I have noticed a lump in my breast. What should I do?

If you have noticed a lump in your breast (or in any other part of your body), you need to book an appointment with your General Practitioner immediately, so they can refer you to the hospital as quickly as they can. Because, let me tell you something: time is gold.

Forget about your fears. There will of course be fear; an intense preoccupation that shall last for weeks, for sure, but you don´t want to take the risk of having a quiet Cancer killing you slowly, or do you?

Once you get your appointment arranged at hospital, go with someone. Even if you are one of those who prefer to do everything on their own. I am one of those, but at the end of the day, you want a friendly and loving hand who holds your sweaty one, while you are doing all the thinking and all the waiting among ultrasound, mammogram and biopsy. It will slightly calm down your nerves to have someone with you. Guaranteed!

Don´t be stressed on the day. It won´t help much. I know it is easier said than done, but you must try. If it is 100% clear that you don´t have Cancer, if it is just a cyst, you will know it quite soon, and you will get to go home pretty early.

What to expect (ultrasound, mammography and biopsy)

The doctor will always start by feeling the lump with their hands and, then, an ultrasound will be performed on you. If your lump is just a cyst, this will be seen  straight away, as these are fluid-filled masses, and the sound waves of the machine will pass through the cyst. So, the ultrasound technician won´t have any doubts, if what you have is a cyst. He will see that straight away. Tumours, instead, are solid masses.

If the ultrasound performer (not necessarily a doctor) see that what they are touching is not a cyst, a mammography exam will be carried out. A mammogram is a specialised imaging that uses a low-dose x-ray system to see inside both breasts.

And, yep, everything you heard about it is true: it hurts as hell, so try to think of something nice while having one done. I know, I know, that is just not possible. Then think of how much you would like to slap someone´s face. A bit aggressive but, hey, you might find that it helps you!

This test won´t tell you if you have Cancer; it will just tell you if there is something suspicious: the machine sees abnormal lesions, lumps, calcifications and dense tissue. However, sometimes it is impossible to say if a tumour is benign or malignant with just a mammogram, especially if you are young or youngish, because the breasts, then, are usually dense, which makes the whole tissue unclear.

There could also be calcifications in the tissue of the breast: small dots of calcium. They are usually not felt with the hands, but they can be seen in the mammogram. If they are big, they are usually not associated with Cancer, but if there is a group of little ones together, they could be associated with extra breast cell activity, and this needs to be checked in future revisions, as it could lead to develop into Breast Cancer.

So, if at this stage the doctors are still unsure of the nature of your lump, they will always perform a biopsy on you; the last question of this terrifying exam. This is probably the scariest step of them all, because you know you are going to go home not knowing if you have Cancer or not. Plus the biopsy itself is not really pleasant; I am afraid that it also hurts.

There are several types of biopsy. One involves a fine needle, but this is normally used with lumps that are suspected to be cysts. If the lump is more of a solid mass, you will be practised a core needle biopsy. The radiologist or surgeon will then use a thicker needle to remove tissue samples from the breast mass, using the ultrasound for guidance, to reach well the tumour. This is to avoid doing this procedure twice (because a fine needle does not give much information of the tissue collected).

It is a bit painful, but bearable and necessary. Sometimes, they put local anesthesia, but, when I had mine done, they did not put anything at all to numb my area (cheers, NHS!) So, if this is your case, grab someone´s hand and press it as strongly as you can. If you are alone, don´t worry, because a nurse will probably be there for you. Shout if you need to! I found that shouting was highly therapeutic.

The sample or samples taken will need a few days to be analysed, so if you have Cancer, you will never know on the same day, so, again, there is no point to panic. Of course you will be worried, but you will see that, as days pass and after doing lots of thinking, your nerves will get better (OK, not much, but slightly).

Even for private patients the process might take a week in order for you to know the results. For me it took a very long time: sixteen days, and that made me incorrectly think (how innocent I am) that my tumour wasn´t malignant. But that is just the NHS in England. They just have so many patients… So, unfortunately, you are just another number to add to their Cancer list.

I am afraid that, at the beginning of the process, you tend to feel like you are a customer that isn´t paying. And that is so strange, when you have indeed paid your taxes for many years. But I suppose that is unavoidable, because they take so very long to see you every time, that you just learn to feel that way.

If you complain about it, to make you feel relaxed, oncologists say that tumours do not grow that fast; they kind of change every 28 days. But mine was Grade 3, and that is the maximum speed they can grow at. But, again, they considered that I could wait. 

So basically it might take you a whole month to know that you have Cancer: from the moment you feel the lump to the moment you finally get your results.

The waiting is the worst; so if you have the chance to go through your private insurance, then go. I had the chance and didn´t go, I suppose that it was just because I wanted to postpone the bitter reality. But, looking back, I regret not to have gone the Private way.

But let´s hope you don´t have Cancer and this is just a scare. It could just be a Fibroadenoma, a solid benign tumour quite frequent in premenopausal women. These aren´t painful and they move easily when the doctor feels it.

Mine was very movable but it ended up being Cancer, unfortunately. After this first visit, before having any results, the doctor will rate your lump with numbers, based on the looks of the tumour, where:

1 is definitely not a malignant tumour

2 is probably not, but you never know

3 they don´t know; they can´t say 

4 is probable that it is Cancer

5 it is definitely Cancer; 100%.

I was given a 3, although the doctor insisted that it didn´t look at all like a malignant tumour. I remember how she mentioned how stressed I looked and told me off for it, because “it was probably not Cancer”. But I guess I was right to be fearful and stressed, and she was wrong.

But, hey you, if you do have Cancer, like I do, this is not the end of the world. You are going to fight. And, if you fight, you will always win.