Ask the Doctors: The only way for definitive diagnosis is biopsy
Dear Doctor: I'm 30 years old, and I have a lump in my breast, which imaging tests suggest is a fibroadenoma. I'm getting married in six months, and I am leaning toward having a biopsy so I won't worry during my wedding and honeymoon. With the COVID-19 pandemic, is it selfish of me to have the biopsy right now?
Dear Reader: It's understandable that, even with reassuring results from a mammogram and an ultrasound, you want a definitive diagnosis. As you mentioned in your letter, the only way to achieve that is with a biopsy. However, due to the pandemic, many hospitals have been forced to shift their attention and resources to dealing with COVID-19 patients, and some have put elective surgeries and routine medical care on hold. This means that decisions that in normal times would have been fairly straightforward have now become complex issues.
Let's start with what we do know. Your radiologist has reported that the imaging tests you've undergone suggest the mass in your breast is a fibroadenoma, which is a benign tumor. It's made up of both connective and glandular tissue, and it typically feels hard and smooth to the touch. Fibroadenomas are the most common type of noncancerous growth in young women between the ages of 15 and 35. Some are so small that they can only be seen in a scan, while larger ones are discovered through touch, as during a monthly breast self-exam. No matter the size, in most cases fibroadenomas don't play a role in risk for breast cancer.
The good news is that imaging techniques are quite good at differentiating between benign masses, such as fibroadenomas and cysts, and those that are malignant. When a benign growth is discovered via imaging, it is often recommended that a follow-up scan be performed within six months. If the results of the subsequent imaging tests raise a red flag, then the next step is a biopsy. This is a surgical procedure in which a small sample is removed from the suspicious tissue and sent to a pathology lab to be looked at under a microscope. It's only when the tissue is examined at the cellular level that a pathologist can state conclusively if the mass is benign or malignant.
A woman's age adds another layer to the decision-making process here. When a woman is in her teens and 20s, benign causes for a breast mass are considered to be more likely. But that changes for women in their 30s, particularly now, as we are seeing more young women diagnosed with breast cancer. In your case, it would be wise to seek guidance from both the radiologist who performed and interpreted your scans and your family doctor. This type of biopsy is usually an outpatient procedure that can be performed in a surgical center rather than in a hospital operating room. Wherever you go, check that you are comfortable with the safety protocols that are in place. If your particular region is not hard-hit by the COVID-19 pandemic, and if your medical team agrees that a biopsy is a better choice for you than watchful waiting, there's nothing selfish about moving forward.
Eve Glazier, M.D., MBA, is an internist and associate professor of medicine at UCLA Health. Elizabeth Ko, M.D., is an internist and assistant professor of medicine at UCLA Health.