Breast lumps are a common concern for many women. A breast lump may be caused by a variety of benign (non-cancerous) conditions or, in some cases, may be a sign of breast cancer. Women who find a concerning breast lump often wonder if they should see their gynecologist or if they need to make an appointment with a different type of doctor.
What causes breast lumps?
There are many potential causes of breast lumps, both benign and malignant (cancerous). Some common causes of benign breast lumps include:
- Fibrocystic breast changes – where breasts feel lumpy and breast tissue is dense
- Fibroadenomas – benign solid tumors made up of gland and connective tissue
- Cysts – fluid-filled sacs that can develop in the breasts
- Fat necrosis – where a bruise or injury to the breast heals with fatty scar tissue
- Abscesses – a pocket of pus caused by bacterial infection
Cancerous lumps may be a sign of breast cancer, such as invasive ductal carcinoma. Less commonly, breast lumps could be due to other cancers like lymphoma.
Should you see a gynecologist for a breast lump?
A gynecologist specializes in women’s reproductive health including disorders of the female reproductive system. They have expertise in conditions relating to the ovaries, uterus, vagina, and cervix. While gynecologists have some general knowledge about the female body, they do not specialize in diseases of the breast.
Gynecologists do not typically have the training or expertise needed to fully evaluate breast lumps, perform diagnostic breast exams, order breast imaging tests, or biopsy breast tissue. Therefore, they are not considered the appropriate physician to evaluate and manage concerning breast lumps.
What type of doctor treats breast lumps?
When a woman finds a suspicious breast lump, she should make an appointment with a specialist who has expertise in diagnosing and treating breast conditions. This would be either:
- A primary care physician (PCP) like a family medicine doctor or internal medicine doctor
- A breast surgeon, also called a surgical oncologist
- A breast specialist such as an obstetrician/gynecologist who has fellowship training in breast health and disease
These doctors have specialized training in diagnosing breast lumps through a clinical breast exam, ordering appropriate imaging tests like mammograms or breast ultrasounds, and performing tissue biopsies if needed. They can determine whether a breast lump is concerning and requires further evaluation or if it is likely benign.
Primary care physician
Many women first bring up a breast lump with their primary care physician or family doctor. A PCP can perform an initial breast exam, determine if imaging is needed, and refer the patient to a breast specialist for further evaluation if the lump seems concerning.
Breast surgeon
A breast surgeon, also called a surgical oncologist, specializes in diseases of the breast including cancer. They have extensive training in the diagnosis and treatment of various breast conditions. When a patient has a suspicious breast lump, a breast surgeon can evaluate the lump through exams and imaging, perform a biopsy if needed, and develop a treatment plan if breast cancer is found.
Breast specialists
An obstetrician/gynecologist (OB/GYN) may pursue additional fellowship training focused on breast health and disease after their residency. These “breast specialists” have expertise in assessing breast lumps, ordering mammograms and ultrasounds, performing biopsies, and developing treatment plans.
Other health professionals who can specialize in breast health include nurse practitioners and physician assistants, with the title of nurse practitioner – breast care or physician assistant – breast care.
Diagnosing breast lumps
When you see a doctor about a concerning breast lump, there are several tests they may use to diagnose the cause:
Medical history and physical exam
The doctor will ask about your medical history and symptoms. They will perform a clinical breast exam, carefully feeling the lump as well as the surrounding breast tissue.
Imaging tests
Imaging tests allow the doctor to visualize the lump and evaluate its characteristics. Common tests include:
- Mammogram: An x-ray of the breast tissue.
- Breast ultrasound: Uses sound waves to create images of the breast and lump.
- MRI: Uses magnets and radio waves to produce detailed breast images.
Biopsy
A biopsy involves removing cells or a small piece of the lump to examine under a microscope. This helps make a definitive diagnosis. There are different types of breast biopsies including fine needle aspiration, core needle biopsy, and surgical biopsy.
Treating breast lumps
Treatment depends on the final diagnosis:
- Benign lumps: Often simply monitored, though some may be surgically removed for comfort or cosmetic reasons.
- Breast cancer: Treated through some combination of surgery, radiation therapy, chemotherapy, hormone therapy, and targeted drug therapies.
When to see your gynecologist
While gynecologists do not specialize in evaluating and treating breast lumps, there are some breast-related issues that do fall under their scope of practice. It is reasonable to see your gynecologist if you have:
- General breast pain or tenderness associated with your menstrual cycle
- Breast pain during pregnancy or breastfeeding
- Nipple discharge associated with hormonal changes
- Breast infection such as mastitis during breastfeeding
For a suspicious lump that is new, palpable, isolated to one area, and not going away, you should see a primary care physician or breast specialist instead.
Conclusion
In summary, gynecologists do not typically evaluate or treat breast lumps. A breast lump should be examined by a primary care physician, breast surgeon, or dedicated breast specialist. These doctors can perform appropriate diagnostic tests and provide treatment recommendations. The exception is breast issues clearly linked to hormonal fluctuations or breastfeeding, which fall under the scope of a gynecologist.
