Straight answers to breast cancer questions

Most breast lumps are not cancer. Cysts, fibroadenomas, and normal hormonal changes all produce lumps. That is the reassuring part.

The part that matters more is that nobody can tell what a lump is by feeling it, including a surgeon. Imaging, and sometimes a biopsy, is the only way to know. So make the appointment rather than waiting to see whether it goes away. If it turns out to be nothing you will have lost an afternoon.

Usually not. A callback normally means the radiologist saw an area the standard pictures do not show clearly enough. The great majority of callbacks end with nothing wrong.

What happens next is usually a diagnostic mammogram with extra views, sometimes an ultrasound, and often a radiologist reading it while you wait. More on the screening page.

Breast pain on its own is rarely a sign of cancer. It is far more often hormonal, and it usually affects both breasts and comes and goes with your cycle.

What is worth an appointment is pain in one specific spot that does not settle, particularly with any other change in the skin or the nipple.

Yes, and it is often diagnosed later because nobody is looking for it. Men have breast tissue and it can develop cancer. A lump, a change in the nipple, or nipple discharge in a man needs the same evaluation it would get in a woman.

A core needle biopsy is done through numbed skin. You feel pressure and hear a click. Most people describe it as much less bad than they had braced for, and it leaves a nick rather than a cut.

A biopsy does not cause cancer to spread. This worry comes up often and it is not supported by the evidence. Biopsies are how a diagnosis gets made, and delaying one is the actual risk.

This depends on who you ask, which is not a satisfying answer but it is the true one. For average risk, the recommendations range from every year starting at 40, to every other year starting at 40, to a conversation in your forties and then every other year from 50.

The screening page sets out all four positions side by side, and explains why respected organizations reading the same evidence land in different places.

Dr. Perkins puts it this way: women save their own lives every day by finding their own cancers. If you do not know how to do a breast exam, the steps are on the I found something page, and they will help you be more aware of your breasts until you find your own routine.

What matters most is knowing what is normal for you, so that if something changes you notice. The anatomy page explains what you are actually feeling.

Dense tissue is associated with a somewhat higher risk, and it makes small cancers harder to see on a mammogram because both look white. Since September 2024 every mammogram facility in the United States has had to tell you your density.

A density notice is information to bring to an appointment, not a result to act on by itself. What to do about density is the least settled question in this field. See the screening page.

Not everyone needs it. It is most useful when there is a pattern in the family, such as breast or ovarian cancer in several relatives, cancer at a young age, cancer in both breasts, male breast cancer, or Ashkenazi Jewish ancestry.

A genetic counselor is the right person to decide with, because a result affects your relatives as well as you, and a negative result does not always mean what people assume it means.

Do not skip it. Idaho Women’s Health Check provides free breast and cervical screening for uninsured women in Idaho with household income below 200 percent of the federal poverty level. Call (208) 334-5805 or email WHC@dhw.idaho.gov.

Susan G. Komen’s helpline on 1-877-465-6636 can also help. More on the support page.

No. For people who have a genuine choice between them, survival is the same whether you have a lumpectomy followed by radiation or a mastectomy. That has been shown over decades.

There are still good reasons to choose one over the other, including how far you live from a radiation center and how you feel about keeping your breast. But a bigger operation is not a safer one. See how to choose.

No, and this is one of the most common misunderstandings. Drug treatment is decided from the characteristics of the tumor, not from which operation you had. Choosing a bigger operation does not buy you out of medicine, and choosing a smaller one does not commit you to it.

No. Plenty of people with breast cancer never have chemotherapy. It depends on the type, the stage, the grade, the lymph nodes, and the receptor status.

For some small, early, hormone receptor positive cancers, a test such as Oncotype DX can help work out whether chemotherapy would actually add anything. Ask whether you are a candidate.

Only some treatments cause hair loss. Endocrine therapy pills generally do not. Some chemotherapy regimens do.

If yours will, ask about scalp cooling before you start, because national guidelines suggest considering it. Free and low-cost wigs and head coverings, including two free wigs from the Assistance League of Boise, are listed on the support page.

Because hormone receptor positive breast cancer can come back many years after diagnosis, and endocrine therapy keeps working against that the whole time you take it. It lowers the risk of recurrence, of a new cancer in the other breast, and of dying from breast cancer. Five years is the shortest course that has been shown to do that, which is why it is where most people start. Depending on your own cancer, your team may recommend staying on it for seven to ten years.

If side effects are making it unbearable, tell your oncologist rather than stopping quietly. Switching drugs often helps, and stopping early gives up the benefit you have already paid for in side effects.

No. It is a choice, and choosing against it is a real decision rather than an absence of one. If you decide not to, ask your surgeon about an aesthetic flat closure by name, so the chest is closed deliberately smooth rather than simply sewn shut.

You can also change your mind later. See reconstruction.

Under the Women’s Health and Cancer Rights Act of 1998, a group health plan that covers mastectomy must also cover all stages of reconstruction, surgery on the other breast for symmetry, prostheses, and treatment of physical complications including lymphedema. Ordinary deductibles and coinsurance still apply.

If a plan calls symmetry surgery cosmetic, that is worth challenging. See what insurance has to cover.

If you want one, get one. It is normal, it does not offend anyone, and breast cancer is complicated enough that a second reading of the same file sometimes changes the plan. For almost all early breast cancer, taking a week or two to do this changes nothing about your outcome.

Lymphedema is swelling in the arm, hand, chest, or back caused by lymph fluid not draining freely after nodes have been removed or treated with radiation.

Most people do not get it, and the risk is much lower after a sentinel node biopsy than after a full node dissection. When it does appear it is usually within about three years. Report new swelling, heaviness, or tightness early, because early treatment works far better than late treatment.

It depends on which operation you had and whether you have drains. A lumpectomy is a matter of days to a couple of weeks. A mastectomy is longer, and a mastectomy with reconstruction longer still.

Ask for this in writing at your pre-op visit, and ask specifically when to start shoulder exercises. Getting the shoulder moving again on schedule matters more than most people expect.

Yes, and it catches almost everyone off guard. During treatment there is a schedule, a team, and a plan. When it stops, the structure goes and the feelings that were postponed arrive.

This is not ingratitude and it is not a relapse. It is common enough to have a name, survivorship, and there is help for it. Counselors with oncology experience and virtual support groups are listed on the support page.

Ask this at your pre-op appointment and write the answer on the fridge. Every surgical practice has an after-hours route, and knowing it in advance is worth more than any page on this website.

For a fever, spreading redness, an incision opening, or drainage that changes, call. That is what the number is for. For sudden or severe chest pain or trouble breathing, or a swollen painful calf, call 911.

If the 2am problem is that you cannot stop crying or cannot see a way forward, call or text 988. It is answered around the clock.