When to Biopsy?

QUESTION: My sister-in-law was recently diagnosed with breast cancer, a 10-centimeter tumor. She had a mammogram five months ago and an exam three months ago, but it was not detected until her nipple started to invert.

I have had breast pain (right breast only) for the past year. Mammogram is "normal," but my surgeon found a lump and says it is most likely only fibroadenomas. The surgeon also found two fluid-filled cysts "that are nothing." The surgeon wants me to wait three months and come back. Because of my sister-in-law, I don't feel comfortable with that recommendation. The surgeon suggested taking it out, but then I would have to deal with scar tissue. Should I look at other options, wait three months, have a biopsy, have an MRI? Does this warrant a second opinion?

ANSWER: I can understand why your sister-in-law's situation is upsetting and scary, making you feel less confident in your ability to find a breast cancer problem early with physical exam and mammography. About 25% of the time, breast cancers are found only by physical exam—not seen on the mammogram. Plus, some cancers can act sneaky, becoming big without symptoms or a clear-cut mass, and then they let themselves be known by finally forming a lump or pulling in the nipple or involving the overlying skin. You are not blood-related to your sister-in-law, so her history of breast cancer doesn't impact on your risk.

If the lump in your breast that your doctor thinks might be a fibroadenoma is in any way suspicious, then have your doctor evaluate it further now, rather than later. Or get a second opinion. Most fibroadenoma-looking lumps do prove to be fibroadenomas or another benign process. But in case there is a problem, or just to give you peace of mind sooner than later, it's worth checking it out. With modern-day biopsy procedures using a tiny incision and core-like probe, a reliable analysis can be done with a minimum amount of scar tissue.

Regarding your cyst, when an ultrasound shows a "classic cyst," most doctors feel that's about as close to a 100% sure diagnosis as is possible. Of course, your care requires individual attention by your own team of healthcare professionals. We hope that the general information that we've provided will help you work with your own team, to get the best result possible.

—Marisa Weiss, M.D.