$Unique_ID{BRK01264}
$Pretitle{Skin and Subcutaneous Tissue}
$Title{The Readers Speak: Breast Lump}
$Subject{breast cancer}
$Volume{L-19}
$Log{}

Copyright (c) 1991   Tribune Media Services, Inc.


THE READERS SPEAK


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     There has been much mail concerning an answer to a 29 year old woman with
a breast lump.  Having had two opinions that this was probably cystic, with
doctors refusing to order mammography, she asked about the correctness of this
approach.  The mail reveals some concerns that were not addressed in my
response, as well as other advice that was felt to be important.  There were
several letters of histories where the patient was under thirty where a breast
lump was cancerous, and one letter received notes that the incidence of breast
cancer in women under the age of 30 is increasing by 3 percent to 4 percent
yearly.  "While it is likely that she doesn't have cancer" wrote one director
of a Professional Review Organization, "other readers under 30 just might have
it, and tell themselves. . . they are too young."  Youth, therefore, is not an
absolute, and merely being under the statistical age of thirty does not
guarantee that a lump is not malignant.  Another suggestion was that a
suspicion of a cyst should have required a referral for an ultrasound
examination, which could detect the difference between a solid or a fluid
filled mass.  In the case of a solid mass, this radiologist would then follow
with a mammography and then biopsy.  Another physician would have required the
mammogram and then aspirated or drawn fluid from the cyst if it was so
diagnosed, and sent the fluid for analysis to a pathologist if it was cloudy.
Another irate physician (from a university hospital) advised a third opinion
from a "university medical center" for a qualified opinion that could lead to
an appropriate workup.  Almost everyone agreed that the history of cancer in
this woman's family required more than mere routine investigations.  It is
clear that the diagnosis and treatment of breast cancer is not an easy
problem, and that no one method is sufficient to cover all eventualities.  It
proves again the point that while statistics and averages are fine for
guidelines, each individual must receive the attention that is needed for
their specific situation, and that the concerns of the patient must be
respected.
ÿ
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The material contained here is "FOR INFORMATION ONLY" and should not replace 
the counsel and advice of your personal physician.  Promptly consulting your 
doctor is the best path to a quick and successful resolution of any medical 
problem.
