Dear Doctor: I'm 30 years old, and I have a lump in my breast, which imaging tests suggest is a fibroadenoma. I'm getting married in six months, and I am leaning toward having a biopsy so I won’t worry during my wedding and honeymoon. With the COVID-19 pandemic, is it selfish of me to have the biopsy right now?

Dear Reader: It’s understandable that, even with reassuring results from a mammogram and an ultrasound, you want a definitive diagnosis. As you mentioned in your letter, the only way to achieve that is with a biopsy. However, due to the pandemic, many hospitals have been forced to shift their attention and resources to dealing with COVID-19 patients, and some have put elective surgeries and routine medical care on hold. This means that decisions that in normal times would have been fairly straightforward have now become complex issues.

Let’s start with what we do know. Your radiologist has reported that the imaging tests you’ve undergone suggest the mass in your breast is a fibroadenoma, which is a benign tumor. It’s made up of both connective and glandular tissue, and it typically feels hard and smooth to the touch. Fibroadenomas are the most common type of noncancerous growth in young women between the ages of 15 and 35. Some are so small that they can only be seen in a scan, while larger ones are discovered through touch, as during a monthly breast self-exam. No matter the size, in most cases fibroadenomas don’t play a role in risk for breast cancer.

The good news is that imaging techniques are quite good at differentiating between benign masses, such as fibroadenomas and cysts, and those that are malignant. When a benign growth is discovered via imaging, it is often recommended that a follow-up scan be performed within six months. If the results of the subsequent imaging tests raise a red flag, then the next step is a biopsy. This is a surgical procedure in which a small sample is removed from the suspicious tissue and sent to a pathology lab to be looked at under a microscope. It’s only when the tissue is examined at the cellular level that a pathologist can state conclusively if the mass is benign or malignant.

A woman’s age adds another layer to the decision-making process here. When a woman is in her teens and 20s, benign causes for a breast mass are considered to be more likely. But that changes for women in their 30s, particularly now, as we are seeing more young women diagnosed with breast cancer. In your case, it would be wise to seek guidance from both the radiologist who performed and interpreted your scans and your family doctor. This type of biopsy is usually an outpatient procedure that can be performed in a surgical center rather than in a hospital operating room. Wherever you go, check that you are comfortable with the safety protocols that are in place. If your particular region is not hard-hit by the COVID-19 pandemic, and if your medical team agrees that a biopsy is a better choice for you than watchful waiting, there’s nothing selfish about moving forward.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10880 Wilshire Blvd., Suite 1450, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.)

Dear Doctor: I never had hip problems, but after weeks of quarantine, the outsides of my hips ache and even wake me up when I am asleep. My doctor says it’s bursitis, but I thought that’s from when you exercise too much. I’ve hardly even been outside. How did this happen?

Dear Reader: Bursitis is the name of a condition that occurs when the small, fluid-filled sacs that sit near joints throughout the body become inflamed. Known as bursae (or a bursa, when you’re talking about just one), they act as cushions that ease friction between the bone and other moving parts within the joint, such as tendons and muscles. When a bursa becomes inflamed or irritated, it fills with fluid. The swelling leads to more irritation, as well as pain and a limited range of motion.

Although bursae are present in joints throughout the body, bursitis is most common around the major joints. That includes the hip joints, as you’ve been experiencing, as well as the knee, shoulder and elbow. And you’re correct that bursitis most often occurs due to overuse, particularly through activities that include repetitive motion. Activities like raking, painting and gardening, and sports like tennis, skiing, running, biking and golf can lead to stress and inflammation. Bursitis also is linked to gout, rheumatoid arthritis and psoriatic arthritis; it can result from physical injury; and it may be triggered by reactions to certain medications.

Interestingly, hip bursitis can arise as the result of inactivity. The hip abductor muscles, which we use to move the leg away from the body and to rotate it within the hip joint, can become weak through lack of use. This results in increased pressure on the bursae. Prolonged sitting and standing can also lead to stress and inflammation.

Symptoms of hip bursitis include tenderness and swelling and the ache that you describe on the outside of the hip. This typically increases when rising from a sitting position, walking up stairs or when lying on one’s side. Any problems you may have with your lower limbs, such as knee or foot pain, can cause you to move in such a way that irritates the hip bursae.

Treatment focuses on the dual goals of reducing inflammation and strengthening the supporting hip muscles. Your doctor may prescribe the use of anti-inflammatory medications, and will likely show you some home-based exercises to increase strength and improve muscle tone in the abductors. Some people find that ice can help to minimize swelling and reduce pain. In some cases, the bursae can become infected, which necessitates the use of oral antibiotics. When more conservative treatment approaches don’t bring relief, injections of a corticosteroid may be recommended.

For people who develop hip bursitis due to repetitive overuse, rest is a crucial part of their recovery. In your case, the challenge will be strengthening the supporting muscles without causing additional irritation and inflammation. Avoid prolonged sitting or standing, follow the exercise guidelines that your doctor gives you, and don’t be tempted to overdo it.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10880 Wilshire Blvd., Suite 1450, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.)

Dear Doctor: After my last physical, my doctor said my lab tests show I’ve got prediabetes. What does that mean? Do I or don’t I have diabetes?

Dear Reader: A diagnosis of prediabetes means that your blood sugar levels are elevated beyond the normal range, but are not yet high enough to be considered Type 2 diabetes. And the key word here is “yet.” Prediabetes is a clear warning sign by the body that, without certain lifestyle changes, you run the risk of developing Type 2 diabetes.

Sometimes also referred to as adult-onset diabetes, Type 2 diabetes is a condition in which the body loses the ability to respond to insulin, a hormone produced by the pancreas. Insulin’s job is to move glucose from the blood into the cells, where it is used for energy.

When someone has diabetes, it means that glucose builds up in the blood. A high level of blood glucose causes a range of damage over time, including decreased immune function and harm to the nerves, eyes, heart and kidneys. In fact, diabetes is a leading cause of kidney failure that leads to dialysis or even the need for a transplant. It is also linked to atherosclerosis, sometimes referred to as hardening of the arteries, which raises the risk of heart disease, heart attack and stroke. Although the reasons why some people develop prediabetes and Type 2 diabetes while others do not are unclear, evidence suggests that genetics and family history play a role. The conditions appear more often in overweight individuals who carry excess fat around the abdomen, and in those who are sedentary.

For most people, the shift from normal insulin function to Type 2 diabetes is gradual. With a diagnosis of prediabetes, you’ve now reached the in-between stage. The insulin your body produces is still doing its job, but not well enough. Although it’s sending some of the glucose gleaned from digestion on to the cells, it’s leaving too much behind in the blood. Not everyone has physical symptoms of prediabetes. Those who do may experience persistent thirst, frequent urination, unexplained fatigue, blurred vision and increased hunger. Anyone who notices the onset of these symptoms should see their health care provider.

The good news is that with this advanced warning, you have time to make changes that can reduce the chances of your condition progressing to a Type 2 diabetes diagnosis. Start by adjusting your diet. Skip the added sugars and simple carbs and focus on lean proteins, fresh vegetables, leafy greens, grains, legumes and fresh fruit. Choose healthful fats, and limit their use. Being active is important to all areas of good health. Adults are urged to get at least two to three hours of moderate exercise per week. And remember, excess weight is linked to diabetes risk, so it’s important to reach and maintain a healthful weight. If you haven’t done so already, follow up with your doctor to make a plan to mitigate your diabetes risk and to continue to monitor your condition.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10880 Wilshire Blvd., Suite 1450, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.)