Published in City Times
What you should know about breast masses
Breast lumps or masses are very common and account for over half the referrals seen at breast clinics. They can occur in women of any age and most often they are benign in nature. Apart from muscles, lymphatic and blood vessels which are present in the entire body and also in the breast, the breast, a pyramid-like structure, mainly comprise the mammary lobules which produce milk, fibrous and adipose tissues. The breasts can have disease in all of these structures which may manifest as masses or lumps, reveals Dr.Amer A.Reda Abdul Hade, Specialist General Surgeon, Zulekha Hospital, Sharjah. But not all these masses should be thought of as being tumours or cancerous, for most of the times they are benign assures Dr.Amer.
Are there different types of masses and who are the women who get them?
The commonest types of lumps are cysts, fibrocystic lumps, fibroadenomas, abscesses, periductal mastitis, calcifications and cancers. Cysts may be single or multiple, benign or malignant. Benign cysts are round or oval, well-circumscribed and usually greater than 1.4 cm in size. Between 20% - 50% of women in the reproductive age group may have breast cysts sometime in their life and most of these are small. The peak incidence of cysts is in premenopausal women between 40-50 years of age and less than 5% of women above 60 years, may have the cysts. Benign fibroadenomas are most common in the 15 - 30 age group. While only a low percent of people end up with malignancy, it is the post-menopausal women who are more vulnerable to malignancy.
Is breast pain an indication of the existence of some type of mass?
Breast pain is extremely common and most women, at some stage or other will experience breast pain and/or heaviness of the breast as a symptom. But the pain can be due to a number of problems, most common being related to the monthly cycle, a few days prior to menstruation, about by the female hormones. Fibroadenomas and cysts can also be painful. As a general rule, benign masses are more likely to be associated with pain than cancers, but unless otherwise proven, no painful lump should be presumed to be benign and therefore neglected. For, on rare occasions, breast cancer lumps too may present with pain, particularly so in the advanced cases.
What are the risk factors for malignancy?
Extreme of age, family history of breast cancer, ovarian or cancer, infertility, being unmarried and smoking are the major risk factors for malignancy.
What type of mass should be cause for concern?
Big masses, hard masses, masses that give a different skin texture like an orange peel, masses that are fixed to the chest wall, masses which increase rapidly in size, masses which create lymph nodes and oedema of the skin and masses which create nipple retraction are cause for concern.
How is a benign mass different from a cancerous one?
Cancerous masses are usually not tender or painful at all. Benign masses are tender to feel upon palpation.
Usually, cancerous masses are less mobile. If the tissue around the mass is very dense, the mass will not be able to move as freely as when it is surrounded by fatty tissue.
Cancerous masses will be have an irregular shape and will not have smooth edges, unlike benign masses which normally have a smooth edge and are round or oval in shape.
Benign masses may be soft or hard, but cancerous masses are hard.
If there is change in skin texture, making it look like an orange peel, it is most likely hat there is an underlying cancerous mass.
If there is any puckering or dimpling of the skin around, or at the site of a mass, the mass may be cancerous.
If an inverted nipple is a sudden feature of a woman's breast or if only one nipple is involved, it may point to an underlying cancerous mass.
In the case of cysts, one containing clear fluid may not be cause for concern. However, if the cyst is filled with bloody fluid, it is most likely to be a suspicious one.
There can be inflammation of the breast with redness, heat, swelling and thickening of the tissues including the skin. Most of the conditions like breast abscess and periductal mastitis, which manifest these symptoms are benign. Nevertheless the condition must be checked out since occasionally, breast cancer can present as an inflammatory mass.
What are the diagnostic measures undertaken to identify mass, its type and
whether it is benign or malignant?
Physical examination, sonomammography and mammography are the usual investigative measures, depending on whether we suspect malignancy or not. History taking and clinical examination including palpation of the breast to check for consistency under the hand, are the first steps in diagnosis. Where there is a family history of ovarian tumour, or, other malignancies, we may suspect malignancy in the breast mass since there is a correlation between ovarian tumor and breast malignancy.
In the case of malignancy, biopsy is a must. We need to know the origin of the mass - whether it's from the mammary gland or from the duct or from the other structures of the breast, from the adipose tissue, or from the nipple. There could be a deviation from the normal when we cannot find the origin of the cell which became malignant.
What exactly does it mean when a mammogram report states that there is increased density in the breasts?
Increased density usually refers to the presence of more glandular tissue than fat. It is not associated with malignancy but indicates a degree of fibrocystic change. But the denseness makes mammogram reading, difficult.
How are breast cysts treated?
Mammograms may not detect cysts and hence an ultrasound is required. A benign
cyst is normally aspirated with a fine needle. That is, the fluid in it is drawn out with a needle to be studied in the lab as cytological specimen. We then wait and follow for 2-3 months. If the cyst recollect or recur another cytological exam is required through a fine needle aspirate and to be followed possibly by excision for histopathogical study
Can benign masses turn malignant at any point in time?
Some benign masses may behave like malignant, but usually benign is benign and malignant is malignant from the beginning. Malignant from the beginning is a result of a deviation of the cellular behavior from normality.