Is this a Breast Lump? Can it be Cancer?

Breast lumps are innocuous things that have a hidden potential to land one in a whole lot of trouble. Breast cancer as such is a condition that can be detected and diagnosed early if we are aware of it. I firmly believe anyone who need not go through it should not. All we need is a high degree of alertness and awareness to follow up on suspicions.

How do we know there is a problem?
The commonest way an early cancer can present is in the form of an innocent lump in the breast. This is easy enough to detect by oneself by regular self-examination. Do not examine daily, then you cannot make out any new change. It would be mre sensible to examine once a month instead. Self examination is ideally performed 3 to 5 days after your period as the breast is least painful or lumpy then.
One of the better ways to examine is: Lie down on the bed. To examine the right breast, tuck your right arm under your head and with the flat of the fingers of your left hand, press down in small circular motions on the right breast and check for any lumps. In a standing or sitting position, check the armpit for lumps (some breast tissue extends into the armpit). To examine the left breast, lie down, tuck in the left arm under your head and examine the left breast with the flat of the fingers of your right hand. Again, do not forget to feel the armpit as well. Stand in front of a mirror and examine both breasts with your arms by your side and also with your arms held up straight. Look for changes in shape, contour, texture of skin- any dimpling or indentations that resemble an orange peel and changes in the nipple.
Self examination is very useful indicator, but it cannot substitute being examined by a doctor or a routine mammogram. So you must not depend on this alone.

Who is at risk?
It is rare to find cancer of the breast in women below 20 years. Those above 20 years must routinely self-examine. Women in whose family other women have had breast cancer are at a greater risk. They must have routine examinations by a doctor and routine mammograms.
As far as diet is concerned, high intake of alcohol is linked to an increased incidence of breast cancer. Body weight? Women who are obese have a greater incidence.
Here is something interesting: Breast cancer is more common in women who have not had children. Breast feeding and child-birth at an earlier age have a protective effect. Hormone Replacement Therapy's role in breast cancer is controversial. Usually those on HRT get more benefit from it which will outweigh any risk.
Men are not exempted: Less than 0.5% of those with breast cancer are men.

If you do have a breast lump, who do you go to?
Breast lumps are dealt by surgeons, not gynecologists. So go to a surgeon.
If you are below 40, an ultrasonogram will be of more use than a mammogram. Above 40 years, a mammogram will give better results.
If the lump is confirmed, get a biopsy done. Do not delay. Every day you save will make a difference.

Biopsy:
This is the clincher. There are two types of biopsy:
1. Fine Needle Aspiration Cytology (FNAC)- In this, the surgeon will put in a needle in different parts of the lump and withdraw some aspirate. Cells from this aspirate will be tested for cancerous or as we call it, 'malignant' changes. THIS CAN ONLY BE DEPENDED ON FOR A POSITIVE RESULT. A negative FNAC does not rule out cancer. Its simple logic. If cancer cells are present in an area the needle missed, obviously the result will be negative! But if there is cancer and the cells are picked up by the needle, then we know there is a problem and can plan further.

2. Excision biopsy: Small lumps can ususally be taken out as a day procedure under local anesthesia. Taken with adequate clearance (which is, a margin of normal tissue around the lump) in case this shows cancer cells, further surgery may not even be needed.

All patients who are discovered to have cancer cells must undergo the full list of investigations to check if the cells have spread anywhere else in the body (this sneaky disease starts to spread early at the microscopic level). Further treatment such as chemotherapy and radio therapy are planned depending on the results of such investigations.

I suppose this is about all I need to write here. Do remember, like the old addage says, 'Prevention is better than cure'. Early catch can also be as good as cure. So don't delay on the biopsy if you have a lump. Don't hesitate to get a second opinion.

Two conditions that cause a lot of confusion with breast cancer are 'fibroadenoma' of the breast which is single or multiple small lumps that are mobile and smooth and 'fibroadenosis' in which the whole breast is painful and lumpy. Fibroadenoma can be biopsied to rule out cancer. Fibroadenosis can be ruled out by a doctor's examination though an ultrasonogram or a mammogram may sometimes be necessary.