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Compiled by Safe World. August 2010.

Developing a lump on your breast is quite common. The majority of breast lumps, approximately 85%, are benign (non-cancerous). However, if you do notice a lump, you should have it checked by your GP as soon as possible.

Further information on evaluation, diagnosis and treatment of breast lumps can be found on the NHS website.

In prison situations, prompt evaluation, diagnosis and appropriate treatment of breast lumps is of course equally imperative.

The following is from www.prisonerswithchildren.org

Evaluation of Breast Lumps

Challenges to Accessing Appropriate Medical Attention in Prison

Breast lumps are a thickening of breast tissue commonly found in women of all ages. Some lumps are easily detectable through touch while others are indiscernible except through mammogram and ultrasound technology. Regardless of its size or texture, a breast lump can be the result of a benign cyst or a cancerous tumor.

Women with malignant breast lumps who do not receive prompt treatment can lose a whole breast or significant amounts of breast tissue, or die as cancer cells metastasize and spread throughout their bodies. Because approximately one in nine women will suffer from breast cancer during her lifetime, prompt and accurate assessment of breast lumps are vital to a woman’s basic healthcare.

Assessment of a woman’s individual and family history of breast lumps and a physical examination are the first step in breast lump evaluation.

For women over the age of 35 a mammogram is recommended to determine the lump’s mass and to see if other lumps are located in surrounding breast tissue. Because mammograms miss 10 to 20 percent of palpable breast cancers and cannot detect whether a lump is cancerous or benign, a negative mammography result should not be the end of the diagnosis.

Fine needle aspiration (FNA) is an inexpensive and easily performed procedure that can be carried out in a doctor’s office. A health practitioner uses a small gauge needle to draw fluid from a breast lump. A lack of blood in the specimen typically rules out a chance of a malignancy. If blood is found in the fluid, the specimen should be sent for analysis to determine if cancer cells are present. When no fluid is found a fine needle aspiration biopsy (FNAB) should be performed and the recovered cells analyzed. A core needle biopsy uses a larger gauge needle to provide a larger extraction of the lesions’ mass. Although this biopsy method is not as effective as FNAB, it is easier to perform.

For women under 35 an ultra sonogram is recommended because their breast tissue is typically more dense, making it hard to detect smaller lumps with mammography. This testing is also needed when an aspiration of the mass cannot be made because the mass is too small, too deep, or the patient declines the aspiration procedure.

Because of the high incidence of breast cancer in women, all breast lumps must be aggressively evaluated. A triple diagnosis of a breast lump is recommended. The concurrent use of a physical examination, mammography, and skilled fine needle aspiration biopsy procedure ensures that a malignant breast lump is correctly identified.

Women in whom all three tests indicate benign breast lumps should receive a follow through examination every 3 to 6 months for one year to ensure that the mass either stabilizes or regresses.

CASE STUDY OF CARE AFFORDED PRISONERS

Trina first complained of painful breast lumps in 1991. She also told the prison doctor that there was a family history of breast cancer. In early 1993, she was finally given a mammogram. The radiologist noted the presence of “extremely dense breast parenchyma” and recommended a follow-up mammogram be done in one year.

No follow-up was done until 1994, at which time the radiologist again noted, “dense breast parenchyma could easily obscure a mass mammographically.” The prison doctor refused to order any biopsy, ultrasound or FNA. Instead, he adhered to his diagnosis of “fibrocystic breast disease.”

In July 1995, Trina was assigned to a different prison doctor who immediately ordered a biopsy which was performed on August 8, 1995. On August 23, 1995, Trina’s right breast and four cancerous lymph nodes were removed. Trina continued to complain about pain and lumps in her left breast and on January 8, 1997, her left breast was removed.

In August 2000, after complaining for several months about a painful lump in her neck, Trina learned that the lump was metastasized breast cancer.

This of course is especially relevant to prisoners where medical care may not be readily accessible.

Additional information:

Ref: 1540 Market Street, Suite 490, San Francisco, CA 94102
(p) 415-255-7036 (f) 415-552-3150

www.prisonerswithchildren.org 

info@prisonerswithchildren.org

http://www.prisonerswithchildren.org/pubs/breast.pdf