Wait until weaning to evaluate breast lump?
After nursing my daughter for six months, I noticed a lump right above one nipple. I have had smooth solid cysts before but this lump wasn't smooth and wasn't moveable. I checked it often for six months and it did not seem to change. I told my regular doctor, who sent me to a specialist known to be conservative. The specialist said he wasn't alarmed, but that he would not check it further until I weaned, the timing of which was my call. An ultrasound from two years prior showed a lump in the same spot, only 1 mm smaller than it was now. No mammogram was done.
My regular doctor told me wean soon. After much thought, I decided to continue nursing. Now, a year after I found it, the lump feels about the same. However, I want it checked again (because of some underarm swelling), but I don't necessarily want to quit nursing just to have it checked. Since the lump is so close to my nipple, I'm also concerned that a biopsy could damage my breast and make future breastfeeding impossible.
Is there any other way to determine whether the lump is cancerous without weaning and/or performing a biopsy? I certainly do not want to leave any breast cancer untreated, however, my daughter enjoys nursing so much that I don't want to wean early because of a very, very low chance that the lump is cancerous.
Question:Debbi Donovan
Debbi Donovan is a Board Certified Lactation Consultant, as well as a retired La Leche League Leader. For more than a decade, Debbi... Read more
It is very important not to ignore breast changes during lactation! When a Health Care Provider (HCP) advises waiting to evaluate until weaning, perhaps they aren't aware that weaning could take place years later. Though it is rare to be diagnosed with breast cancer while lactating, years, or even months sounds too long to wait for a thorough evaluation.
In the article, "Diagnosing and Managing Breast Disease During Pregnancy and Lactation", published in the May 1997 issue of Medscape Women's Health, Carol Scott-Conner, MD, PhD, reminds us that when a breast mass is discovered, "watchful waiting" is no more appropriate during lactation than at any other time. A thorough work-up is warranted, including breast biopsy if indicated.
Most breast lumps found by nursing mothers are galactoceles, or milk-filled cysts. These can be caused by a blocked milk duct. There is no need to wean your baby prematurely in order to make an accurate diagnosis.
When a nursing mother has a palpable breast mass, ultrasound can be used as a diagnostic tool. Ultrasound will show the location of the mass, and whether it is fluid filled (usually cystic or benign) or solid (possibly malignant.)
Mammography can also be used in the breastfeeding mother. It can be useful in determining the size and the location of a known lump, though it may not show early tissue changes due to the density of the lactating breast. If mammography is recommended, it is important to find a radiologist accustomed to reading the mammograms of lactating women.
Fine-needle aspiration of a cystic mass, as well as biopsy are other diagnostic tools that can be safely used while breastfeeding.
If possible, nurse your baby just before having a breast exam or any diagnostic procedure. This will help to reduce the amount of milk within your breast, making the procedure more comfortable as well as more easily performed and more accurate.
I would recommend that you let your HCP know that you are still concerned about your breast lump. If you feel that your concerns are being minimized, please do not hesitate to seek a second opinion from a breastfeeding-friendly breast surgeon. My best wishes for good health!
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