Possible lumps and diagnostic treatment options

[shelbysmom]

Hi! I am 29 years old and have not been performing monthly breast exams. Last week, I *thought* I felt a lump in my right breast. I went to see the doctor on Monday and she thinks I'm feeling my rib where the cartidge meets the bone. She recommended a followup in 3 months and that's all - no lump. Since then I have been feeling my breasts everyday and worrying. My breasts seem very lumpy and bumpy to me. I suppose I may be feeling normal anatomy but I'm still worried. My mom is high risk and seen at a high risk clinic - she had two paternal aunts and paternal grandmother who were diagnosed at ages 40-60 years old. She thinks I should have a baseline mammogram done - what's the harm? The doctor disagrees because of my age and because I had a breast reduction 10 years ago. I just don't know how to proceed and I still feel worried that I feel something. Thanks.

[CCF-RN,MSN-rf]

Dear Shelbysmom:  It is not uncommon at all for breast to feel lumpy and bumpy, particularly in the younger years.  The purpose of regular breast examination is to identify changes in the way the breasts feel.  This is why the recommendation is to check the breasts once a month at about the same time (after the menstrual cycle, for example).  Hopefully, by becoming familiar with how the breasts feel, a change would be easier to identify.  If the doctor is unable to detect a lump, it may be that you are indeed feeling a rib - this is not uncommon in young women.
When women are younger, the breast tissue tends to be quite dense.  Mammography may not be the best test to use for dense tissue.  If there were a lump or need for further investigation, diagnostic breast imaging (with mammogram and/or ultrasound) may be a recommendation.  Given the doctor's findings, 3 months may be a reasonable wait for reevaluation - knowing that in the meantime if there were any changes, you could be seen sooner.  Screening mammograms are of unproven  value in women under the age of 40, however, in high-risk individuals screening may begin earlier.  It may be worthwhile for you to undergo formal risk assessment and receive recommendations from a breast specialist such as the one your mother sees in her high-risk clinic.

[shelbysmom]

I just wanted to update that I requested that the doctor go ahead and order me a baseline mammogram and she agreed to do so. Thanks so much for your response.