Abnormal Mammogram

Abnormal mammograms can occur for a variety of reasons, and it is important to remember that receiving an abnormal mammogram result does not necessarily mean that you have breast cancer. Abnormal mammograms can be the result of having dense breast tissue, a cyst, or even a growth that is not cancer. If you do have an abnormal mammogram, additional testing and imaging will need to be done to fully understand and diagnose your condition. You may be asked to return to your doctor for one or more of the following:

• Diagnostic mammogram – This would be similar to your initial mammogram, but more images may be taken to get enhanced details of your breast.
• Breast ultrasound – This would be another form of imaging to get detailed pictures of your breast tissue.
• Magnetic Resonance Imaging (MRI) – If your doctor cannot fully evaluate your breasts with mammogram and ultrasound testing, an MRI may be performed to capture detailed images of your breasts.

Please see more detailed information for imaging here.

Once the additional imaging takes place, you are likely to be told 1 of 3 things, which will guide your individual plan of care:

1. The suspicious area from your abnormal mammogram turned out to be nothing to worry about and you can continue having yearly mammograms.
2. The suspicious area is most likely nothing to worry about, but you should have your next mammogram sooner than a year, which usually means that you will be scheduled for a follow-up mammogram within 3 to 6 months. Getting your next mammogram sooner will enable your doctor to closely monitor your breast and ensure that there are no changes occurring over time.
3. The suspicious area may be cancer, and a biopsy is needed to confirm your diagnosis.

Breast Lumps

Breast Anatomy

Normal breast tissue can feel lumpy so it is important to understand what is normal and what is not normal when feeling your breasts. Each breast has 15-20 sections called lobes. Each lobe consists of many smaller lobules.  At the end of the lobules there are dozens of tiny bulbs that can produce milk.  In this complex internal structure, all of the lobes, lobules and bulbs are linked and interconnected by thin tubes called ducts.  These ducts lead to the nipple, which is centered in a dark area of skin called the areola.  The spaces between the lobes and ducts are filled with fat tissue.

Breasts are made up of both glandular tissue and fat tissue. The glandular tissue is more localized in the outer part of the breast, while the fat tissue is more often located in the inner part of the breast. These tissues feel different and can contribute to the perception of lumps. Therefore, lumps can be a normal finding in the breasts of all women, and can be particularly pronounced in women who are thin or who have small breasts. Although lumps can be normal, do not hesitate to see your doctor if you are concerned about a lump that you have found.

Benign Breast Lumps

On average, 70% of breast lumps that require a biopsy prove to be benign. Some studies show that the chances of developing benign breast changes are higher for a woman who have never had children, have irregular cycles, or have a family history of breast cancer.  Benign breast conditions are more frequently found in women of childbearing age due to the breasts being more glandular during those years – benign issues generally arise in the glandular tissue of the breast. Benign breast conditions are less common among women who take birth control pills and are overweight.

Solitary Lumps

Benign breast conditions include several types of solitary lumps.  Such lumps, which can appear at any time, may be large or small, soft or rubbery, fluid-filled or solid.

Cysts

Cysts are benign fluid-filled sacs.  They occur most often in women ages 35-50, and they often enlarge and become tender and painful just before the menstrual period.  They are usually found in both breasts.  Some cysts are so small they cannot be felt; rarely cysts may be several inches across.  Cysts are usually followed by observation or treated with fine needle aspiration.  They show up clearly on ultrasound.

Fibroadenomas

Fibroadenomas are solid, round and  benign tumors that are made up of both structural (fibro) and glandular (adenoma) tissues.  Usually, these lumps are painless and found by the woman herself.  They feel rubbery and can easily be moved around.  Fibroadenomas are the most common type of tumors in women in their late teens and early twenties and occur twice as often in African-American women as in other women. Fibroadenomas have a typically benign appearance on mammography (smooth, round masses with a clearly defined edge) and they can sometimes be diagnosed with fine needle aspiration. Although fibroadenomas do not become malignant, they can enlarge with pregnancy and breast-feeding.  Most surgeons believe that it is a good idea to remove large fibroadenomas to make sure they are benign.

Fat Necrosis

Fat necrosis is the name given to painless, round and firm lumps formed by damaged and disintegrating fatty tissues.  This condition typically occurs in obese women with very large breasts.  It often develops in response to a bruise or blow to the breast even though the woman may not remember the specific injury.  Sometimes the skin around the lumps looks red or bruised.  Fat necrosis can easily be mistaken for cancer so such lumps may be removed with a surgical biopsy.

Sclerosing Adenosis

Sclerosing adenosis is a benign condition involving the excessive growth of tissue in the breast lobules.  It frequently causes breast pain.  Usually the changes are microscopic, but adenosis can produce lumps and can show up on a mammogram as calcifications. Short of a biopsy, adenosis can be difficult to distinguish from cancer.  The usual approach to diagnosis is surgical biopsy.

Generalized Breast Changes

Fibrocystic Breast Disease or Benign Breast Disease

Generalized breast lumpiness is known by several names including fibrocystic breast disease and benign breast disease.  Generalized lumpiness, or fibrocystic tissue, is often described as feeling “ropy” or “granular”. These lumps can often be felt in the area around the nipple and areola, and in the glandular tissue in the upper outer part of the breast.  Such lumpiness may become more obvious as you approach middle age and the milk-producing glandular tissue of your breasts increasingly gives way to soft, fatty tissue.  Generally this type of lumpiness disappears after menopause.

Cyclical Breast Changes

Breast changes can occur throughout your menstrual cycle as well as throughout your lifetime. From the time you begin to menstruate, your breasts undergo regular changes each month, and you will likely experience swelling and tenderness on a cyclical basis.  At the same time, one or more lumps or a feeling of increased lumpiness may develop during menstruation because of extra fluid collecting in the breast tissue.  These lumps normally go away by the end of the period.

Many doctors believe that nearly all breasts develop some form of lasting changes beginning when a woman is about 30 years old.  Eventually, about half of all women will experience symptoms such as lumps, pain, or nipple discharge, but these symptoms generally disappear with menopause and are not associated with a cancer diagnosis. If you are experiencing breast changes that you cannot distinctly tie to your menstrual cycle, or you are having symptoms that do not go away after your period, it may be best to schedule a visit to see your doctor.

Pregnancy

During pregnancy, the milk-producing glands in your breasts become swollen and your breasts may feel lumpier than usual.  Although very uncommon, breast cancer has been diagnosed during pregnancy.  You should maintain a consistent dialogue with your Obstetrics and Gynecology doctor concerning your breast health throughout pregnancy.

Nipple Discharge

Your breast is a gland, and there are normal circumstances that cause secretion from the nipple. Secretion, or nipple discharge, is not necessarily a sign of disease and can accompany benign breast conditions. For example, small amounts of discharge commonly occur in women taking birth control pills or certain other medications including sedatives and tranquilizers.  If a disease is causing the discharge, the disease is more likely to be benign than cancerous.

Nipple discharge comes in a variety of colors and textures:

• A milky discharge can be traced to many causes including pregnancy, thyroid malfunction and oral contraceptives or other drugs.
• Women with generalized breast lumpiness may have a sticky discharge that is brown or green.
• A common source of a bloody and sticky discharge is an intraductal papilloma, which is a small fern-like growth that projects into the breast ducts near the nipple.  Any slight bump or bruise in the area of the nipple can cause the papilloma to bleed.
  • Single (solitary) intraductal papillomas usually affect women nearing menopause.
  • Multiple intraductal papillomas are more common in younger women.  They often occur in both breasts and are more likely to be associated with a lump than with nipple discharge.  Multiple intraductal papillomas or any papillomas associated with a lump, need to be removed.

Treatment for nipple discharge is dependent upon what is causing the discharge. In order to diagnose the cause of your discharge, your doctor may take a sample of the fluid and send it to a laboratory to be analyzed. For benign and sticky discharge, simply keeping the nipple clean is the general treatment, while discharge caused by an infection may require antibiotics. If discharge persists and becomes too bothersome, the contributing duct can be surgically removed without damaging the appearance of the breast.

Infection and/or Inflammation

Infection and/or inflammation of the breast tissue and ducts are conditions that are typically benign. Two known infections are mastitis and mammary duct ectasia.

Mastitis

Mastitis is an infection most often seen in women who are breastfeeding.  Mastitis most commonly occurs when a duct becomes blocked and milk begins to pool. As milk pools it causes inflammation and creates an environment that promotes the growth of bacteria leading to an infection.  It may cause your breast to appear red and feel warm, tender and lumpy. In its earlier stages, antibiotics can cure mastitis.  If an abscess forms, it will need to be drained or surgically removed.

Mammary Duct Ectasia

Mammary duct ectasia occurs when ducts beneath the nipple become inflamed and blocked. It most commonly affects women nearing menopause. Mammary duct ectasia can become painful, and it can produce a thick, sticky discharge that is gray in color.  Treatment consists of warm compresses, antibiotics, and possibly surgery to remove the duct.