Breast lumps – Is it cancer?

Lila’s whole world came crashing down around her when, one morning in the shower, she found a small but distinct lump in her right breast. She panicked; her first thought was “Could it be cancer?” She felt for pain; yes, it does seem a little tender.She read it somewhere, if it hurts, it can’t be cancer. But then, what if it is? Dr R N Tagore, oncologist at Paras Hospital, Patna, suggests keeping your cool if you have just found out that you have a lump in your breast. “Eight out of ten lumps found in breasts are benign in nature, that is, not cancerous. It has been observed that in young and premenopausal women breast, these types of breast lumps are very common,” says Dr Tagore. “Benign lumps often feel like well-encapsulated, smooth, soft to firm and freely mobile, while cancerous tumour, on the other hand, tend to feel much harder, irregular and fixed (cannot be moved as easily),” he says. If you notice a lump in your breast, irrespective of whether it is for the first time or you had lumpy breasts before, or even if it is right after you get a clean mammogram, consult a doctor as early as possible. The breast lump may be caused by any of the following conditions: Fibrocystic breast changes Earlier known as fibrocystic breast disease or FBD and then changed to fibrocystic breast changes, it is a common condition affecting women of childbearing age. I. Symptoms: It is a benign condition characterized by lumpy, nodular breasts and breast pain that varies throughout the menstrual cycle. II. Cause: Although the exact cause of the condition is not yet known, it is determined by oestrogen predominance and progesterone deficiency (hormonal changes) during the menstrual cycle. The condition does not increase the risk of breast cancer, but it may become more difficult for you to feel a new breast lump or any other abnormality in the breast. It is important that you consult your doctor and get treatment. As researcher Helmuth Vorherr points out, ‘Fibrocystic breast disease is not a harmless nondisease but a distinct clinical entity that requires treatment to bring about relief to the patient, to reduce the incidence of breast surgical procedures, and to diminish the risk of breast cancer.[1]  Read more about How to take care of your breasts? Breast cyst Breast cysts are fluid filled sac like structures inside the breasts. They may occur in one or both breasts. Breast cysts are either simple, complex, or complicated cysts. Cysts are typically soft and mostly benign, except for complex cysts which could be malignant and merit a biopsy. Read here 5 absolutely normal reasons why your breasts feel lumpy Twenty five percent of all breast lumps turn out to be breast cysts. Cysts are common in premenopausal women over 35 years of age and uncommon in postmenopausal women unless they have received hormone therapy. [2] Incidentally, postmenopausal cysts are much more common. I. Symptoms:

• Simple cysts are fluid-filled, round or oval structures that can occur singly or in multiples, isolated or diffused. Cysts can fluctuate in size and number with the menstrual cycle and it has been found to be most prominent in the premenstrual phase. [3]
• Complicated cysts are also fluid-filled, but in addition, they contain pus, proteins from cell turn-over, and other proteins that are collectively called debris. Such cysts may occur along with simple cysts and are often painful, inflamed, or rapidly enlarging. Sometimes nipple discharge too can occur.
• Complex cysts are solid masses with thick walls. These lumps are uncommon but when they do occur, there are high chances it could be malignant. You will be asked to get a biopsy done.

II.  Causes: Scientists do not yet know what causes breast cysts. Evidence suggests predominance of oestrogen and deficiency of progesterone in the menstrual cycle can possibly cause breast cysts. Breast fibroadenoma Breast fibroadenoma is a smooth, firm mass made up of fibrous and glandular tissue. It is one of the most common benign tumours found in adolescent girls and young women under 30 years of age. Breast fibroadenomas account for 68 percent of all breast lumps. [4] The lumps are generally 1-3 cm in size found in upper outer quadrant of the breast. Some lumps can be larger than 10 cm in size as well, causing breast asymmetry. Read more about Breast cancer in a 25-year-old? Really??!! (True story) Fibroadenomas are categorized into simple fibroadenoma, giant juvenile fibroadenoma, and multicentricfibroadenoma. I. Symptoms:

• The fibroadenomas are painless, smooth, movable rubbery masses that have distinct borders.
• Normally, they are 1 cm to 3 cm in size, but giant fibroadenomas have a diameter of more than 5 cm and weigh over 500 gm.
• Fibroadenomas are generally found in upper right quadrant of the breasts, but in multicentricfibroadenomas multiple masses occur at different quadrants of the breasts.
• Giant fibroadenomas are associated with skin ulcerations and venous engorgement.
• Fibroadenomas may enlarge slowly without associated pain or nipple and skin changes, but fluctuations in size may occur with the menstrual cycle.
• Symptoms last an average of 5 months. [5]

II. Causes: As with other breast lumps, here too, oestrogen influence the development of fibroadenomas. III.  Risk factors:Exposure to oestrogen-progesterone oral contraceptive before menopause and an increasing BMI of 25-30, increase the risk of fibroadenoma. Although fibroadenomas are benign in most cases, a study reported that women with fibroadenomas are at a 2.17 times increased risk for breast cancer. [6] Breast cancer Breast cancer is a malignant tumour that develops from the cells in the breast. These malignant cells invade the neighbouring cells and can then spread to different parts of the body, if left unchecked. I.  High risk factors for breast cancer:

• Age 50 years or older
• History of breast cancer
• Family history of breast cancer
• Breast cysts, especially hard ones
• Hormone therapy
• Exposure to ionizing radiation
• Obesity

II.  Symptoms: Studies have shown that breast cancer is significantly associated with the occurrence of symptoms. Common symptoms are

• Breast lumps
• Breast pain
• Nipple discharge

1. One study found a cancer rate of 3.2, 16.4 and 12.0%, respectively, in patient with breast pain, lump and nipple discharge. [7] 2. Another study reported a risk of more than threefold in women who had a lump in the screening exam but no significant association between nipple discharge, breast pain and breast cancer risk. [8] 3. Although breast pain was not associated with malignancy, pain that is unilateral, localized and intense may be associated with cancer, reported another study. [9] 4.Sometimes, early detected breast cancers have lumps that are mobile. Fixed lumps are more dangerous since these lumps are usually associated with more advanced type of cancers, that is, those that have spread to other parts of the breast. 5. Given that there is no hard and fast rule to determine whether the breast lump is benign or malignant just by touching and feeling the lump, seek medical attention as soon as possible. Depending upon the type of breast lump you have, your doctor will chalk out a treatment plan for you. Reference:

1. Vorherr, H. Fibrocystic Breast Disease: Pathophysiology, Pathomorphology, Clinical Picture, And Management. American Journal of Obstetrics and Gynecology 154.1 (1986): 161-179.
2. [Heisey RE, McCready DR. Office management of a palpable breast lump with aspiration. CMAJ : Canadian Medical Association Journal. 2010;182(7):693-696. doi:10.1503/cmaj.090416.
3. Berg WA, Sechtin AG, Marques H, Zhang Z. Cystic Breast Masses and the ACRIN 6666 Experience. Radiologic clinics of North America. 2010;48(5):931-987. doi:10.1016/j.rcl.2010.06.007.

4. Lee M, Soltanian HT. Breast fibroadenomas in adolescents: current perspectives. Adolescent Health, Medicine and Therapeutics. 2015;6:159-163. doi:10.2147/AHMT.S55833.
5. Cerrato F, Labow BI. Diagnosis and Management of Fibroadenomas in the Adolescent Breast. Seminars in Plastic Surgery. 2013;27(1):23-25. doi:10.1055/s-0033-1343992.
6. Dupont WD, Page DL, Parl FF, Vnencak-Jones CL, Plummer WD, Rados MS, et al. Long-term risk of breast cancer in women with fibroadenoma. N Engl J Med. 1994;331:10–5.
7. Lumachi F, Ermani M, Brandes AA, Boccagni P, Polistina F, Basso SM, Favia G, D'Amico DF. Breast complaints and risk of breast cancer. Population-based study of 2,879 self-selected women and long-term follow-up. Biomed Pharmacother. 2002 Mar; 56(2):88-92.
8. Singh D, Malila N, Pokhrel A, Anttila A. Association of symptoms and breast cancer in population-based mammography screening in Finland. International Journal of Cancer Journal International du Cancer. 2015;136(6):E630-E637. doi:10.1002/ijc.29170.
9. Foulkes RE, Heard G, Boyce T, Skyrme R, Holland PA, Gateley CA. Duct Excision is Still Necessary to Rule out Breast Cancer in Patients Presenting with Spontaneous Bloodstained Nipple Discharge. International journal of breast cancer. 2011;2011:495315.

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