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Ask The Experts: What happens when my mammogram shows up abnormal

An unusual screening result does not instantly mean that you have breast cancer, according to Senior Consultant and Breast Surgeon, Dr Lee Wai Peng

Going for annual mammogram screenings is the recommended way to detect breast cancer early and begin treatment if required. PHOTO: SOLIS BREAST CARE AND SURGERY CENTRE

According to the Singapore Cancer Registry Annual Report 2018, over 2,000 women are diagnosed with breast cancer each year, and one in 13 women will get it in their lifetime.

That is why it is the most common type of cancer affecting women in Singapore.

While breast cancer usually occurs in older women between the ages of 40 and 60, it can affect younger women too. One in six women in Singapore under the age of 45 has been diagnosed with more aggressive forms of the disease, according to the Breast Cancer Foundation

Going for a mammogram is the best way to detect breast cancer early, says Dr Lee Wai Peng, Senior Consultant and Breast Surgeon at Solis Breast Care and Surgery Centre. Here, she shares more about the implications of abnormal mammogram screening results.

Dr Lee Wai Peng, Senior Consultant and Breast Surgeon at Solis Breast Care and Surgery Centre, emphasises that an abnormal mammogram screening result does not equate to breast cancer. PHOTO: SOLIS BREAST CARE AND SURGERY CENTRE

When do you need to go for a mammogram?

A mammogram is an X-ray of the breast and is used to look for any abnormal lesion. It is non-invasive and one of the simplest screening tests for breast cancer.

A mammogram can pick up cancers at a very early and treatable phase, way before malignant lumps can be felt. When performed regularly, it improves one’s chances of survival, and women may even avoid having to go for extensive treatment such as chemotherapy.

The Health Promotion Board recommends women aged 40 to 49 to go for mammogram screening yearly after speaking to their doctor about the benefits and limitations. Screening is recommended once every two years for those above 50 and who are asymptomatic.

Healthy women below 40 with no breast-related symptoms should consult their doctors before going for a mammogram. After all, they often have extremely dense breasts, which will render mammograms less effective.

What does an abnormal mammogram result mean?

An abnormal mammogram result means that there is a possibly suspicious lesion seen on the X-ray image of the breast. However, it does not automatically mean that the patient has cancer. 

It depends on whether the underlying cause of the lesion is benign or malignant, although the possibility of cancer cannot be ruled out. 

There are three possible outcomes: 

  • Benign 

This means that the lesion is non-cancerous. They may be fibroadenomas – non-cancerous breast nodules, which are made up of breast tissues, common among women under 30 – breast cysts, which are fluid sacs in the breast, or fibrocystic changes, in which the breast feels lumpy. 

These conditions can occur to any woman from her 20s until she reaches menopause. 

  • High risk

High-risk lesions may include atypical ductal hyperplasia (a pre-cancerous condition of abnormal cells in the milk ducts) or lobular carcinoma in situ (cells that look cancerous in the milk glands), also known as LCIS. 

Such high-risk lesions are often advised for complete removal upon detection. If left alone, they have a high chance of developing into invasive breast cancer. They make up five to 20 per cent of abnormal mammogram findings.

  • Malignant 

If a malignant lesion is detected, it means breast cancer. Your doctor will advise on the appropriate course of treatment. 

Besides a mammogram, there are various advanced imaging methods to detect minute or less obvious lesions in the breast. PHOTO: SOLIS BREAST CARE AND SURGERY CENTRE

What happens after an abnormal mammogram result?

During consultation with a breast specialist, the doctor can evaluate for any breast-related symptoms, such as pain, swelling or lumps, or any predisposing risk factors for breast cancer. 

A clinical examination is usually done to look for signs such as breast lumps or nipple changes that might account for the mammographic abnormality. 

This may be followed by further appropriate imaging such as targeted mammography, 3D mammogram and an ultrasound to determine the cause of the abnormality. 

A breast biopsy may be offered to patients if the results from these imaging methods remain inconclusive for breast cancer.

Some 10 per cent of women with abnormal mammograms will need some form of biopsy. Of this group who undergo a biopsy, a further 80 per cent will have a benign result. A breast biopsy can be performed via minimally invasive methods such as vacuum-assisted biopsy with the aid of ultrasound or mammogram.

Currently, vacuum-assisted biopsy is recommended to remove benign breast lumps because it is minimally invasive and easily tolerated by women of all age groups. 

Used to spot any abnormal lesion, a mammogram is non-invasive and one of the simplest screening methods for the breast. PHOTO: SOLIS BREAST CARE AND SURGERY CENTRE

There might also be a possibility that mammograms might miss extremely minute lesions, especially in women with extremely dense breasts. Advanced imaging technology, such as 3D or digital mammography, can help pick up these less obvious lesions.

If the biopsy result is malignant, the patient will be advised on appropriate treatment.

The doctor may first request the patient to undergo more detailed tests to determine what type of cancer she has and if the cancer has spread beyond the breast.

If the tumour is detected at an early stage and has not spread beyond the breast, the patient can opt for breast-conserving surgery, which removes cancer cells and some neighbouring tissues, without the need for a mastectomy (complete removal of the breast).

It is prudent to seek a specialist consultation to evaluate the abnormality. Most of the time, this does not equate to breast cancer. Even if cancer is detected, it is often at a very early stage.

Visit Solis at solis.sg to find out more or call 6979-9011 to book an appointment with our breast specialist today.

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