I should mention here that among health workers, the word ‘tumour’ is used to describe any abnormal lump anywhere in the body. Tumours may be benign (non-cancerous) or malignant. If you hear your lump described as a tumour, don’t be frightened and assume that you have cancer.
Cysts are the most common cause of breast lumps for women between the ages of 35 and 55, but rarely occur in younger women. They result from fluid being trapped by a blocked duct. A cyst may develop suddenly or slowly and may reach up to several centimeters in diameter. It will feel smooth and round, soft or tense, and is often tender. Cysts usually can be moved around easily within the breast tissue. Some cysts disappear slowly as the fluid in them is absorbed, but usually they need to be emptied by needle aspiration (drawing out the fluid with a fine needle), which makes them disappear immediately. If the cyst refills or if the fluid withdrawn is bloodstained or if a lump can still be felt after the cyst is emptied, further investigation is needed.
The most common solid breast lump in young women is an overgrowth of fibrous and gland tissue (fibroadenoma). These lumps feel smooth and firm, and move around so easily within breast tissue that when you try to feel them they seem to dart away from your fingers. For this reason they’re often called ‘breast mice’. Fibroadenomas are benign and removal is unnecessary unless you’re worried by the presence of the lump, but examination of a fragment of the lump under the microscope is necessary if you decide not to have it removed.
Other lumps and thickenings, such as those caused by hormonal changes or by scar tissue, are more difficult to identify as benign. These days just about all breast lumps are investigated further to rule out the possibility of cancer. Following are the tests commonly used.
Diagnostic mammography
This is a special X-ray technique for examining abnormalities felt in the breasts, and is usually the first test offered to women aged over 25 years. Most women who think they have a lump can be reassured that they don’t have cancer after negative results from a specialist examination, a mammogram, and often an ultrasound.
Previously it was feared that the dose of radiation from mammography might itself increase the risk of cancer. However, the special equipment and techniques used now give such a small dose of radiation that it is no longer considered any risk.
Ultrasound
This test is generally the first performed for women aged under 25 years. It is also used for any woman who has a lump that can be felt but doesn’t show up on mammography, or to look at a change seen in the mammogram but not felt. It involves passing sound waves into the breast. These waves are reflected back differently by tissues of different density, for example cysts and solid lumps. The reflections are analyzed by a computer screen to give a ‘picture’ of the breast tissue. Ultrasound should be used when there is any doubt about a change found by feeling the breast or by mammogram.
Biopsy
This involves removal of some of the suspicious breast tissue so that it can be examined under the microscope. It is done when there is any uncertainty after mammography or ultrasound. Biopsy may be done in two ways.
Fine-needle aspiration A fine needle is inserted into the tissue and a fragment drawn out. The same procedure is used to empty the fluid from cysts. This can be done in your doctor’s rooms. Surgical biopsy Some tissue is removed through a small incision. This may be done in hospital or a day centre under general anaesthetic. The sample removed by either type of biopsy must be examined by an expert in microscopic examination of breast tissue.
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