Goldilocks: THIS breast is too lumpy... THIS breast is too pebbly...

September 11, 2008 6:43 PM

How worried should I be? (You are not my doctor.)

Essentially, I have a small (1 cm) lump in one of my breasts. I saw an NP who examined me and referred me to a radiologist for ultrasound and maybe biopsy. She also told me my breasts are "pebbly." I'm 24, some family history of cancers (including breast cancer), no previous weird pap smears or anything like that.

What I am having trouble with is this: I realize that it's probably nothing (a hard cyst? a fibroid? whatever that is?) but I am still somewhat upset about it. Part of what I am having trouble with is that when I think about it and get upset, I tell myself, "don't be stupid! It's nothing!" and then I still feel upset, but also stupid. Similarly, when I think about it optimistically, I feel like I don't have enough worry, and I'm tempting fate or something.

I think I would feel better if I just had some sense of how worried a reasonably well-informed person would actually feel. Either I should be very worried, which will mean that I have "permission" to feel that way, or I shouldn't be, which will mean that I have "permission" to feel optimistic.

I hope this is not too badly phrased. I have tried googling around, but it's not all coming together into something that makes sense. What is the scientific, statistical, common-sense level of worry that would be reasonable to feel in this situation?

posted by anonymous to health & fitness (14 comments total)

Of course you're upset. You are faced with the possibility of the worst.

I think a lot of people will tell you the best thing to do is not worry until you have something to worry about.

We all have situations that make us anxious. But really, how worried should you be at just the possibility of something happening?

I have been faced with a number of health-related unknowns. At some point I thought I might have ovarian cancer. Then I thought I had an ectopic pregnancy. Then I was actually faced with having complications with a pregnancy that ended up with me delivering 8 weeks early and having a preemie.

What I do is think of the most likely options, and how I'd address them. This type of logical thinking calms me down because I thrive on plans.

You can also look at stats that breast cancer is largely an older woman's disease, and that at 24 it's very unlikely that you have it. Lots of women get lumps, and because of the popularity of breast self-exams, many women have found them. That doesn't mean they have cancer; it means you need to be responsible to yourself and have it checked. That's the best you can do. You are doing it. Good for you!
posted by FergieBelle at 6:52 PM on September 11, 2008

You have permission to feel however you feel. But it certainly isn't something to dismiss without further medical investigation.

Statistics can't really tell you whether to worry-- some people find a 10% chance of cancer (i'm making this number up) a reason for intense worry, other people say that means 90% of people are fine. Risk is nothing without context and values.

You will interpret them however you want to interpret them, so the best thing to do is feel what you feel, but get it checked out. Once you have the appointment made, you have permission not to worry unless worrying makes you feel better, in which case, go ahead.
Many people feel like worrying gives them control and if they don't worry, they'll be struck down. Other people feel like if they *do* worry, it will cause it to happen.

Figure out which kind of worrier you are and act accordingly.

And good luck... at that age, it's probably OK-- but if it is something, early detection really matters, so you can look at it that way.
posted by Maias at 7:17 PM on September 11, 2008

Don't be worried.

Easier said than done.

I have been through this twice, the first time at your age (I also have a family history of breast cancer). I was scared shitless...went through all sorts of death thoughts and everything. Thoughts on how I would handle chemo after seeing family go through it, blah blah blah. It was absolutely terrible and it was like 2-3 weeks before they even did the ultrasound. Needless to say I was a wreck. Don't get that way.

Honestly though, at this point in the game, you've got age on your side, it's really unlikely you've got cancer...it's very likely it's a fibroadnoma (did the doc mention this?). Now after they do the ultrasound (mind you I'm no doctor), if the edges of the lump are smooth, you're also very likely in the clear, it's probably just a fibroadnoma. If the edges of the lump are not smooth, you'll have to rely on the results of the biopsy.

Fibroadnomas are very common for women in their early 20s. Sometimes they remove them, sometimes they don't. They removed my first one, when I was 24, it was rather large. I was in the small 10% that gets multiple ones, and they didn't remove the 2nd. They did a biopsy each time. Don't worry if they don't remove it...turns out the scarring is worse than the lump and can hide actual cancer when you're older. Don't worry, having fibroadomas doesn't put you at any greater risk than cancer.

Be careful though, going through a lump experience and winding up in the clear can make you a tad casual about the whole situation if it comes up again. My doctor gave me a serious talking too when my second fibroadnoma turned up, it had been a few months before I got down to see him. He wasn't happy and told me not to be complacent.

I hope everything works out ok. It's hard to think logically during a time like this, but you have some good statistics on your side.
posted by pokeedog at 7:37 PM on September 11, 2008

A "reasonably well-informed person" in your situation is naturally going to feel worried until they can see a specialist and find out what's going on. That does not mean that there is actually a high risk that what you have is cancer. You're feeling anxious because breasts are personal and cancer is scary, even though the risk that you, personally, have breast cancer is really, really low.

'Pebbly breasts' are common. They're completely harmless, but they make self-checking for lumps more difficult because it's easy to confuse the natural bumpiness with actually having A Lump. If it's any consolation, I find weird little lumps all the time, but my doc says they're just part of the structure of the breast tissue.

You've done the right thing by checking your breasts, seeing a doctor straight away and being referred to a specialist. Right now, that's all you can do. Actively worrying about cancer won't magically protect you from it; if anything, worrying is bad for your health. So tell a close friend or two that this is a difficult time for you. Ask for video nights and chocolate biscuits, or a night out on the town to get your mind off the worry. Tell them you need hugs and a bit of sympathy if you're not your usual cheerful self.

Do NOT google breast cancer between now and your appointment with the specialist. Seriously, I mean it - online medical anecdotes are horribly biased towards gut-wrenchingly tragic outcomes. Nobody joins cancer forums to tell everyone how they found a lump but hooray, it wasn't cancer.

Give yourself permission to feel whatever you feel, but do your best not to make a 'project' out of the worrying. I hope you get good news soon.
posted by [ixia] at 7:47 PM on September 11, 2008

You're mostly freaked out by this because you are very young and have presumably not had too many things go wrong with you yet. In the decades to come you will likely have quite a number of health scares, some more serious than others. Most of them will turn out fine. Along the way you will gradually get used to the whole process, and feel more nonchalant about having diagnostic tests because you will know from experience that although worst-case scenarios always grip the mind dramatically, reality usually turns out to be more mundane. Even when biopsies come back bad, it doesn't play out like the Sunday night movie. You go, you get your surgery, you do your followup, just like millions of others. That's as close as I can get to quantifying a "common-sense level of worry" for something like this.

Best of luck to you, I hope it turns out to be nothing.
posted by HotToddy at 7:47 PM on September 11, 2008 [2 favorites]

I have a little cyst in my breast that was about the same size as yours. It was totally cool. They did the ultrasound and didn't have to do the biopsy. Cysts are pretty common, actually.

I'm a little annoyed at your NP for freaking you out, actually.

My breasts are "pebbly" too. Again, the NP shouldn't have made you worry about this! My doctor said that they word for it is "fibrous". Fibrous breasts are completely normal. Apparently you can reduce the...er...fibrousness by cutting down on the caffeine. It doesn't hurt anything and none of my partners have ever complained, though, so I don't worry about that either.

Good luck, but I think you'll be fine.
posted by sondrialiac at 7:48 PM on September 11, 2008

The rational answer is that you don't need to be very worried. I had a fibroid removed from my breast when I was in my early 20's though, and it freaked me right out. So I understand why you'd feel worried. But here's why I think you don't need to be:

According to this table from the CDC, about 13 women per 100,000 in your age group get diagnosed with invasive breast cancer every year.

According to this medline plus article, fibrocystic breast disease affects about 60% of women.

The point is, fibroids are incredibly more likely in your age group. Google fibrocystic breast disease for more info.

This is not exactly an apples-to-apples comparison - the CDC numbers are talking about the number of women newly diagnosed every year (incidence), while the medline article is talking about the total number affected (prevalence). But I'll bet the breast cancer number is around 1% or less, while the fibroids number is around 60%.

So you have a <1% chance of having something bad (but at an early, treatable stage because you are young) vs. a 60% chance of something benign. Those are good odds.
posted by selfmedicating at 7:50 PM on September 11, 2008 [1 favorite]

One of the problems with a workup of this kind of report is that it takes a number of steps, which stretch out over a lengthy period of time.

"Go here on Tuesday. Have this test done."
"Go there a week from Friday. Have this one done."
"Then come back and see me in two weeks."

In the meantime, you are left to wait and wonder. And there is not much that one person can do to push the process along.
posted by yclipse at 8:07 PM on September 11, 2008

Feel however worried you need to, and no more than that. If only it were that easy, right? Everyone's experience is different, and it's totally ok to feel however you feel. It will probably change from moment to moment, hour to hour, and that is ok too.

Here is a big list from the American Cancer Society about things that could be going on that aren't cancer, in case that kind of info might ease your mind.

Here is their information for women facing a breast biopsy, including info on what the lump might be, and what kinds of tests might be done. If the details of medical procedures freak you out, skip it. If knowing what's coming helps calm you down, check it out.
posted by vytae at 8:25 PM on September 11, 2008

medical student's perspective:

In technical terms, feeling for breast lumps is considered a "sensitive" test that is used for screening. Screening tests by nature are great at ruling diseases out, but not so great at ruling them in (there are lots of false positives).

Your doctor will perform "specific" tests such as some sort of radiological imaging, and these tests are designed to be confirmatory.

As others have said, you definitely have age and odds on your side. Don't freak out.

And way to go on getting yourself checked out! Pat yourself on the back for me.
posted by expletivization at 10:59 PM on September 11, 2008

From the other direction, I had breast cancer at age 25 and I am perfectly fine and healthy 13 years later. Whatever happens you will have the resources to deal with it. Trust yourself. You're allowed to feel nervous of course, but you're also allowed (encouraged, really) to put off worrying until later - it will NOT tempt fate, I promise!
posted by Theresa at 12:41 AM on September 12, 2008

From what I understand, a fibroadenoma is a benign tumor in the breast. Fibroids appear in the uterus.

I had two fibroadenomas removed when I was 22. At the same time I was informed that I have fibrocystic breasts (basically lumpy breasts--yeah, thanks, I noticed) and should probably avoid caffeine. I chose to have the lumps removed rather than a needle biopsy for two reasons. One is that they said they could get a more accurate biopsy if they could test the whole thing rather than a tiny piece. The other was that if they came back positive I'd have to have them out anyway, and if they came back negative I'd either have to have them out anyway or always have lumps in my boob. I do have light scars but they'd be hidden by even a tiny bikini top so it's no problem. They ended up being benign, in case that's not obvious.

I can't believe I'm admitting this, but one reason I was really calm about it when it happened to me was that I remembered a very early episode of the original Beverly Hills 90210 when the exact same thing happened to Brenda. And I remember them talking about how common benign lumps are for 20-somethings and how the risk of cancer is very low for someone that young and so on. So...thank you, TV, for helping me be calm when my mother was far from it.

It's strange but all in all I'm kind of glad it happened to me. I've always been really nervous in hospitals and all that, so it was good to learn that I can handle it when it comes down to it. The ultrasound was actually kind of neat--my boomer mom was shocked that I didn't have to have a mammogram even after finding obvious lumps! But apparently they just don’t give them to people that young. You get to skip right to the ultrasound, which, from what I understand of mammograms, is WAY more comfortable.

So...between talking openly about the inside of my breasts, my taking comfort in horrible 90s TV shows, and my nerdy enjoyment of my own medical issues, this is probably the most embarrassing comment I've ever written on Metafilter. And so I hope my experience helps you feel a little bit better, at least. I know you can't help being nervous, but you have every reason to be optimistic, too. This is a very common things for women your age. Hang in there.
posted by lampoil at 7:22 AM on September 12, 2008

For whatever it's worth, I've met a couple of women in the last couple of years who had variations on this. The first one I freaked out about and made a big deal of telling her (I kind of hadn't really noticed it as being striking in the moment, but a couple of days later I was like, holy shit, I wonder if she knows about it). I told her and she was like, yeah, I know, I have issues with that. Anyway, from my very limited experience, it's not uncommon. (I'm a dude, if that isn't clear).
posted by sully75 at 9:40 AM on September 12, 2008

follow-up from the OP:

I am deeply grateful to everyone who answered. I felt much better after reading the answers. You guys helped a lot.

And: it was a cyst!

posted by jessamyn at 3:59 PM on September 18, 2008