65.

Susan is thirty eight. Her risk is 1 in 208.

Any other risk factors? Susan’s sister had breast cancer. It is estimated that less than 10 percent of all breast cancers have genetic predisposition.

Breast cancer may or may not be painless.

A fine needle aspiration biopsy of the lump was required to establish whether the lump is solid or cystic. A cystic lump has a very low probability of cancer. I also arranged a mammogram. This would provide further information on the nature of the lump. It would also pick up smaller lumps which were not felt during the physical examination.

Susan and Dave were made aware that eighty percent of breast lumps are benign in nature but a breast lump is suspected to be malignant unless proved otherwise.

Within a week I had good news for Susan. The needle biopsy and mammogram did not reveal cancer. She was advised to see me seven to ten days after she starts her next menstrual cycle.

Susan arrived as planned.

I gave her another physical examination to see if the lump had changed or even disappeared. The lump was still there.

Unfortunately, none of the tests we do are hundred percent accurate to rule out cancer.

“Doctor, I know this. I have been talking to my sister. What’s next for me? A surgical biopsy?”

Yes. This would entail a surgical procedure under local or general anesthetic.

Susan underwent day surgery as planned. There was no cancer.

I saw Susan again a few weeks later. She was happy and relieved.

“Doctor, what should I do to stay one step ahead of the game?”

Mammography and physical examination are the mainstay of screening in breast cancer (Cancer Screening in 1995; Current Oncology; March 1995).

Susan got ready to leave. I gave her some pamphlets to read.

“Call me if you have any questions,” I said as Susan stepped out of the door.

She smiled and said, “Thank you, doctor!”

(This series of articles explore the health problems of Dave and his family. They are composite characters of a typical family with health problems)

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