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Ask The Experts: When to worry about breast lumps

Though non-cancerous breast lumps are common in women, it is important to know the warning signs of cancer and when you should see a doctor, says Senior Consultant and Breast Surgeon, Dr Tang Siau-Wei

Felt a lump in your breast? Don’t panic – take heed of these warning signs for early detection and treatment of breast cancer. PHOTO: SOLIS BREAST CARE AND SURGERY CENTRE

Breast cancer is typically first detected through symptoms that include lumps in the breast. Feeling a lump in your breast may not be cause for panic, though, as it is a common occurrence.

“While there are no studies that evaluate the incidence of breast lumps in women in Singapore, some global studies suggest that 30 to 50 per cent of women may have breast lumps.

Fortunately, 80 to 90 per cent of these are benign,” says Dr Tang Siau-Wei, a Senior Consultant and Breast Surgeon at Solis Breast Care and Surgery Centre who has treated patients at different stages of breast cancer for 15 years. 

Breast lumps are either malignant (cancerous) or benign (non-cancerous) – the latter of which are largely harmless and do not require treatment. Benign lumps tend to be smooth and regular in shape and their location in the breast may vary over time. 

Malignant lumps, on the other hand, tend to be hard, irregular, painless and gradually enlarge over time. The skin over the lump may become red or develop the texture of orange peel. 

A common misconception is that painless breast lumps are harmless. Conversely, Dr Tang adds that it is very rare for breast pain to signify an underlying cancer. “Breast pain is more likely caused by hormonal changes or muscle aches on the ribs and chest wall,” she says.

As the symptoms of breast cancer aren’t always clear-cut, Dr Tang Siau-Wei recommends diligent self-checks. These include yearly breast screenings and keeping track of your family history of cancer. PHOTO: SOLIS BREAST CARE AND SURGERY CENTRE

Common types of benign breast lumps 

Fibroadenomas: These lumps of fibrous tissue usually feel firm, rubbery and smooth. They are most common in younger women between the ages of 18 to their 30s and are thought to be related to reproductive hormones.

Breast cysts / fibrocystic change: Fluid-filled sacs within the breast are extremely common, with more than one developing at the same time when an overgrowth of glands and connective tissue (fibrocystic changes) blocks milk ducts, causing them to dilate and fill with fluid. Cysts may feel soft or firm and cause some discomfort. They may also fluctuate in size with the menstrual cycle, and can develop at any age, though they are most common in women from their 30s to 50s. Such cysts may occur in pregnant or breastfeeding women. In their case, the breast cyst is filled with milk and the blockage occurs in the breast ducts during or just after they have stopped lactating. 

Though most benign lumps do not require treatment, Dr Tang says that they should be removed if they are growing or are quite large and cause discomfort and pain. 

However, she notes that benign simple cysts, detected through self-examinations or routine breast ultrasounds, do not increase your risk of breast cancer. “The chances of a benign lump turning cancerous is quite rare. However, it is important to evaluate the lump thoroughly to determine if it is benign,” she cautions. 

This is because symptoms aren’t always clear-cut. Dr Tang cites the example of a patient of hers who had recently delivered her second baby and noticed swelling and hardening in one area of her breast for four months. Thinking that it was caused by blocked ducts as she was weaning her infant from breastfeeding, she saw a breast masseuse to clear the blockage. 

However, the patient’s symptoms progressively worsened, despite being administered antibiotics by a GP to treat what was thought to be a breast infection. 

“Her GP subsequently referred her to me, and she was diagnosed with breast cancer,” shares Dr Tang. “Fortunately, the cancer had not spread to any other organs, and she was treated and remains well now.” 

If you notice physical changes to your breasts such as swelling, dimpling or nipple discharge, consult your doctor right away for a scan. PHOTO: SOLIS BREAST CARE AND SURGERY CENTRE

Warning signs to look out for 

You should see your doctor upon detection of physical changes including breast lumps; a swollen underarm; distortion and bulging of the breast; or dimpling, discolouration, redness and thickening of the skin over the breast. Other potential symptoms of cancer to look out for include an inversion of the nipple, a persistent rash or peeling skin over the nipple, or spontaneous nipple discharge – especially if it is bloody. 

Your doctor will typically review your medical history and perform a thorough physical examination, followed by scans via a mammogram, ultrasound or MRI.

“If there is a lump, it is likely that you would require a biopsy, whereby a needle is used to obtain a small portion of tissue from the lump to be sent to the lab for further analysis to determine if it is malignant,” shares Dr Tang.

If your breast lump is found to be cancerous, your doctor will discuss your treatment options, which often involve a multi-disciplinary team comprising a surgeon, radiologist, pathologist, medical oncologist and radiation oncologist.

 “Surgery – options include a lumpectomy (removal of just the cancerous lump) or mastectomy (removal of the entire breast) – is usually performed first, followed by other forms of treatment such as chemotherapy, radiotherapy, hormonal therapy as well as targeted therapy (if necessary),” says Dr Tang.

Visit Solis at solis.sg to find out more or book an appointment at 6994-5490 to see our breast specialist today.

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