Hi.  I have a sad story to tell.  I have been working with a charming
Chinese lady -- not long in this country -- with whom I've had multiple
contacts due to persistant over-supply related problems.  Baby fussy and
unsettled, though chubby, and Mom constantly engorged with multiple
experiences of plugged ducts (one which progressed to mastitis.)  We worked
on weaning down to more acceptable volumes, but still she had sporadic
episodes of plugs -- generally resolving w/in 12 hrs of cold therapy.
Episodes moved around in both breasts, but more common in the left.  Last
Fri. she felt a tender spot in left breast before leaving for work, couldn't
stop to treat, and by evening was very engorged.  Treated all weekend as
we'd discussed, but breast didn't soften til Mon.  In the aftermath, she
detected a lump about 1.5 cm. in that breast   She saw OB who wanted her to
see a surgeon.  She phoned me because she was certain the lump was related
to lact. and didn't want to see a surgeon.  I was insistant she should, and
ref. her to the surgeon I use who is so supportive and knowledgeable about
the lactating breast (I thank God for this man at least once a week!)
Anyway, ultrasound has dx the lump as a very suspicious tumor -- the MD
suspects a very fast-growing kind -- and he has ordered an emerg. weaning --
something I've never known him to do.  She called after seeing him, and we
are doing a hurry-up weaning so that the next steps can proceed without delay.

I share this story for sev. reasons:  One to say that it is critical to
realize that while most of the time lumps in the lactating breast probably
ARE related to the lactation, they aren't always (I hoped and thought we
were dealing with an abscess.)  Two, we need to cultivate respectful and
friendly relationships with physicians in various specialties so that there
is someone we can trust and direct our clients to. Thirdly, I want to thank
Kathy Auerbach for her talk at the Rush Breast Cancer  During Preg. and
Lactation Seminar last year in Chicago where she made the remark:  "Mastitis
can't cause cancer, but cancer can cause mastitis."  That remark really
stuck in my mind, along with the cautions (repeated by Ellen Petok in her
very important JHL article of last year on tumors in lactating women) to
seek additional dx if lumps don't resolve in 72 hrs.  This client of mine
lost no valuable time thanks to what I learned.

Go to conferences!  Read the literature!  Things aren't always what they seem.

Barbara Wilson-Clay, BSE, IBCLC
priv. pract Austin, Tx