Alpha Patient Education Series #1 – Breast Lumps

1. What are breast lumps?

Breast lumps are swellings felt within the breasts.  They may be single or multiple.

2. How are breast lumps detected?

Breast lumps are usually discovered by the patient herself.  This may be on self-examination or during unrelated activity e.g. during a shower.  They can also be detected by a doctor during a health check-up.  Breast lumps are reliably detected on screening by breast imaging, either with ultrasound or mammogram.

3. What are the related symptoms?

Most breast lumps are painless.  Pain is found in a rapidly growing lump or if there is infection (abscess).  Pain is not a feature in breast cancer.

Your doctor will ask relevant questions when you present with a breast lump.  These include whether you had a previous history, how long it was there, fluid discharge from the nipple, the number of children you have, taking oral contraceptives (the ‘Pill’), whether you still have periods or if you are menopausal, and whether you have a family history of breast cancer.  These questions aid in diagnosing the nature of the breast lump.

4. What are the types of breast lump?

Breast lumps are either cystic (liquid-filled) or solid.  Cysts are almost entirely benign.  Solid lumps can be either benign or malignant (cancerous).  Benign lumps are mostly fibroadenomas (firm white lumps containing the protein collagen).  Other benign lumps include haematoma (old blood clots), galactocoele (collection of breast milk), mastitis (inflammation), abscess (infection) and granuloma (chronic infections including tuberculosis).

5. What are the tests required?

The ultrsound scan will distinguish between cystic and solid masses.  Mammography (‘Mammo’) is useful in detecting changes in the breast pattern (architecture) on plain x-ray films; some of these changes may indicate early cancer even before a ump is detected.  Mammograms are usually recommended after the age of 40.  Because these tests provide different kinds of information, a combination of both is often used.  In cystic swellings, the fluid may be aspirated (drawn out) and sent for cytology, which is a microscope test to look for cancer cells.  Solid lumps can also be studied by this method, namely fine needle aspiration cytology (FNAC).  The accuracy of this test is over 90%.

6. What is the treatment?

Cysts should mostly be left alone.  They can be aspirated if large and/or cause symptoms, such as discomfort.  Should a solid lump be left alone of removed?  Based on the history, physical examination, and ultrasound and/or mammogram, your surgeon will advise on the best treatment plan for you.  If there is any suspicion of cancer, urgent FNAC and/or excision is vital.

7. Surgery for breast lumps

Excision is done under general anaesthesia.  This is not a major surgery and can be performed in a day-care setting; i.e. you do not require overnight hospital stay.  It is a short procedure (about 30 minutes).  The scar will match the size of the lump.  If absorbable sub-cuticular (under the skin) sutures are used,  they do not have to removed and scarring is much less.  All excised lumps are sent to the laboratory for histological examination (HPE) to determine their exact nature.  Needless to say, early surgery offers the best chance of cure in breast cancer.