Health Magazine

What You Need to Know About Breast Lumps

By Dr Gbenga Adebayo

 

 It was her nightmare becoming a reality. She lost her mom to it. An aunt was also a victim. Now at 32 years old she had felt the lump. She feared it had came for her too. Thank God it was not so. The doctor said it was not!

Today let’s look at a cluster of diseases that is the dread of many women. We shall be looking at breast lumps.

Finding a breast lump can be really alarming, but it doesn’t necessarily mean you have breast cancer. The truth is, a breast lump can result from one of many benign breast conditions. But the possibility also exists that it could be cancer. Hence every woman should be aware of the possible causes of breast masses and their presentations.

Detailed below are the types of breast lumps (or masses), their causes and what kind of diagnostic or treatment measures might be necessary.

Fibrocystic changes

These are quite common with more than half of all women experiencing them as the get older. With these changes, the breasts may get lumpy and thickened with some tender areas. Multiplying cells within breast glands and overgrowth of fibrous tissue (fibrosis) in the breasts’ supporting tissue cause fibrocystic changes. Large or small cysts can result when such overgrowth blocks ducts and prevents secretions from draining.

Fibrocystic areas of the breasts blend into the surrounding tissue and may move slightly when pressed. There may feel dull pain and a sensation of fullness in the upper, outer part of the breasts. Fibrocystic changes are associated with fluctuations in hormone levels both during the menstrual cycle and as one approach menopause. You may notice increasing lumpiness and tenderness in the breasts as the levels of the reproductive hormones fluctuate during these times. The condition often improves after menopause when levels of estrogen and progesterone drop.

Treatment for fibrocystic changes ranges from lifestyle adjustments to medication. Some research suggests that fibrocystic changes are linked to caffeine consumption, which promotes fluid retention. The doctor may advise you to cut down on products containing caffeine, such as chocolate, coffee or cola. However, studies show mixed results regarding the effectiveness of limiting caffeine.

Other self-care options include wearing a supportive bra and taking over-the-counter pain relievers, such as acetaminophen (e.g. paracetamol) or ibuprofen  Other medications that have been effective in treating symptoms related to fibrocystic changes include oral contraceptives and danazol, a synthetic drug similar to the male hormone testosterone. However, danazol is rarely prescribed— e.g. in cases of severe breast pain that don’t respond to other treatments — because side effects include menstrual irregularities, weight gain, facial hair, acne and hot flashes. TheseDoctor and Patient side effects may be unacceptable to many people.

Cysts

Cysts are a type of tumor that may be found in many organs and parts of the body. They are fluid-filled sacs. In the breasts, cysts are caused by dilated ducts and are oval or round, smooth and firm, and they move slightly when you press them. Women in their 40s who are approaching menopause (perimenopause) often detect them as they experience fluctuating hormone levels. Cysts may come and go. Breast lumps caused by cysts feel hard and tender to the touch. Cysts appear most often during the two weeks before the period and resolve spontaneously after the period. Any associated breast pain usually goes away as the cyst resolves.

A clinical breast exam alone may not be sufficient to delineate a breast lump as a cyst. An ultrasound scan or the more invasive fine-needle aspiration (FNA) in which a thin needle is inserted into the breast and the suspected cyst to withdraw (aspirate) any fluid. The fluid so aspirated is sent for analysis to determine the nature of the cyst. FNA usually relieves any pain associated with the cyst.

A breast lump caused by a cyst may resolve on its own. If the breast lump disappears after the doctor removes the fluid, and it doesn’t return after six weeks, you won’t need any further treatment. If the breast lump doesn’t disappear on its own, or it recurs, you may need to have it surgically removed.

Fibroadenomas

These are fairly common in young women and is a cause of concern for many.

Fibroadenomas are round, firm, rubbery masses that arise from excess growth of glandular and connective tissue. These masses can grow to the size of a small plum, but they’re benign and usually painless. If you have a fibroadenoma, it may bounce or move slightly when you press the area.

Fibroadenomas respond to hormonal changes and tend to enlarge during pregnancy and shrink after menopause. Women of any age may have them, but they’re usually detected in women in their 20s or 30s. Mammography and ultrasound may help with the diagnosis, but the only way to be certain of a fibroadenoma is to take a sample of tissue for lab analysis (biopsy). The current philosophy in the treatment of breast lumps is to remove all such lumps. Hence surgical removal is the preferred mode of treatment.

Fibroadenomas sometimes disappear spontaneously.

Breast infection (mastitis)

Mastitis is a breast infection most often caused by bacteria that enter breast tissue during breast-feeding. You may feel a breast lump or area of thickened skin if you develop an abscess, one of the possible complications of mastitis.

Postmenopausal women may develop periductal mastitis. In this condition, milk ducts become inflamed, especially near the dark skin surrounding the nipple (areola). This can lead to scarring and widening of the milk ducts and could cause signs and symptoms such as a breast lump, pain, nipple discharge and nipple retraction. The causes of periductal mastitis are not exactly known yet.

Treatment for mild forms of mastitis includes antibiotics. However, if the antibiotics don’t control the infection, or if the mastitis is severe, surgery may be needed to remove the mass. Among older women, mastitis that isn’t associated with pregnancy or that doesn’t respond to antibiotics needs to be evaluated to make sure it isn’t inflammatory breast cancer.

Trauma or injury to the breast (fat necrosis)

Trauma or other injury to the breast — such as after surgery or an accident — can lead to a condition known as fat necrosis. Fat necrosis often results in a lump of scar tissue that’s firm, round and movable. If the injury is old, the breast lump may be painless. If the injury is recent, there may be pain and bruising in the overlying skin. Breast lumps caused by fat necrosis often resolve spontaneously. However, if this doesn’t happen, follow up with a doctor to make sure the breast lump isn’t cancerous (malignant) is important.

Because a cancerous lump may have features similar to a breast lump caused by fat necrosis, imaging tests, such as ultrasound, mammography or both may be necessary.

Phyllodes tumor

A phyllodes tumor develops as a painless breast lump within the connective tissue of the breast. In rare instances, some phyllodes tumors are cancerous, but most are benign. Benign phyllodes tumors grow rapidly and may become very large.

Often it’s difficult to distinguish between a phyllodes tumor and a fibroadenoma — even after imaging tests and a needle biopsy. However, phyllodes tumors are much less common than fibroadenomas. Rapid growth of the mass may signal that the breast lump is a phyllodes tumor.

Treating a phyllodes tumor usually involves surgery to remove the mass. After surgical removal, recurrence of the tumor remains a possibility.

Intraductal papilloma

An intraductal papilloma — a small, noncancerous growth in a milk duct — can cause a small breast lump that may be felt behind and near the edge of the nipple (areola). An intraductal papilloma may also cause discharge from the nipple, either spontaneously or when you press on the breast lump. The discharge is often bloody. Treatment usually involves surgery to remove the affected duct and examination of the tissue to check for cancer.

Breast cancer

breast cancer ribbonThis is the second most common cancer worldwide. A cancerous (malignant) breast lump is often painless, hard and irregularly shaped. It feels different from surrounding breast tissue. If the breast lump is attached to underlying muscle, it may not move when you press on it. Overlying skin on the breast may be dimpled or red.

Other signs include:

  • A spontaneous clear or bloody discharge from the nipple
  • Retraction or indentation of the nipple
  • A change in the size or contours of the breast
  • Any flattening or indentation of the skin over the breast
  • Pitting of the skin over the breast, like the skin of an orange

Treatment depends on the type of cancer, its stage and the appearance of cancer cells under the microscope. Options include surgery, radiation, chemotherapy and hormone therapy. Detecting breast cancer in its earliest possible stage — by having regular self breast examinations, mammograms, and clinical breast exams — gives you the best chance for successful treatment.

How To Do A Self-Breast Examination

I was invited to a church to speak on Wellness and Health recently. One of the issues I discussed was self-breast examination. I couldn’t help but notice the embarrassed look on the face of the pastor and many men there as I stood in front of the whole church demonstrating how women should examine their breasts.

A self-breast examination may be the difference between a curable breast mass and a death sentence. Practice this every month preferably one week after you start your menses which is when your breasts are most full. You may also choose any pther day in your cycle that suits you. The important thing is to stick to the day. This is because the characteristics of the breasts change with the hormonal levels during the menstrual cycle.

Some evidence from studies in Russia and Shanghai seems to suggest that self-breast examination may not be useful in preventing breast cancer deaths with concomitant increases in discovery of benign conditions by women leading to unnecessary interventions.  I think used properly self-breast examination is still a useful tool for breast cancer prevention and awareness.

Below is how to perform a self-breast examination using a clock pattern:

 

  • Stand in front of a mirror and look for change in shape and size of the two breasts raising your hands and standing akimbo.
  • Visualize your breast as the face of a clock.
  • Place your left hand behind your head and examine your left breast with your right hand.
  • Place your right hand at 12 o’clock — at the very top of your breast.
  • Press the pads of your three middle fingers firmly on your breast in a slight circling, massaging motion.
  • Move your hand down to 1 o’clock, then 2 o’clock, continuing until you return to 12 o’clock.
  • Continue in the same pattern, moving your hand in smaller circles toward your nipple.
  • Check the tissue under the nipple and look for discharge.
  • Check the tissue under your armpit and surrounding your breast.
  • Place your right hand behind your head and repeat the examination on your right breast using your left hand.

Your comments and questions are welcomed. All the best!

h/t mayoclinic


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