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Breast Lumps

You should get them checked!
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breast lumps
Breast lumps must be checked out by a specialist.

Breast lumps are uneven bumps and growths you can feel over your breasts. It is commonly found in women but can occur in men as well, though less common.

More than 25% of women will encounter breast lumps in their lifetime. Thankfully, most of these breast lumps are benign (non-cancerous). In Singapore, according to the Singapore Cancer Registry Annual Report 2021, breast cancer remains the most frequent type of cancer occurring in women over the past 5 years. From 2017 to 2021, this occurrence comprised nearly 30% of all types of cancer.

What signs and symptoms of breast lumps should you be aware of?

You should see a doctor if you notice any of the following:

  • A palpable (can be touched/felt) lump in your breast or underarm
  • Inverted nipple
  • Abnormal nipple discharge
  • ‘Dimpling’ or ‘tethering’ of the breast(s) skin
  • Unresolved rash over the nipple skin
  • Breast pain

As these symptoms may be red flags suggestive of breast cancer, early evaluation and treatment are paramount as they can be life-saving.

doctor breast checkup
Your doctor will obtain further information through examinations and tests.

What can I expect when I see my doctor for breast lumps?

Your doctor will obtain a history to understand the timeline and progression of the breast lump(s), a family history of any medical conditions related to breast issues, and will physically examine both your breasts and armpit region. Depending on individual symptoms, risk factors, and concerns, your doctor may recommend imaging scans to evaluate the breast lump(s).

What are the non-invasive tests available for screening breast lumps?

Common screening/imaging options for breast lumps include:

  • Breast ultrasound: breast ultrasound is an imaging test using sound waves to visualise the internal structures of the breasts further. This can be done with an ultrasound Doppler probe device, which is painless and safe.
  • Mammogram: this is a scan imaging test done by a mammographer. The mammographer will place your breast on the X-ray machine. Two pieces of plastic/metal will slightly compress the breasts during the process of taking the X-ray. The whole scanning process takes about 30 minutes to an hour.
  • Breast MRI scan: Breast MRI scan helps screen breast cancer in high-risk patients or patients who have breast implants. MRI uses magnetic frequency to outline a thorough structural imaging of a body. MRI scanner allows a person’s body structure to be analysed from various angles (from the front, side, and above the head), creating 3D images of the structure being screened for.

The modalities of screening for breast lumps may differ from patient to patient as this depends on the patient’s symptoms, age, risk factors, and general medical background. You are advised to consult your doctor first to understand your symptoms and, secondly, to examine the area of concern physically. This will allow your physician to guide you on the screening option that is best suited for your individual needs.

mammogram
Mammograms should be done per your doctor’s recommendation for early detection of breast cancer.

What are the common causes of breast lumps?

As mentioned, thankfully, the majority of the breast lumps are benign. The 2 common causes of non-cancerous breast lumps are breast fibroadenoma and breast cysts. However, occasional breast lumps can be due to a more sinister cause, such as breast cancer. Hence, it is important to get yourself checked if you have any breast lumps.

fibroadenoma and cysts
Benign breast conditions can cause breast lumps.

What is breast fibroadenoma?

Breast fibroadenoma is a common non-cancerous breast finding that usually presents with palpable lumps. They typically develop during puberty or early reproductive ages due to the exposure and sensitivity of oestrogen hormones. The breast tissues, under the influence of oestrogen, will then grow, intertwining with the breast glands and ducts, leading to the formation of a solid nodule (lump).

What are breast cysts?

Breast cysts are common benign breast condition. Breast cysts are lesions that are fluid-filled in nature. Breast cysts may come and go over any part of the breast(s), which can be influenced by the level of oestrogen hormone in a person. Big cysts can cause pain and discomfort in some women. Small breast cysts are usually left alone with regular monitoring by your doctor. In large, uncomfortable cysts, your doctor may offer a procedure to drain out the fluid of the cysts.

What is breast cancer?

Cancer happens when the cells in a person’s body cannot stop growing. If the cell growth is out of control and occurs in the breast cells and tissues, you can develop breast cancer. The breast cancer cells can grow bigger with time and spread to the surrounding tissues through the bloodstream and lymphatic drainage. Over time, they can disseminate to other organs of the body.

Although most breast lumps are not dangerous, a breast cancer diagnosis should not be delayed and missed as early detection and treatment can be potentially life-saving. In the late stages of breast cancer, the cancer cells can affect other parts of the body, eventually developing into cancer.

Please see a doctor if you have a breast lump!

What are the risk factors of breast cancer?

Below are the factors that determine your risk for breast cancer:

  • Age: the older you get, the higher the risk of developing breast cancer.
  • Gender: breast cancer is more common in women.
  • Family history: a family history (especially on your maternal side) of having breast cancer or breast cancer genes increases your risk of developing breast cancer.
  • Overall BMI: the higher the BMI, the higher the risk of developing cancer, including breast cancer.
  • Diet: high intake of red meat, animal fats, and alcohol has been associated with the occurrence of breast cancer.
  • Oestrogen exposure during reproductive years: an early onset of period before the age of 11 and late menopausal age after age 55 or someone who has yet to have children by age 35 may increase the exposure time to oestrogen, predisposing one to developing breast cancer.
  • Previous abnormal breast biopsy findings: a history of abnormal breast sample findings predisposes a person to breast cancer

It is worthwhile speaking to your doctor about lifestyle measures to reduce your risk of exposure to breast cancer.

early detection
Early detection of breast cancer increases your chances for proper treatment and management.

What is the role of early detection of breast cancer?

Although there is no absolute way to prevent breast cancer, early detection with appropriate screening may be life-saving. Treatment for early stages of breast cancer is curative. Hence, don’t wait and take a chance; screen and treat early.

What are the current breast cancer screening guidelines?

Monthly breast self-examination should be performed at home regularly. Your doctor can guide you on how to examine your own breasts and the pitfalls to look out for. You are advised to consider routine mammogram screening annually from age 40 to 49 and two yearly routine mammograms from age 50 and above.

As guidelines are used for the recommendation of the general population, it is still good practice to discuss with your physician which are the suitable breast tests or imaging for you.

Key take-home messages

Breast lumps are common, and most of the findings are not dangerous. However, breast cancer can present as lumps; hence, breast screening is vital for early detection and treatment!

References

  1. Daly C, Puckett Y. New Breast Mass. [Updated 2022 Oct 6]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK560757/
  2. “Singapore Cancer Registry Annual Report 2021,” n.d., https://www.nrdo.gov.sg/docs/librariesprovider3/default-document-library/scr-ar-2021-web-report.pdf?sfvrsn=591fc02c_0
  3. Luo C, Wang L, Zhang Y, Lu M, Lu B, Cai J, Chen H, Dai M. Advances in breast cancer screening modalities and status of global screening programs. Chronic Dis Transl Med. 2022 May 25;8(2):112-123.
  4. Fiorica JV. Breast Cancer Screening, Mammography, and Other Modalities. Clin Obstet Gynecol. 2016 Dec;59(4):688-709.
  5. “Breast Cancer,” Singaporecancersociety.org.sg, 2018, https://www.singaporecancersociety.org.sg/learn-about-cancer/types-of-cancer/breast-cancer.html

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