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Lump in breast with soreness

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I've been searching all online for a situation similar to mine, but I'm suprised to see that this isn't a common problem. I am 22 years old and my left breast has had a lump at the top of it for awhile now (a few months approx). The lump changes in size, as it is sometimes too small to locate easily by feeling of it, and other times it's so large that I can see it poking up under the skin when I look in a mirror. I'm worried because my family has a history of breast cancer. On my dad's side, there's not been any breast cancer that I know of but other types of cancers. On my mom's side however, there's been several instances. My mom died from breast cancer when I was young so I've been freaked out about possibly getting it ever since. I was told that my mom's mother died of breast cancer too, before I was born. My mom had 2 sisters and 1 brother, one of my mom's sisters died but never had any cancer, and her other sister has breast cancer now. None of her brother's daughters or any of my other cousins have had any cancer so far. Recently my left breast has started feeling sore, and the soreness has spread all over my left side including my left shoulder and the left side of my back and neck. I haven't strained or injured myself recently, so I don't know what could be causing it or even if it's related. I thought it might have something to do with the fact that I'm on my period now. My period occurs differently from "normal" females because I had a tubal coagulation operation (cutting & burning of the tubes as a sterilization procedure), so my period occurs once every few months and lasts for two weeks or so. I had this procedure for permanent birth control as a result of a firm decision I made to never bear children. Also, I've never been pregnant, therefore I've never breastfed. Additionally I'm not currently on any prescription medications, if that's important. I've read online where people were having similar issues but they also had some sort of leakage from the nipple, and I have not. My boyfriend (who is the only person I've told about it) seems to think that the lump might have something to do with a hormonal issue especially since I'm on my period now (but of course he's had no experience in this type of thing so he's not sure). This might come off as strange, but I've made a personal decision that if I ever get cancer, I don't want to be treated for it; I'd rather die a natural death, because I've seen people who have had breast cancer and suffered while the doctors kept them alive longer just for them to die anyway, and I don't want that to happen to me. Also the reason I've only told my boyfriend about this is because he's the only one I confide in not to let the information get back to my dad. If my dad found out, he'd have me at the doctor immediately (which I don't want, like I said) and I'd cause him to stress even more, and he has his own problems and I don't want to make it worse by him knowing since he already lost my mom previously to breast cancer. So I come to you asking, can these symptoms mean anything other than breast cancer; if so, what, and how can I tell the difference? I've read that breast cancer doesn't usually affect women under 30, but I didn't know if given my family history whether it would make me an exception. And if is breast cancer... how long would I maybe live on average assuming I continue going without any sort of treatment?
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replied June 28th, 2009
It saddens me to read your inquiry, and on several different levels, First of all, I am sad that you lost your mother to breast cancer early in your life. Secondly, I am sad that this understandably traumatic loss has caused you to swear to yourself that you would avoid treatment for breast cancer should you ever be diagnosed with this disease. As more than 85 to 90 percent of all women who are diagnosed with early-stage breast cancer will be alive and free of breast cancer 10 years after their initial diagnosis, condemning yourself to a certain and early (and likely unpleasant) death, should you ever develop breast cancer, really does not make a lot of sense to me.

As for your own personal situation, the vast majority of breast cancers are completely painless unless they are very advanced. On the other hand, breast pain (mastodynia) is, unfortunately, very common in young women, particularly around the time of their menstrual periods. Having said this, there is no way for me to tell you that this breast lump is benign or malignant simply based upon your description. At a minimum, you should have your physician perform a thorough breast examination, as well as ordering a breast ultrasound to further evaluate this lump (especially given your family history of breast cancer). I would also strongly recommend a referral to a genetic counselor, so that your family history can be comprehensively reviewed. If this evaluation suggests that you are at high risk for carrying one of the known hereditary breast cancer gene mutations, then you should at least consider undergoing genetic testing for these breast cancer gene mutations.

I have cared for many women with advanced breast cancer over the years, and while their length of survival has varied considerably, some of them have suffered very unpleasant and lingering deaths from neglected breast cancers. Despite the severe trauma that you have experienced related to your mother's death from breast cancer, your thoughts about avoiding treatment should you develop breast cancer is not logical, and it is not rational. So, please do yourself, your boyfriend, your father, and everyone else who is dear to you in this world a favor. Get your breast lump evaluated, see a genetic counselor, and if you should ever be unfortunate enough to be diagnosed with breast cancer in the course of your life, get yourself aggressively treated without delay, so that you can join the millions of other women in this country who have beaten breast cancer, and who go on to live full and long lives after their diagnosis and treatment.

Sincerely/ Robert A. Wascher, MD, FACS

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