Howard LeWine, M.D., is chief editor of Internet Publishing at Harvard Health Publications. He is recognized as an outstanding clinician and teacher and is a recipient of the Internal Medicine Teacher of the Year award at Brigham and Women's Hospital. Dr. LeWine continues to practice Internal Medicine; most recently he became a hospitalist after practicing primary care for over 20 years.

Question:

If a woman finds a nodule on her breast, does it have to be removed immediately? Does it matter if it is cystic?

Answer:

Anytime you discover a breast lump, you should see a doctor. But finding a lump does not always mean you will need a biopsy or surgery. This is especially true if the lump appears to be a simple cyst.

Breast lumps are common in women, especially during their reproductive years (between puberty and menopause). When there are multiple small lumps, they are almost always noncancerous (benign).

A single lump is a little more concerning. But most are benign. This is especially true when you are younger.

My approach is to examine the area where the woman feels the lump. I then do a full exam of both breasts and check the armpits for lymph node swelling. If I feel the lump, the next step often depends on the woman's age and when her next menstrual period is due.

The choices may include:

• Repeating the breast exam at the end of the next menstrual cycle

• Inserting a fine needle into the lump. If it is a cyst, fluid will come out.

• Sending the woman for an ultrasound or mammogram

If I don't feel the lump, I will have the woman return again next month, or order a mammogram or ultrasound during this visit.

Whenever a woman feels a persistent lump in the same spot in her breast, she should have it evaluated. This is true even if a prior exam suggested there was nothing to worry about.