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Doc Talk

Seek help early rather than live in fear

Susanna, 33, kept a painful secret for about six years. It started with a painful lump near her left nipple.

For years she would squeeze the nipple when it became tender, to relieve the pressure and pain. A small amount of yellowish discharge would ooze out.

Doctors would give her different courses of antibiotics which eased the pain, months at a time. As a result, it was easy to ignore the problem for a time. But the lump would recur, and the stress and pain would begin again.

Exactly a year ago, the intervals between her symptoms became shorter. One day, the pain escalated and became excruciating. An angry red lump appeared at the areola, the area around the nipple.

Doctors diagnosed it as an abscess and advised her to have surgery to drain the pus. She underwent surgery and was well immediately after. It was a huge relief. Her nipple was gradually getting pulled inwards over the years, she explained.

During those years, she didn't dare see a breast cancer doctor as she was terrified it was cancer. She simply hoped that her problem would one day go away.

What she wasn't quite prepared for were the repeat operations that followed. Within the last year, she went through four drainage procedures with no promise of having her problem completely eradicated.

In between the procedures, she suffered from a persistent discharge from the wound that would predictably build up to an abscess and lead on to the next surgery.

She began to doubt the doctors' diagnosis, fearing that a cancer might indeed be festering in her non-healing wound.

Susanna has Zuska's disease.

It is a little-known and often undiagnosed non-cancerous condition. It arises due to obstructed breast ducts near the nipple from overproduction of ductal cells and its debris.

The nipple has many ducts and these are lined by cells. When the cells go into overproduction, they block up the ducts.

The blockage gradually leads to a local inflammation, somewhat like an infected pimple.

Skin bacteria from the nipple surface creep inwards and an infection ensues. Sometimes, a persistent tract between the inflamed area and the skin forms, leading to chronic pus discharge and resulting in an additional site where more skin bacteria may enter. Repeated infection and healing from treatments with antibiotics and surgery result in physical scarring and nipple retraction. It contributes to a vicious circle of more debris and bacteria being trapped.

Drainage procedures relieve symptoms of a painful abscess but do not address the underlying problem.

Zuska's disease can be cured.

The obstructed ducts, any pre-formed tracts, as well as the inflamed tissue behind the nipple, need to be surgically removed. It is a simple procedure. It cures the problem and restores the normal appearance of the nipple without the need for a mastectomy or removal of the nipple. The tissue is then sent for analysis to confirm that there are no cancerous cells.

Susanna underwent the removal of her obstructed ducts beneath the left nipple earlier this year.

Her problem is now finally behind her. She also knows that she does not have breast cancer.

However, Zuska's disease often has symptoms which feed into every woman's fear of breast cancer.

This fear of being diagnosed with the dreaded disease frequently cripples her resolve to seek help early.

It is particularly deplorable when the problems ultimately reveal themselves to be non-cancerous.

Women are encouraged to conduct regular breast self-examinations and to go for mammograms.

Breast cancer is not only treatable; it is eminently curable - but early detection is the key.

Do not be dismissive of any persistent, particularly progressive symptom. Seek help early.

It may not be cancer, despite your worst fears.

•Dr Esther Chuwa is a consultant breast surgeon at Gleneagles Hospital. She sub-specialises in oncoplastic breast surgery.

A version of this article appeared in the print edition of The Straits Times on November 10, 2015, with the headline 'Seek help early rather than live in fear'. Print Edition | Subscribe