Breast Cancer Cases

Breast Lumps

The leading cause of physician delay in diagnosing breast cancer continues to be inappropriate reassurance that a mass is benign without biopsy. As concluded in the previously cited breast cancer study published in the Archives of Internal Medicine, reducing delay in diagnosis will require less willingness (by the primary care physician or gynecologist) to rely upon clinical examination to decide that a mass is benign, less reliance on benign mammography reports to decide not to biopsy a mass, and a requirement that fine needle aspiration biopsy be done by persons with demonstrated competence in that procedure.

The American College of Obstetricians and Gynecologists published guidelines in April of 2003 pertaining to the clinical evaluation of palpable breast masses. According to these guidelines, women with a palpable mass should initially be evaluated with diagnostic mammography or ultrasound breast imaging. However, even if the mammogram or ultrasound is reported as benign, the standard of care requires that the physician further investigate a solid, persistent, and dominant mass by fine needle or tissue biopsy.

Relying on a negative mammogram to rule out cancer in a woman with a clinically suspicious breast mass is unacceptable. False negative results from mammography in women with palpable breast masses have been reported to be as high as twenty-two percent (22%).²

A physician conducting a breast examination may also mistakenly conclude without adequate testing that a palpable breast lump represents benign fibrocystic disease. Some of the features which raise the index of suspicion for breast cancer include a mass which has a hard or gritty texture, is fixed or immobile, has irregular borders, and does not vary in size during the menstrual cycle. In clinically evaluating the patient, the examining physician should also consider whether the patient has any risk factors for breast cancer including age (over 40), onset of menstruation before age 12, menopause after 55, a family history of breast cancer among first-degree relatives, or a history of hormone replacement therapy.

² Ediken S., Mammography and Palpable Cancer of the Breast. Cancer 1988 Jan. 15; 61(2) 263-265.

Next Topic: Mammography.