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Keeping an Eye on Benign Breast Lumps is Safe Alternative to Immediate Biopsy

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Breast lumps often are found during breast self-exam, "accidentally" (while bathing, for example), and during a breast exam by a medical professional. Lumps found one of these ways are called palpable masses or palpable lesions. (Palpable means something that can be touched or felt.) Doing a mammogram or ultrasound (or both) of the palpable mass is usually the next step your doctor will take to evaluate the mass. A biopsy may then be done to figure out if the mass is cancer. Most palpable masses are benign (not cancer).

A study suggests that if a mammogram or ultrasound shows a palpable mass is benign, keeping a close eye on it with regular medical exams and mammograms is a reasonable and safe alternative to immediately biopsying the mass.

The researchers reviewed the records of 320 women about 34 years old who had developed one or more palpable breast masses. The study looked at 375 breast masses. All of the masses were first evaluated with either a mammogram and ultrasound, or just ultrasound, and all were classified as benign. About 80% of the masses were managed with careful observation and no biopsy. The average follow-up time was nearly 3 years. The researchers looked for any differences between the outcomes of the masses that weren't biopsied right away and masses that were biopsied immediately.

More than 70% (264) of the masses were benign in follow-up; this means that the masses went away, got smaller, or didn't change in any way. The benign masses were most likely benign fibroadenomas (a benign lump that is firm and moveable) or cysts.

Of the masses that weren't immediately biopsied, 7% (26) grew during follow-up; most of these were biopsied and none of those biopsied were found to be cancer.

About 25% (75) of the masses were biopsied immediately at the request of the woman or her doctor:

  • all but one were benign
  • one mass had a very small (1.5 mm) area of DCIS (ductal carcinoma in situ), which is stage 0 non-invasive breast cancer; the researchers believe this DCIS finding was a coincidence and not associated with the original palpable mass

Close monitoring with no biopsy is common follow-up if a mass can't be felt, is first identified by mammogram, and the mammogram shows characteristics that suggest the mass is benign. Only about 1% to 2% of these types of masses eventually are diagnosed as cancer. The results of the study reviewed here suggest that the risk of a palpable mass being cancer when the mass has benign features is similarly very low. So the researchers feel that a wait and watch approach is a good and safe alternative to immediate biopsy for a palpable breast mass.

If you or your doctor discover a palpable breast mass, you'll understandably worry that the mass might be cancer. But be reassured that it's likely not cancer. Your doctor will order one or more imaging tests to evaluate the mass and will consider many factors -- including the mass's characteristics -- in deciding on a course of action that makes the most sense for you. If all factors suggest the mass is very likely benign, your doctor may recommend close follow-up, including follow-up mammograms or ultrasound, without doing a biopsy right away. The study reviewed here suggests that this approach is reasonable and safe.

If you've found a breast lump, you may think an immediate biopsy to get an immediate answer is a better option. Still, remember that a biopsy is an invasive procedure that should be done only when absolutely necessary. If waiting and watching doesn't feel like a good approach to you, talk to your doctor about your situation, your concerns, and your preferences. Together you can decide on a plan that makes the most sense for you.

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