Breast Cancer Risks: What to Do After a Suspicious Lump

High-risk groups for cancer?

Last month, I discovered a hard lump in my right breast that is less than one centimeter in size.
After two outpatient visits, I underwent fine needle aspiration and core needle biopsy.
The doctor initially suspected it was ductal carcinoma in situ (DCIS), but the pathology report indicated a lesion (insufficient data) that requires outpatient excision with an expanded margin for further pathological examination.
This is because cancer cells often coexist with lesions.
Should I proceed with the excision as soon as possible? Will there be any indentation in my breast? Is it true that cancer cells can survive at the edges of the tumor? Will I be considered a high-risk patient for breast cancer for the rest of my life?

Cai Ling, 40~49 year old female. Ask Date: 2006/04/23

Dr. Wu Jingtang reply Breast and Thyroid

Dear Miss Tsai-Ling,
I apologize for the delayed response due to the system not forwarding your question in a timely manner.
Regarding the breast lump, if both fine needle aspiration and core needle biopsy results are negative for cancer, you can feel relatively reassured.
However, since ductal carcinoma in situ (DCIS) is more challenging to confirm through the aforementioned tests, an excisional biopsy may still be necessary.
This should be accompanied by other examinations or clinical findings to guide the decision.
If a wider excision of the breast is performed, there may be some indentation, but it should not be severe.
If I were to offer a suggestion, it would be to proceed with the tumor removal first, and then plan further actions based on the pathology report.
Wishing you a pleasant day,
Dr.
Wu

Reply Date: 2006/04/23

More Info

When faced with a suspicious lump in the breast, such as the hard mass you discovered, it is crucial to take the necessary steps to ensure proper diagnosis and treatment. Your experience of undergoing fine needle aspiration and core needle biopsy is a standard procedure to evaluate breast lumps. The initial suspicion of ductal carcinoma in situ (DCIS) or stage zero breast cancer indicates that there was a concern for cancerous changes, but the pathology report revealing "line syndrome" (likely referring to atypical hyperplasia or another benign condition) suggests that there may not be invasive cancer present.

Given the nature of your findings, it is essential to follow your doctor's recommendations for further evaluation and treatment. The suggestion to perform an excisional biopsy to remove the lump and surrounding tissue is a prudent approach. This procedure not only allows for a more comprehensive assessment of the tissue but also helps to ensure that any potentially cancerous cells are removed. It is important to understand that cancer cells can sometimes exist at the margins of a tumor, which is why a wider excision may be necessary to minimize the risk of recurrence.

Regarding your concerns about breast deformity, such as a dent or indentation, this can depend on various factors, including the size of the lump, the surgical technique used, and the amount of tissue removed. Surgeons often aim to minimize cosmetic changes, and discussing your concerns with your surgeon can help you understand what to expect post-surgery.

As for your worry about being a lifelong high-risk patient for breast cancer, it is essential to recognize that having a benign condition or even atypical hyperplasia does not automatically classify you as having breast cancer. However, it does indicate that you may have an increased risk compared to the general population. Regular monitoring and screenings, such as mammograms and clinical breast exams, will be vital in managing your breast health moving forward. Your healthcare provider may also discuss additional risk-reduction strategies, including lifestyle modifications and possibly medication, depending on your overall risk profile.

In summary, it is crucial to proceed with the recommended excisional biopsy to ensure a thorough evaluation of the lump. While concerns about breast cancer and its implications can be daunting, maintaining open communication with your healthcare team and adhering to follow-up care will be essential in managing your breast health. Regular screenings and proactive measures can significantly reduce the risk of developing breast cancer in the future.

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