Breast Lumps – To Worry Or Not To Worry?

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By Dr. Jayadeva Ph.

One fine morning while taking a shower, Tombisana found a small lump in her breast. That night she kept thinking whether to be concern of the lump or ignore it. She is 32 years old, unmarried and otherwise a healthy and active person. Tombisana was always a bit shy and this prevented her to go to a doctor and consult about the breast lump. She eventually decided to ignore it.

3 years passed, the lump was painful and her skin over it was red and thick. After consulting a doctor and taking appropriate investigations, she got the shock when the lump turned out to be a cancer!

She thought for a while and regretted that she should have thrown her shyness away and done a check-up at the earliest when the lesion was pre-malignant.

What mistake did she do?

Breast cancer is the most common cause for death in women around the world.Global breast cancer incidence increased from 641,000 (95% confidence intervals 610,000 -750,000) cases in 1980 to 1,643,000 (1,421,000—1,782,000) cases in 2010, an annual increase of 3•1%. Over 100,000 new breast cancer patients are estimated to be diagnosed annually in India.

Previously, it affect women living in the western countries more often, probably due to their lifestyle and eating habits. Now, India is increasingly facing the problem of breast cancer. Same can be said for places like Manipur, where women may face breast diseases like any of her counterparts in the world.

Many newer investigations are present in the world to detect breast cancer. But the first test is always the self-examination. Women of any age can do a thorough self-examination of both the breast to check for any lump or swelling.

The most common mode of examination for detecting breast cancer is the mammography. Mammography is a type of specialised X-ray machine which can detect both benign and malignant lesions. Mammography is recommended for patient who are above the age group of 35 years but not recommended for patients who are pregnant, lactating or below 35 years due to radiation hazard.Mammographic positioning is also painful for the patient.

Even though PET and MRI scan has higher accuracy, its availability is a concern.

The easiest and the more comfortable type of investigations is ultrasound screening of breasts. Ultrasound is a specialised device that uses high frequency sound waves (inaudible to human and similar to sound waves used by bats!) to visualise the soft tissue of the body. It does not uses radiation like mammography. So, ultrasound can be used in any individual whether she is pregnant or younger individuals which are unfit for radiation exposure.

The sensitivity for detecting breast cancer ultrasound ranges from approximately 80 to 90 per cent, which hold very good for patients who are young or pregnant and even for those who cannot afford other higher imaging modalities like MRI and PET or patients who does not want to be exposed to unnecessary radiation for screening purpose by mammography.

Ultrasonography is indeed a simple and inexpensive tool for evaluation of breast lumps. Not only it provide prompt diagnosis but also it is safe and painless.

Ultrasound detects early stage cancers in women with mammographically negative dense breasts, with higher contribution in women younger than 35 years .It is useful in the evaluation of palpable masses not visible in mammographically dense breasts, abscesses and masses that are not completely evaluable with mammography and in young patients who are susceptible to radiation.

Fine needle examination of any breast lump done blindly may yield false negative cases, i.e. it may wrongly take the sample for the biopsy from the area which may be of benign nature, other than taking the sample from the exact malignant site. False negative results are seen in 4-10% and are most common in fibrotic or well differentiated tumours

With the help of the ultrasound guided fine needle aspiration, the aspiration of the malignant cells become more reliable. Thus, making the patient worry lesser!

New development in the field of ultrasonography like Elastography has been developed which follow the simple rule of elasticity , telling that the more the lump is hard, the more likely it is to be malignant. Other newer techniques includes contrast enhanced Sonography.

Nowadays, not only women are affected by breast cancer. Many cases of breast cancer in man has also been reported. But most of the cases goes unreported or gets reported very late in life as the usual false presumption that man does not have breast! That they have chest!!

Every men that I know have breasts. It may be a rudimentary gland for them, but they do have breast glands which can very much develop breast cancer at any stage of his life. Men should also be aware as much as their female counterparts. Actually, men should worry more as breast cancer is often more aggressive than women;the breast tissue in men are very close to the chest wall and it can metastasis (spread) faster than breast cancers of women.

Every year, October is taken as the month to create awareness for breast cancer. In US and many other countries, prominent personalities, breast cancer survivors and any individual who want to share their knowledge to tackle this dreaded disease.

Lastly, the mistake that our friend Tombisana did was nothing. She was simply unaware of the consequences of the simple breast lump. She was not aware that the simple breast lump may turn out malignant. She does not know what could be the next step for diagnosis and treatment. Now that we all know some few simple test to be followed if you find a breast lump. Never to ignore even the smallest of them!

(Author: Dr. Jayadeva Ph., Md., Consultant Radiologist, Advanced Hospital & Research Centre, Imphal.)

 

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