Q I recently went for a mammogram. Two tiny lumps were detected, but the report stated that the lumps were "not suspicious".
I was referred to a specialist who examined me and told me I had nothing to worry about.
I also mentioned to him I feel pain in my breast quite regularly. He said it was just muscle pulls.
I am 54 and go for a mammogram every two years. Since I have these two tiny lumps in my breast, do I have to go for a check-up more regularly, say, once every four months?
My worry is that these tiny lumps may grow quickly in no time. I have no family history of breast cancer.
Given that you are 54 and have no palpable breast lumps, it is apt that you went for a screening mammogram.
In Singapore, a screening mammogram is recommended yearly for all healthy women above 40, and once in two years for those above 50.
If any new abnormality is detected, further tests will be done to characterise the abnormality.
Such patients will also be referred to a breast surgeon.
A "nodule" describes a small round abnormality that can be seen on a mammogram.
Most nodules are benign, including cysts, fibroadenomas and small lymph nodes normally seen within the breast. Fibroadenomas are benign solid tumours, while cysts are benign fluid-filled structures.
Occasionally, a "nodule" can turn out to be just breast tissue superimposed on it.
When doctors see a nodule, they typically do other mammogram films called "spot" films that compress a particular area.
Sometimes, the nodule disappears upon doing these films, proving that the density was caused by superimposed breast tissue.
Doctors may also perform ultrasound scans to look at the area in question.
Rarely are these nodules found to be malignant.In your case, two small nodules were detected. If they are new, you need an ultrasound scan or an additional view of the mammogram, apart from a clinical examination.
Four scenarios can happen:
•If all the tests did not reveal any suspicious issues or are indeterminate, it is sufficient to continue going for your usual screening mammogram once every two years.
•If any suspicious or indeterminate lesions are seen on the ultrasound scan or additional mammograms, you would need to go for a biopsy to rule out early breast cancer.
If the biopsy is benign and the lesion is not a high-risk one, then you can continue with your screening mammogram once in two years. If the biopsy shows cancer or other suspicious lesions, you need further treatment by a breast surgeon.
•If the ultrasound scan shows a new nodule that is small and looks benign, you need to go for another ultrasound scan six months later, then annually for two years, to assess the stability of the lumps. This is on top of the regular screening mammograms.
•If the nodules were present in previous mammograms, you just need to assess if they had remained stable, by comparing your current and previous films.
Even though your mammograms did not show any worrying lesions, you should continue to do a breast self-examination every month to look for any new lumps or any nipple discharge. If you detect these signs, see a doctor.
Meanwhile, breast pain is not a symptom of early cancer.
Such pain can arise from musculoskeletal to hormonal effects in the breast tissue.
Common musculoskeletal causes include costochondritis, an inflammation of the junction of the ribs and the breast bone, and myalgia (muscle ache). These conditions can be treated with simple painkillers and by getting enough rest.
Hormones can cause cyclical pain in your breasts, too, according to your menstrual cycle.
That means you experience more pain two weeks after your menstruation, and the pain will subside once your menses start again.
Dr Preetha Madhukumar
Senior consultant in the SingHealth Duke-NUS Breast Centre and department of general surgery at Singapore General Hospital