UNDERSTANDING

BREAST CHANGES

A HEA LTH GUIDE FOR WOMEN

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

National Institutes of Health

National Cancer Institute

PATIENT

family &

EDUCATION
Understanding Breast Changes

You’re probably reading this booklet because you or your health

care provider found a breast lump or other breast change. It 

may be helpful for you to know that breast changes are very

common. In fact, most breast changes are not cancer. But it is 

still important to get the follow-up tests and care that your health

care provider suggests. 

This booklet will:

■ Help you understand the most common types of breast

changes

■ Explain routine tests that your health care provider may order

to learn more about your breast change 

■ Provide ways for you to learn more and get the support 

you need 

Use the Table of Contents to find the sections that are most

helpful to you, as this booklet covers many topics. Also, a

dictionary, beginning on page 32, explains terms that may be 

new to you. These terms will appear in bold.

“This booklet answered a lot of the questions

I had in the back of my mind, but was afraid

to bring up. Now that I know more about

breast changes, it’s easier to talk with my

doctor about what I need to do.”

—KATHY, AGE 45
Getting Your Biopsy Results....................................................20

Benign Changes ................................................................20

Atypical Ductal Hyperplasia (ADH) or Lobular 

Carcinoma In Situ (LCIS) ...........................................21

Cancer Cells Found in the Lining of the Ducts 

(Ductal Carcinoma In Situ or DCIS) ..........................22

Cancer That Is Invasive ....................................................23

Finding the Support You Need.............................................23

For More Information ..........................................................24

Chart 1: 

Possible Mammogram Results and Follow-Up Care.......26

Chart 2: 

Possible Biopsy Results and Follow-Up Care ..................28

Dictionary.............................................................................32

Table of Contents

About Your Breasts ................................................................1

Types of Breast Changes ........................................................3

Lumpiness ...........................................................................3

Breast Changes Due to Your Period....................................3

Single Lumps.......................................................................4

Nipple Discharge.................................................................4

Finding Breast Changes ........................................................ 5

Mammograms .......................................................................... 6

Getting Your Mammogram Results ..........................................9

What a Mammogram Can Show ..............................................9

Lumps (or “mass”) ..............................................................9

Calcifications ....................................................................10

Are Mammogram Results Always Right? ................................11

Changes That Need More Follow-Up .....................................11

Breast Changes During Your Lifetime 

That Are Not Cancer.......................................................12

Getting a Second Opinion....................................................14

Follow-Up Tests to Tell You More.........................................15

Ultrasound...............................................................................15

Biopsies ....................................................................................15

Types of Biopsies .....................................................................17

Fine-Needle Aspiration .....................................................17

Core Needle Biopsy...........................................................18

Surgical Biopsy..................................................................18
About Your Breasts

Breast Basics

The breast is a gland that produces milk in late pregnancy and

after childbirth.

What are breasts made of?

■ Each breast is made of lobes.

■ Lobes are groups of milk glands called lobules.

■ Lobules are arranged around thin tubes called ducts.

■ Ducts carry the milk to the nipple. 

■ These lobules and ducts make up the glandular tissue.

What is the lymphatic system?

The breasts also contain lymph vessels, which carry a clear fluid

called lymph. 

■ The lymph vessels lead to small, round organs called lymph

nodes. Groups of lymph nodes are found near the breast in

the underarm, above the collarbone, in the chest behind the

breastbone, and in many other parts of the body.

■ The lymph nodes trap bacteria, cancer cells, or other harmful

substances that may be in the lymphatic system. Their job

is to make sure harmful substances are safely removed from

the body.

1
2 3

Types of Breast Changes

Breast changes occur in almost all women. Most of these changes

are not cancer. However, some breast changes may be signs of

cancer. Breast changes that are not cancer are called benign. For

more information on benign breast changes that are more likely to

happen during certain times of your life, see Breast Changes

During Your Lifetime That Are Not Cancer (page 12).

Common breast changes include:

■ Lumpiness 

■ Breast changes due to your period

■ Single lumps

■ Nipple discharge

Lumpiness 

Most women have some type of lumpiness in their breasts. Some

areas may be more dense than others and can feel lumpy in an

exam. What you are feeling may be glandular breast tissue. 

Breast Changes Due to Your Period 

Many women have swelling, tenderness, and pain in their breasts

before and sometimes during their periods. You may also feel one or

more lumps during this time because of extra fluid in your breasts. 

Because some lumps are caused by normal hormone changes,

your health care provider may suggest watching the lump for a

month or two to see if it changes or goes away.

See your health care provider about a

breast change when you have: 

■ A lump in or near your breast or under your arm 

■ Thick or firm tissue in or near your breast or under your arm

■ Nipple discharge or tenderness

■ A nipple pulled back (inverted) into the breast

■ Itching or skin changes such as redness, scales, dimples, or

puckers

■ A change in breast size or shape

If you notice a lump in one breast, check the other breast. If both

breasts feel the same, it may be normal. You should still see

your health care provider for a clinical breast exam to

see if more tests are needed. 
4 5

Finding Breast Changes 

There are two ways to find breast changes:

■ Clinical breast exams—a breast exam done by your health 

care provider 

■ Mammograms—an x-ray of your breasts 

One way to find breast changes is with a clinical breast exam done

by your health care provider. He or she will check your breasts and

underarms for any lumps, nipple discharge, or other possible changes.

This breast exam should be part of a routine medical check-up.

The best tool for finding breast cancer is a mammogram. 

A mammogram is a picture of the breast that is made by using

low-dose x-rays. It is currently recommended that women over age

40 receive a mammogram every 1 to 2 years. 

Some women check their own breasts for changes. If you find a

change, it’s important to call your health care provider for an

appointment. Make sure to watch the change you found until you

see your provider. But a breast self-exam and a clinical breast exam

are not substitutes for mammograms.

Single Lumps

Single lumps can appear at any time and come in various types

and sizes. Most lumps are not cancer, but your health care provider

should always check the lump carefully. He or she may do more

tests to make sure the lump is not cancer. See Chart 1: Possible

Mammogram Results and Follow-Up Care (page 26) for more

information about these types of lumps.

Check with your health care provider if you notice any kind

of lump. Even if you had a lump in the past that turned out to be

benign, you can’t be sure that a new lump is also benign. 

Nipple Discharge 

Nipple discharge is common for some women. It is fluid that

comes from the nipple in different colors or textures. Usually, it is

not a sign of cancer. For example, birth control pills and other

medicines, such as sedatives, can cause a little discharge. Certain

infections also cause nipple discharge. However, for women who

are going through or have passed menopause, nipple discharge

can be a sign of cancer. 

See your doctor if you have nipple discharge for the first time, or a

change in your discharge’s color or texture. He or she may send a

sample of the discharge to be checked at a lab.

Questions to ask your health care provider

about a breast change

■ How can I tell the difference between my usual lumps and

lumps I need to do something about? 

■ How will you be able to tell what kind of breast change I have?

■ What should we do to watch this change over time?
6 7

Mammograms 

Mammograms are used for both screening and diagnosis. 

A screening mammogram is used to find breast changes in

women who have no signs of breast cancer. Most women get two

x-rays of each breast. 

If your recent screening mammogram revealed a breast change

since your last one, or if you or your health care provider noticed a

change, he or she will probably

recommend a diagnostic

mammogram. More x-rays are

taken during a diagnostic

mammogram than a screening

mammogram to get clearer, more

detailed pictures of the breast. It is

also used to rule out other breast

problems.

A digital mammogram is another way to take a picture of your

breasts. The procedure for having a digital mammogram is the

same as a screening mammogram, except that it records the x-ray

images in computer code instead of on x-ray film. 

Take your original

mammogram and a

copy of the medical

report with you if 

you change doctors 

or centers or need 

a second opinion.

TIP

It is important to see your doctor and get a

mammogram every 1 to 2 years after age 40 

to find breast changes.
8 9

Getting Your Mammogram Results

Ask your doctor when you will get your results. You should get a

written report of your mammogram results within 30 days of

getting the x-ray. This is the law. Be sure the mammogram facility

has your current address. 

If your results were normal, it means the radiologist did not find

anything that needs follow-up.

If your results were abnormal, it means the radiologist found:

■ A change from a past mammogram

■ A change that needs more follow-up

What a Mammogram Can Show

The radiologist will look at your x-rays for breast changes that do

not look normal. The doctor will look for differences between your

breasts. He or she will compare your past mammograms with your

most recent one to check for changes. The doctor will also look for

lumps and calcifications. 

Lumps (or “mass”) 

The size, shape, and edges of a lump sometimes can give doctors

more information about whether or not it is cancer. On a

mammogram, a growth that is benign often looks smooth and

round with a clear, defined edge. On the other hand, breast cancer

often has a jagged outline and an irregular shape. (See Chart 1:

Possible Mammogram Results and Follow-Up Care, page 26.)

Here are mammograms of three different women. Doctors look at

these x-rays for any breast changes that don’t look normal.

Normal Benign Cyst

(Not Cancer)

Cancer

Mammograms and Breast Implants

When you go for your mammogram, tell staff if you have

breast implants. A technologist who is trained in 

x-raying patients with implants will do your mammogram.

Breast implants can hide some breast tissue and make it

harder to read your mammograms.

If you got implants for cosmetic reasons:

■ You still need to get screening mammograms, with extra

pictures to help get an accurate reading.

If you got an implant after having a mastectomy for breast

cancer:

■ You should continue to get mammograms of your other

breast. Ask your doctor if you still need mammograms of

the breast with the implant. 
11

“I used to think

whenever a

mammogram found 

a lump or a mass, 

it was probably

cancer—it turns out

that most breast

changes are not

cancer. That’s one

thing I sure didn’t

mind being wrong

about.” —ANNE, AGE 60

10

Are Mammogram Results Always Right?

No. Although they are not perfect, mammograms are the best

method to find breast changes. If your mammogram shows a

breast change, sometimes other tests are needed to better

understand it. Even if the doctor sees something on the

mammogram, it does not mean it is cancer.

Changes That Need More Follow-Up

Sometimes your doctor needs more information about a change on

your mammogram. Your doctor may do follow-up tests such as an

ultrasound or more mammograms. The only way to find out if

an abnormal result is cancer is to do a biopsy. It is important to

know that most abnormal findings are not cancer. 

Calcifications

A calcification is a deposit of the mineral calcium in the breast

tissue. Calcifications appear as small white spots on a

mammogram. There are two types:

■ Macrocalcifications are large calcium deposits often caused

by aging. These are usually not cancer. (See Chart 1: Possible

Mammogram Results and Follow-Up Care, page 26.)

■ Microcalcifications are tiny specks of calcium that may be

found in an area of rapidly dividing cells. If they are found

grouped together in a certain way, it may be a sign of cancer.

(See Chart 1: Possible Mammogram Results and Follow-Up

Care, page 26.)

Depending on how many calcium specks you have, how big they

are, and what they look like, your doctor may suggest that you: 

■ Have a different type of mammogram that allows the

radiologist to have a closer look at the area

■ Have another screening mammogram, usually within 

6 months

■ Have a test called a biopsy (See page 15.)

Calcium in the diet

does not create

calcium deposits

(calcifications) in

the breast. 

Calcification
12 13

While breastfeeding, you may get an infection called mastitis

that happens when a milk duct becomes blocked. Mastitis causes

the breast to look red and feel lumpy, warm, and tender. Mastitis is

often treated with antibiotics. Sometimes the duct may need to

be drained. If the redness or mastitis does not go away with

treatment, call your doctor, as you may need further care.

As you approach menopause, your periods may become less

frequent. Changing hormone levels also can make your breasts: 

■ Feel tender, even when you are not having your period

■ Feel more dense

■ Feel more “lumpy” than they did before

As you age, other breast changes are more common, such as:

■ Intraductal papilloma. This is a growth inside the nipple

that looks like a wart. It can be removed by surgery without

changing the way the breast looks. 

■ Mammary duct ectasia. As you near menopause, ducts

beneath the nipple can become swollen and clogged. This can

be painful and cause nipple discharge. The problem is treated

with warm packs, antibiotics, and sometimes surgery to

remove the duct. 

If you are taking hormones, such as hormone replacement

therapy (HRT), birth control pills, or injections, when getting

your mammogram be sure to let your doctor know. Hormones may

cause your breasts to be more dense. This can limit your doctor’s

ability to read a mammogram. 

When you stop having periods (menopause), your hormone

levels drop, and your breast tissue becomes less dense and more

fatty. You may stop having the lumps, pain, or nipple discharge

you used to have. And because your breast tissue is less dense,

mammograms can be easier to read. This means doctors are more

likely to find breast changes or early breast cancer.

Breast Changes During Your Lifetime

That Are Not Cancer

You might notice different kinds of breast changes at different

times in your life. Many of these are caused by changes in your

hormone levels and are a normal part of getting older. 

Younger women may have more glandular (more dense, less

fatty) breast tissue than older women who have stopped having

their period (menopause). This kind of tissue is where breast

changes usually occur. 

Before or during your period, you might have lumpiness,

tenderness, and pain in your breasts. The lumpiness and pain

usually go away by the end of your period. 

During pregnancy, your breasts may feel lumpy, as the glands

that produce milk increase in number and get larger. Still, breast

cancer has been found in pregnant women, so talk with your

doctor if you have questions about any breast lumps. 

“Everything changes

over time, including

your body. The

important thing is to

work with your doctor

to deal with the

changes in a calm

and sensible way.” 

—CARMEN, AGE 70
14 15

Follow-Up Tests to Tell You More

Doctors often use ultrasound or biopsies to follow up after 

finding signs of a breast change. 

Ultrasound

An ultrasound uses sound waves to make a picture of breast tissue.

This picture is called a sonogram. It helps doctors look more

closely at lumps. An

ultrasound shows if a lump

is solid or filled with fluid

(cyst). (See Chart 1: Possible

Mammogram Results and

Follow-Up Care, page 26.) 

An ultrasound also can help

your doctor decide if more

tests are needed.

It is important to know that

an ultrasound may not find

all abnormal changes.

Biopsies

During a biopsy, the doctor removes some cells or tissue, an area of

small calcium deposits, or the whole lump. The tissue is sent to a

lab where a doctor called a pathologist will look at the cells. He

or she checks the cells for cancer or other diseases. Biopsies are

usually done on an outpatient basis, meaning you can go home

the same day as your test. Biopsies are the only way to find out if

cells are cancer.

Getting a Second Opinion

After seeing your health care provider, you may want to get a

second opinion from another health care provider. Sometimes, a

second opinion may be covered by your health insurance. Many

women feel uneasy about asking for a second opinion, but it is

very common. Your health care provider will not be surprised or

offended if you seek a second opinion. A second opinion might

help you feel more confident that you are making the best choices

about your health. 

“I wasn’t sure if it

was okay to ask for

a second opinion...

it’s good to know

that lots of other

people are asking.

After all, it is my

body; I owe it to

myself to be sure.”

—MARIE, AGE 55

A Cyst: The Most

Common Breast Change

A cyst is a lump filled with fluid.

Cysts are usually not cancer.

If a cyst is found, your doctor

may decide to: 

■ Remove fluid in the cyst to

make it go away

■ Look at it with an ultrasound

■ Watch it closely over time
16 17

Types of Biopsies

The most common types of biopsies are:

■ Fine-needle aspiration 

■ Core needle biopsy 

■ Surgical biopsy 

Fine-Needle Aspiration

Fine-needle aspiration only takes a few minutes and can be done

in the doctor’s office. It is often done when a doctor finds a lump

that appears to be a cyst. The doctor tries to remove fluid from the

lump using a thin needle and a syringe. If the lump is a cyst,

removing the fluid will make it go away. If the cyst returns, it can

be drained again. Because cysts are rarely cancer, doctors test the

fluid only if it is bloody or if there are other reasons to be

concerned. If the lump is solid, cells can be taken out with the

needle. These cells are checked for cancer.

Questions you might want to ask if your

health care provider suggests a biopsy:

■ What type of biopsy will I have? Why? How much tissue will

be removed?

■ Will only part of the lump or the whole lump be removed?

■ Will the shape of my breast change?

■ Will I have a scar?

■ Where will the biopsy be done? How long will it take?

■ Will I be awake? 

■ Will it hurt?

■ Will there be any side effects? 

■ What tests will be done on the tissue?

■ When will I know the results?

■ Will I be able to go back to work the same day?

After the biopsy, you might want to ask:

■ What do the results mean? 

■ Do I need to have other tests?

■ Will I need follow-up tests or treatment?

■ How do I care for the biopsy site?

■ Is it okay if I exercise? 

■ Does my result mean I am at higher risk for breast cancer?

Sometimes it’s hard—even for the experts—to tell benign breast

changes from cancer. If you have any questions about your biopsy

results, have more than one doctor look at the results.

Fine-Needle

Aspiration
18 19

Sometimes, a needle is used to guide a surgical biopsy. A

mammogram or ultrasound is used to find breast changes that

cannot be felt. Once the breast change is found, a radiologist puts

a needle into the breast so that the tip of the needle is at the area

of breast change (called needle localization). Then a fine wire is

placed through the needle. The needle may be removed and the

wire stays in place. You may be asked to walk to another room or

to the operating room for the biopsy. During surgery, the doctor

uses the tip of the wire as a guide to what tissue to take out.

Core Needle Biopsy

This type of biopsy can be done in the doctor’s office or hospital. A

core needle biopsy is a type of biopsy that uses a needle with a

special cutting edge. The core needle is inserted through a small cut

in the skin. A small core of tissue is removed. More than one tissue

sample can be taken through the same small cut in the skin. This

test may cause a bruise but rarely leaves a scar.

During the biopsy, the doctor may insert a guided probe into the

area of the breast change. The probe gently vacuums tissue

samples from the area. 

Sometimes the doctor uses other methods to guide the core needle

or probe to the breast change. These include: 

■ Ultrasound-guided needle biopsy. Doctors use ultrasound to

guide the needle during the biopsy. This method is used when

lumps are hard to feel on a breast exam or see on a mammogram.

■ Stereotactic core needle biopsy localization. A threedimensional (3-D) x-ray guides a biopsy needle to a lump or

other change that cannot be felt on a breast exam. With one

type of equipment, you lie face down on an exam table with a

hole in it. The hole allows your breast to hang below the table,

where the x-ray machine and needle are. Or, special equipment

can be attached to a standard mammogram machine to x-ray

your breast from two angles.

Surgical Biopsy

A surgical biopsy is an operation to remove part or all of the breast

lump. Most of the time, you have the biopsy and go home the

same day. Sometimes a doctor will do a surgical biopsy as the first

step. Other times, a doctor may do a surgical biopsy if the results

of a needle biopsy do not give enough information. 

Surgical 

Biopsy

Needle 

Localization
“Even though I was

scared, I am glad 

I went for follow-up

to find out what 

I had. Now my

doctor and I can 

do something about

the breast change.” 

—JACKIE, AGE 63

20 21

Atypical Ductal Hyperplasia (ADH) 

or Lobular Carcinoma In Situ (LCIS) 

ADH and LCIS are not cancer. However, having ADH or LCIS in

one breast does mean that you have a higher risk of getting cancer

in either breast. Your doctor will want to follow your breast health

very closely if you have ADH or LCIS. For example, your doctor

may suggest that you:

■ Get more mammograms or see him or her more often

■ Take a drug, called tamoxifen, which has been shown to

lower some women's risk of getting breast cancer

■ Take part in clinical trials of promising new preventive

treatments. In a cancer prevention trial, a large group of people

is studied to help find better ways of preventing or lowering

the chances of getting cancer. 

Getting Your Biopsy Results

On average, you should get your biopsy results from your doctor 

7 to 10 days after your biopsy.

The biopsy results will tell your doctor if you have:

■ Benign breast changes

■ Changes that may increase your chances of getting 

breast cancer

■ Cancer cells in the lining of your breast ducts

■ Cancer throughout the breast (invasive breast cancer) 

Here are more detailed descriptions of biopsy results.

Benign Changes

■ Fibroadenomas—Hard, round lumps that feel like rubber 

■ Fat necrosis—Painless, round, firm lumps 

■ Sclerosing adenosis—Growths that may contain

calcifications and are often painful

Your health care provider will probably suggest that you get

follow-up care for these types of benign changes. See Chart 2:

Possible Biopsy Results and Follow-Up Care (page 28) for more

information.

Two types of changes that may increase your chances

of getting breast cancer

■ Abnormal cells found in the breast ducts (Atypical Ductal

Hyperplasia, or ADH)

■ Abnormal cells found in the breast lobules (Lobular

Carcinoma In Situ, or LCIS)
22 23

Cancer That Is Invasive

Even if you have breast cancer that has spread to other parts of your

breast, finding it early gives you the best chance to get treatment

that may save your breasts and your life. It’s also true that women

with breast cancer that has spread have reasons for hope. 

Some women with breast cancer may want to take part in a

clinical trial. Clinical trials are research studies to find better ways

to treat cancer. Some studies on new cancer-fighting drugs, drug

combinations, and ways of giving treatment have already begun to

show good results.

For more information about breast cancer and its treatments, 

call 1-800-4-CANCER for a free copy of What You Need To Know

About Breast Cancer or visit www.cancer.gov and search for “breast

cancer.” (See For More Information, page 24.)

Finding the Support You Need

It can be scary when you find out about a breast change, get an

abnormal mammogram result, or learn you have breast cancer.

Many women have found it helpful to:

■ Ask friends or loved ones for support. Take someone with you

while you are learning about your testing and treatment choices.

■ Ask your doctor or nurse to:

• Help you understand medical terms that are confusing

• Tell you how other people have handled the types of

feelings that you are having

■ Contact the organizations listed on pages 24–25. 

A very small number of women with LCIS have surgery to remove

both their breasts. They do this to try to keep breast cancer from

developing. Talk to your doctor about what is best for you. 

See Chart 2: Possible Biopsy Results and Follow-Up Care (page 28)

for more information about ADH and LCIS. 

Cancer Cells Found in the Lining of the Ducts 

(Ductal Carcinoma In Situ or DCIS)

DCIS is a condition in which cancer cells are only found inside

the lining of a breast duct. The abnormal cells have not spread

outside the duct to the surrounding breast tissue. Therefore, most

women with DCIS are cured with treatment. However, if not

treated, DCIS sometimes spreads to other parts of the breast (also

called invasive breast cancer). Your doctor may discuss some of

these treatment choices for DCIS:

■ Getting breast-sparing surgery (the surgeon removes only 

your cancer and some normal tissue around it) with

radiation therapy 

■ Getting breast-sparing surgery without radiation therapy 

■ Getting a total mastectomy (surgery to remove the entire breast)

■ Taking the drug tamoxifen after surgery and radiation to lower

the chances of the cancer coming back 

See Chart 2: Possible Biopsy Results and Follow-Up Care 

(page 28) for more information about DCIS.

Getting a Second Opinion

You can ask to have another pathologist review your biopsy results.

This is important because biopsy results determine treatment(s) 

for breast changes and diseases. Ask your medical team to help

you with this process.
Centers for Medicare and Medicaid Services (CMS)

Toll free: 1-800-MEDICARE (1-800-633-4227) 

TTY/TDD: 1-877-486-2048

Web site: www.cms.gov or www.medicare.gov

CMS provides information about Medicare benefits to pay for

screening mammograms.

Centers for Disease Control and Prevention (CDC)

Toll free: 1-888-842-6355

Web site: www.cdc.gov/cancer

CDC conducts, supports, and promotes efforts to prevent cancer

and increase early detection of cancer. CDC’s National Breast and

Cervical Cancer Early Detection Program provides free breast and

cervical cancer screening and diagnostic services to women with

low incomes. 

National Women’s Health Information Center (NWHIC)

Toll free: 1-800-994-WOMAN (1-800-994-9662)

TTY: 1-888-220-5446

Web site: www.4woman.gov

NWHIC provides a gateway to women’s health information.

NWHIC is sponsored by the U.S. Department of Health and

Human Services Office on Women’s Health. 

U.S. Food and Drug Administration (FDA) 

Web site: www.fda.gov/cdrh/mammography

The FDA has information about mammography on its Web site,

including a section for consumers, a list of FDA-approved

mammography facilities, and laws about how these facilities 

are run.

24 25

For More Information

The following organizations can give you more information on

mammograms, breast changes, finding breast cancer early, and

different breast cancer treatments. 

National Cancer Institute (NCI)

You can find out more from these free NCI services:

Cancer Information Service

Toll free: 1-800-4-CANCER (1-800-422-6237)

TTY: 1-800-332-8615

■ Answers to your questions about cancer 

■ Tips to prevent and screen for cancer 

■ Informational materials 

■ Other resources 

NCI Online

Web site: www.cancer.gov 

This Web site provides current and accurate information from the

National Cancer Institute. Through instant messaging (LiveHelp),

Information Specialists can answer your questions about cancer

and provide help in navigating NCI’s Web site. You will find a

wide range of cancer information, including: 

■ Treatment options

■ Clinical trials

■ Ways to reduce cancer risk

■ Prevention and screening information

■ Ways to cope with cancer
26 27

What Your Doctor May Recommend

• Doctors often watch cysts over time or use fine-needle

aspiration to remove the fluid from the cyst.

• Ultrasound may be used to see whether a lump is solid or

filled with fluid.

• Sometimes diagnosed with fine-needle aspiration 

• If the fibroadenoma does not appear normal, the doctor

may suggest taking it out to make sure it is benign.

• Ultrasound may be used to see whether a lump is solid 

or filled with fluid.

• Surgical or core needle biopsy is often used for diagnosis as

well as treatment.

• Have another mammogram to have a closer look at the area

• Surgical biopsy is often used for diagnosis as well as

treatment.

• Have another mammogram to have a closer look at the area

• Surgical biopsy is often used for diagnosis as well as

treatment.

Chart 1

Possible Mammogram Results and Follow-Up Care

Conditions

Cysts

Fibroadenoma

Macrocalcifications

Mass

Microcalcifications

Features

• Fluid-filled lumps 

• Usually not cancer 

• Occur most often in women ages 35–50

• Often in both breasts

• Some too small to be felt

• Hard, round, benign growth

• Feels like rubber; moves around easily

• Usually painless

• Often found by the woman herself

• Appears on mammogram as smooth, round

lumps with clearly defined edges

• Can get bigger when the woman is 

pregnant or nursing

• Appear on a mammogram as large calcium

deposits

• Often caused by aging 

• Usually not cancer

• May be round and smooth or have irregular

borders

• May be caused by normal hormone changes

• Appear on a mammogram as tiny specks of

calcium that might be found in an area of

rapidly dividing cells

• If they are found grouped together in a

certain way, they may be a sign of cancer.
28 29

What Your Doctor May Recommend

• Getting more mammograms and/or seeing the doctor

more often 

• Taking tamoxifen

• Surgery

• Chemotherapy

• Radiation therapy

• Hormonal therapy

• Biological therapy

• Treatment may depend on the stage of the disease.

• Breast-sparing surgery and radiation therapy 

(with or without tamoxifen)

• Breast-sparing surgery without radiation therapy 

(with or without tamoxifen)

• Total mastectomy (with or without tamoxifen)

• Sometimes removed with surgical biopsy because it 

can look like cancer 

• Sometimes diagnosed with fine-needle aspiration 

• If the fibroadenoma does not appear normal, the

doctor may suggest taking it out to make sure it is

benign.

Chart2

Possible Biopsy Results and Follow-Up Care

Conditions

Atypical Ductal

Hyperplasia (ADH)

Cancer

Ductal Carcinoma 

In Situ (DCIS)

Fat Necrosis

Fibroadenoma

Features

• Abnormal cell growth 

• Abnormal cells dividing without control in 

the breast

• Could spread to other parts of the body

• Cancer cells in the breast ducts 

• Has not spread to other parts of the breast 

• May develop into cancer that spreads to other

parts of the breast (invasive breast cancer)

• Painless, round, firm lumps

• Formed by damaged fatty tissue

• May occur after surgery to the breast

• Often occurs in response to a bruise or blow

to the breast, although a woman might not

recall being injured

• Hard, round, benign growth

• Feels like rubber; moves around easily

• Usually painless

• Often found by the woman herself

• Appears on mammogram as smooth, round

lumps with clearly defined edges

• Can get bigger when the woman is pregnant

or nursing

Chart 2 continues on next page.
31

• Surgery to remove the growth 

• Regular check-ups to look for signs of breast cancer

• Tamoxifen may be suggested 

• Evaluation of breast cancer risk by your doctor 

• Clinical breast exam

• Annual mammogram

• More tests if breast changes are noted on breast 

self-exam, clinical breast exam, or mammogram

What Your Doctor May Recommend

More information on these conditions can be found on

www.cancer.gov or by calling 1-800-4-CANCER.

30

Chart2 (continued)

Possible Biopsy Results and Follow-Up Care

Intraductal

Papilloma

Lobular Carcinoma 

In Situ (LCIS)

Sclerosing Adenosis 

• Growth inside the nipple that looks like 

a wart

• May cause nipple discharge

• Abnormal cells found in the lobules

• Not cancerous but associated with a greater

chance of getting cancer in either breast in

the future

• Too much tissue growth in lobules

• Can contain calcifications

• Often painful

• Changes usually very small but can produce

lumps

Conditions Features
32 33

calcium (KAL-see-um): A mineral normally found in teeth, bones,

and other body tissues. Clusters of calcium deposits (calcifications)

seen on a mammogram may indicate an abnormal condition or

breast cancer.

cancer (KAN-sir): A term for diseases in which abnormal cells

divide without control. Cancer cells can invade nearby tissues and

can spread through the bloodstream and lymphatic system to other

parts of the body. 

clinical breast exam: A physical exam performed by a health

care provider to check for lumps or other changes.

clinical trial: A type of research study that tells how well new

medical treatments or other interventions work in people. Such

studies test new methods of screening, prevention, diagnosis, or

treatment of a disease. The study may be carried out in a clinic or

other medical facility. Also called a clinical study.

core needle biopsy: The removal of a tissue sample with a

needle for examination under a microscope.

cyst (sist): A sac or capsule in the body. It may be filled with fluid

or other material. 

DCIS (ductal carcinoma in situ): A noninvasive, precancerous

condition in which abnormal cells are found in the lining of a

breast duct. The abnormal cells have not spread outside the duct

to other tissues in the breast. In some cases, DCIS may become

invasive cancer and spread to other tissues, although it is not

known at this time how to predict which lesions will become

invasive. Also called intraductal carcinoma.

diagnosis: The process of identifying a disease by the signs and

symptoms. 

diagnostic mammogram: X-ray of the breasts used to check for

cancer after a lump or other sign or symptom of breast cancer has

been found.

Dictionary

antibiotic (an-tih-by-AH-tik): A drug used to treat infections

caused by bacteria and other microorganisms.

areola (a-REE-o-la): The area of dark-colored skin on the breast

that surrounds the nipple.

aspiration (as-per-AY-shun): The removal of fluid from a lump,

often a cyst, with a needle and a syringe. 

atypical (ductal) hyperplasia (AY-TIP-I-kul hy-perPLAY-zha): A benign (noncancerous) condition in which cells look

normal under a microscope and are increased in number.

benign (beh-NINE): Not cancerous. Benign tumors do not spread

to tissues around them or to other parts of the body.

biopsy (BY-op-see): The removal of cells or tissues for examination

under a microscope. When only a sample of tissue is removed, the

procedure is called an incisional biopsy or core biopsy. When an

entire lump or suspicious area is removed, the procedure is called

an excisional biopsy. When a sample of tissue or fluid is removed

with a needle, the procedure is called a needle biopsy or 

fine-needle aspiration. 

breast implants: A silicone gel-filled or saline-filled sac placed

under the chest muscle to restore breast shape.

calcifications: Small deposits of calcium in tissue. Calcification

on the breast can be seen on a mammogram, but cannot be

detected by touch. There are two types of breast calcification,

macrocalcification and microcalcification. Macrocalcifications are

large deposits and not usually related to cancer. Microcalcifications

are specks of calcium that may be found in an area of rapidly

dividing cells. Many microcalcifications clustered together may be

a sign of cancer.
34 35

problems, depending on the site of the infection. When the body’s

natural defense system is strong, it can often fight the germs and

prevent infection. Cancer treatment can weaken the natural

defense system.

intraductal papilloma (in-truh-DUK-tul pap-uh-LO-muh): A

small wart-like growth that projects into a breast duct.

LCIS (lobular carcinoma in situ): Abnormal cells found in the

lobules of the breast. This condition seldom becomes invasive

cancer; however, having lobular carcinoma in situ increases your

risk of developing breast cancer in either breast.

lobe (lohb): Part of the breast that contains lobules.

lobule (LAHB-yule): Part of the breast that contains dozens of

milk-producing bulbs. 

lymph (limf): The clear fluid that travels through the lymphatic

system and carries cells that help fight infections and other

diseases. Also called lymphatic fluid.

lymph node (limf node): A rounded mass of lymphatic tissue

that is surrounded by a capsule of connective tissue. Lymph nodes

filter lymph (lymphatic fluid), and they store lymphocytes (white

blood cells). They are located along lymph vessels. Also called a

lymph gland.

lymph vessels (limf VES-suls): Thin tubes that carry lymph

(lymphatic fluid) and white blood cells through the lymphatic

system. Also called lymphatic vessels.

lymphatic system (lim-FAT-ik SIS-tem): The tissues and organs

that produce, store, and carry white blood cells that fight infections

and other diseases. This system includes the bone marrow, spleen,

thymus, lymph nodes, and lymph vessels (a network of thin tubes

that carry lymph and white blood cells). Lymph vessels branch, like

blood vessels, into all the tissues of the body. 

digital mammogram: A technique that uses a computer, rather

than x-ray film, to record x-ray images of the breast.

duct (dukt): A tube through which body fluids pass. Breast ducts

transport milk from the breast’s lobules to the nipple. 

fat necrosis (fat neh-KRO-sis): Lumps of fatty material that form

in response to a bruise or blow to the breast.

fibroadenoma (fye-bro-ad-uh-NO-muh): Benign breast tumor

made up of both structural (fibro) and glandular (adenoma) tissues.

fine-needle aspiration (fine NEE-dl as-per-AY-shun): The

removal of tissue or fluid with a needle for examination under a

microscope. Also called needle biopsy. 

gland: An organ that makes one or more substances, such as

hormones, digestive juices, sweat, tears, saliva, or milk. Endocrine

glands release the substances directly into the bloodstream.

Exocrine glands release the substances into a duct or opening to

the inside or outside of the body. 

glandular (GLAN-dyoo-lar): Refers to the part of the breast that

includes lobules where milk is produced and ducts (milk passages)

through which milk is carried to the nipple. (The fatty tissue and

the ligaments that support the breast make up the stromal part of

the breast.)

high risk (for breast cancer): A measure of the chances of getting

breast cancer when risk factors known to be associated with the

disease are present. 

hormone: A chemical made by glands in the body. Hormones

circulate in the bloodstream and control the actions of certain cells

or organs. Some hormones can also be made in a laboratory.

infection: Invasion by and multiplication of germs in the body.

Infections can occur in any part of the body and can be localized

or systemic (spread throughout the body). The germs may be

bacteria, viruses, yeast, or fungi. They can cause a fever and other
37

macrocalcifications (MAK-ro-kal-si-fi-KAY-shuns): Coarse

calcium deposits. They are most likely due to aging, old injuries, or

inflammation and usually are benign.

mammary duct ectasia (MAM-uh-ree dukt ek-TAY-zhuh): A

benign breast condition in which ducts beneath the nipple

become dilated and sometimes inflamed, and which can cause

pain and nipple discharge.

mammogram (MAM-o-gram): An x-ray of the breast.

mammography (mam-OG-gra-fee): The use of x-rays to create a

picture of the breast.

mastectomy (mas-TEK-toe-mee): Surgery to remove the breast (or

as much of the breast tissue as possible). 

mastitis (mas-TYE-tis): Infection of the breast. Mastitis is most

often seen in nursing mothers.

menopause (MEN-o-pawz): The time of life when a woman’s

menstrual periods stop permanently. Also called “change of life.”

microcalcifications (MY-krow-kal-si-fi-KAY-shuns): Tiny deposits

of calcium in the breast that cannot be felt but can be detected on

a mammogram. A cluster of these very small specks of calcium

may indicate that cancer is present.

needle localization: A procedure that uses very thin needles or

guide wires to mark the location of an abnormal area of tissue so it

can be surgically removed. An imaging device is used to place the

wire in or around the abnormal area. Needle localization is used

when the doctor cannot feel the lump of abnormal tissue.

nipple discharge: Fluid coming from the nipple. 

pathologist (pa-THOL-o-jist): A doctor who identifies diseases by

studying cells and tissues under a microscope. 

probe: A slender, flexible medical instrument used to explore a

wound or body cavity.

36

radiation (ray-dee-AY-shun): Energy released in the form of

particles or electromagnetic waves. Common sources of radiation

include radon gas, cosmic rays from outer space, and medical x-rays.

radiologist (RAY-dee-OL-o-jist): A doctor who specializes in

creating and interpreting pictures of areas inside the body. The

pictures are produced with x-rays, sound waves, or other types 

of energy. 

sclerosing adenosis (skluh-RO-sing a-den-OH-sis): A benign

breast disease that involves the excessive growth of tissues in the

breast’s lobules.

screening: Checking for disease when there are no symptoms.

screening mammogram (SCREEN-ing MAM-o-gram): X-rays of

the breasts taken to check for breast cancer in the absence of signs

or symptoms. Two views of each breast are taken—one from above

the breast and one from the side.

sonogram (SON-o-gram): A computer picture of areas inside the

body created by bouncing high-energy sound waves (ultrasound)

off internal tissues or organs. Also called an ultrasonogram.

stereotactic core needle biopsy (STAIR-ee-o-TAK-tik BY-op-see):

A biopsy procedure that uses a computer and a 3-D (threedimensional) scanning device to find a tumor site. It guides the

removal of tissue for examination under a microscope.

surgical biopsy (SIR-ji-kul BY-op-see): The surgical removal of

tissue for microscopic examination and diagnosis. Surgical biopsies

can be either an excisional biopsy or an incisional biopsy.

tamoxifen (ta-MOK-si-FEN): A drug that is used to treat breast

cancer. Tamoxifen blocks the effects of the hormone estrogen in

the breast. It belongs to the family of drugs called antiestrogens. 

technologist: A health professional who has been trained to

position patients for x-rays and take x-ray images (such as

mammograms). The images are then sent to a doctor (radiologist)

to be examined.
38 39

Notes

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ultrasound: A procedure in which high-energy sound waves are

bounced off internal tissues or organs and make echoes. The

echoes form a picture of body tissues called a sonogram. Also

called ultrasonography.

ultrasound-guided needle biopsy (BY-op-see): A biopsy

procedure that uses an ultrasound imaging device to find an

abnormal area of tissue and guide its removal for examination

under a microscope.

x-ray: A type of high-energy radiation. In low doses, x-rays are

used to diagnose diseases by making pictures of the inside of the

body. In high doses, x-rays are used to treat cancer.
40

Notes

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NIH Publication No. 02-3536

Printed August 2004