DEAR DR. DONOHUE: I am 20 and need your help. I felt a lump in my right breast. I told a friend about this, and she said breast cancer never happens to anyone my age. If that’s the case, I am relieved. If it’s not the case, what should I do? How can you tell a cancer lump from one that isn’t cancer? This is on my mind all the time. – L.G.

ANSWER: Breast cancer does happen to young women. It’s often said that it does not, but that’s misinformation. It’s true that breast cancer is more prevalent at older ages and that the risk for it increases the longer a woman lives. So someone your age is less likely to have it, but youth doesn’t make you immune to it.

Size, how the lump feels and whether it is tightly fixed in place are some of the qualities that sway a doctor into judging a lump as being cancerous. Cancer lumps are hard. They’re firmly anchored to the tissue beneath them; you can’t move the lump. Cancer lumps have irregular borders. Frequently, the overlying skin of a cancer lump is drawn down toward it to form a little dimple.

This sounds like it’s easy to tell if a lump is or isn’t cancer. It’s not easy. If a doctor, after examining the breast, cannot be sure, then he or she usually has the patient come back in a month or two to see if the lump has changed in size. If doubt still exists, an ultrasound in a woman less than 35 and a mammogram in an older woman usually can settle the matter. Should either of these tests not provide a definite answer, the next step is to obtain material for microscopic examination. That might be done with a very thin needle, with a larger bore needle or with a scalpel. Self-examination is good for discovering a lump. Self-diagnosis is foolish for proclaiming the lump benign or cancerous. You have to let the doctor do that; see yours today.

Incidentally, it is better to have a breast exam one week after a period. At the time of a menstrual period, many breast lumps enlarge and become tender, and this can make a difficult diagnosis more difficult.

The booklet on breast cancer explains the details of this illness and its treatments. Readers can obtain a copy by writing: Dr. Donohue – No. 1101, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Can. with the recipient’s printed name and address. Please allow four weeks for delivery.

DEAR DR. DONOHUE: My son was just discharged from the Army after serving two terms overseas. Before discharge, he was skin-tested for tuberculosis. His test was positive. He had many tests, including chest X-rays, and was told he didn’t have TB, but he was put on medicine and told to take it for nine months. Our family doctor says he doesn’t have to take it. What do you say? – G.Z.

ANSWER: He should take the medicine as the Army told him. A recently positive skin test indicates that a TB germ found its way into his body. He must have been exposed to TB, and that’s why the Army tested him. This does not mean he has TB. It does mean that, later in life, the germ could come to life and he could develop TB. The medicine he was given prevents this from happening. The Army has great experience in handling such matters.

DEAR DR. DONOHUE: I am 87 and had an abdominal ultrasound to look for gallstones. I don’t have any, but I have two kidney cysts. My doctor says I don’t need to have them removed. Is it because I am too old? – H.W.

ANSWER: It’s not because you’re too old. It’s because they don’t need to be removed. Small kidney cysts rarely are a source of any trouble. Many people have them. They’ve been there for a long time and haven’t caused you any grief. They’re not likely ever to cause you any.

Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Readers may also order health newsletters from www.rbmamall.com.

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