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Go for screening as breast cancer symptoms are few

Breast cancer has very few symptoms and may not show up in the early stages, when it is easily treated. This is why doctors advise women to go for breast screening.

Dr Wee Siew Bock, a breast surgeon at Mount Elizabeth Hospital, tells you what are the symptoms to look out for and what tests you can expect.

SYMPTOMS

• A lump in the breast is the most common symptom. This is a persistent hardening in the breast or a bump. It may feel uneven to the touch and is seldom painful. In its early stages, it is usually moveable within a small area of the breast. The commonly cited immobility occurs only later on.

•Pain is an uncommon symptom, occurring in about 5 to 15 per cent of breast cancer cases. Cancer-related pain is described as a dull ache, similar to the pain from a bruise, and can be pinpointed to the location of the lump. It tends to be associated with larger tumours and is believed to be linked to tumour-related inflammation or the weight of the growth, or both.

Changes to the appearance of the nipple or skin of the breast, and breast asymmetry are other uncommon features of breast cancer, and these seldom occur in isolation.

•A bloodstained or dark- coloured nipple discharge may indicate the presence of cancer beneath the nipple, especially if it appears on only one breast. This feature is seen only with centrally-located tumours and, though uncommon, is an important symptom to be aware of, as such cancers tend to be very small ones within the milk ducts.

•Changes to the appearance of the nipple or skin of the breast, and breast asymmetry are other uncommon features of breast cancer, and these seldom occur in isolation.

WHAT TESTS TO EXPECT

If you have a lump, the doctor will examine it for its hardness, shape and smoothness, and check for accompanying skin changes. Apart from this, the tests that are likely to be performed include:

Ultrasound scan: Breast ultrasound scans can detect lumps that are as small as 2mm and this helps detect cancers at their smallest possible size. This test is especially useful for those below the age of 40, as mammography is less reliable due to the age-related density of younger women's breasts.

Mammography: This is an X-ray of the breast. Together with the ultrasound scan, it helps to determine further features of the lump.

Biopsy: This is usually a test in which tissue is retrieved from the lump through a needle for diagnostic analysis. If the lump happens to be a cyst, this test becomes a treatment in itself, as it drains the fluid from the cyst.

For cases in which there is nipple discharge, the additional tests that may be carried out include:

•A nipple smear for cytology to allow for a study of the cells within the nipple fluid.

•A ductoscopy to inspect the discharging duct with a fine scope to detect growths in the ductal lining.

•For pain in the breast, the tests are generally imaging ones like ultrasound scans and mammography. The aim is to rule out the presence of cancer, which means these are seldom useful in finding out the root cause of the pain.

Joyce Teo

•This is the last of a two-part series on breast cancer. Last week's article was on breast cancer myths.

A version of this article appeared in the print edition of The Straits Times on October 25, 2016, with the headline 'Go for screening as breast cancer symptoms are few'. Print Edition | Subscribe