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    Breast exam question
    nic14120 posted:

    I am a 33 yr old female, with two children. I have PCOS, and after having my daughter in March, I have only had two subsequent periods. My last period was end of Aug. I went to see my dr for my annual exam, and wanted to have her feel my right breast, a few inches above the areola. (I did breastfeed up until July when my supply decreased, then I stopped). I had a breast exam last Aug, I didn't check my breast through my pregnancy, and just started again last Month. Because I have not had a period I am not sure if I should be doing it now, or when, because of my missing period. In the shower yesterday I felt some tissue above the areola that felt dense, and near it (deep in) I felt a small lump. I marked the area for the dr today to feel. She felt deep, and on the surface and said it feels like tissue to her. She did not seem concerned until I said that I never really felt that before. So from there she recommended I go for a sono to give me piece of mind. When she was writing my script she said she will request a mamo as well. I had had a mamo in 2007 after my son for a white bump I had on my areola, and am not a fan of the radiation to my breasts if not needed. My question to you is, would the sonogram show any lumps if this was in fact a lump instead of tissue? I really don't feel comfortable to get a mamo since she was not concerned until I said it felt new, but I don't not want to take this seriously either. Could the lack of period cause a cyst deep in the tissue in where I am feeling it?
    Jane Harrison Hohner, RN, RNP responded:
    Dear nic: Yours is a complex question with several sub-questions. With your permission I would like to take each individually, OK?

    1. Given your age a breast ultrasound is as reasonable as a mammogram in trying to screen for a mass. You are "on the cusp," as it were, where mammograms can be most effective. In scheduling you for both, as per your concern, your GYN is being very thorough. Radiation from a modern mammogram has been considered similar to flying cross country in a jet. Here is a link to the National Cancer Institutes for their take on radiation:

    No one wants unnecessary radiation, yet when a patient says "I never felt this before," no MD wants to end up in court with a missed diagnosis of breast cancer malpractice suit.

    2. An ultrasound is best at discerning solid from cystic masses. A mammogram is good at detecting calcification. Both together give a more complete description of an area.

    3. When doing a best exam, if one deeply examines from the nipple out to the border of the aerola, one can often feel an area of clearing where ductal tissue can be readily palpated. This is different from the rest of the breast where fatty, dense tissue can mask underlying structures.

    4. As you likely know, not having a period (including PCOS) usually means missed ovulations and thus more estrogen effects, and less progesterone. There are studies which suggest that benign, fibrocystic breasts are more comon in PCOS. Here is a recent citation on this from the National Library of Medicine site:

    Arch Gynecol Obstet. 2009 Aug;280(2):249-53. .
    Polycystic ovary syndrome and fibrocystic breast disease: is there any association?
    Gumus II, Koktener A, Dogan D, Turhan NO.

    Department of Obstetrics and Gynecology, Fatih University School of Medicine, Ankara, Turkey.


    We aimed to investigate the association between a polycystic ovary syndrome (PCOS) and fibrocystic breast disease.

    A total of 93 women, aged between 17 and 36 years, not using oral contraceptives, were entered in this case-control study. Laboratory, clinical and ultrasound findings were used to diagnose PCOS. The study group was consisted of 53 PCOS women and the control group consisted of 40 women. Breast ultrasonography was performed for all patients. Fibrocystic breast disease is described as common benign changes involving the tissues of the breast.

    Twenty-one (39.6%) of 53 women with a PCOS had fibrocystic breast disease. Five (8%) of 40 controls had fibrocystic breast disease. The difference between the groups was statistically significant (p = 0.004). Relative risk (95% CIs) was 3.17 (1.31-7.68). Overall sonographic benign breast pathologies were significantly higher in the PCOS group (p = 0.036).

    This study showed a statistically significant association between a PCOS and fibrocystic breast disease. Women with a PCOS should be evaluated for fibrocystic breast disease.

    nic14120 replied to Jane Harrison Hohner, RN, RNP's response:
    Jane- I greatly appreciate all your information on both my posts!! I will read through them both before I make any final decisions, but I think I will start with waiting out a week or so and re-visit the area. If I am in the time when I would have been having my period (as I had it last at the end of Aug), would that create a feeling of lumps? Also, if I wait out a few monts, based on the dr saying it feels like tissue, would that be life threatning if something was going on?

    My last question to you, the fibrocystic breast disease, I did see that online. I was reading that as lumps that move around, is that correct? The area I feel does not move. I do feel similiar "lumps" in other parts of my breasts, more at the surface. This one is more deep in a few inches directly above my areola. Is there ducts there? Or tissue that can feel this way in that area. Whenever I feel something on one side, I check the other and don't get nervous when they feel similiar, however this one is only on the right side in this area. I may also like to add that I did have a breast reduction in 2001. My areola's were placed up and an incision below straight down.

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