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Breast Lump

Breast lumps are very common in women. It is estimated that every year in developed countries, about 2-3% of all women will visit a doctor regarding a problem with their breasts, with breast lumps being by far the most common presentation. Although in the great majority of cases (90%), breast lumps prove to be benign (non malignant, not cancerous), they may cause a lot of concern for any woman discovering a new breast lump.

Schematic diagram showing a breast lump

There are different types of breast lumps, and these include:

1)    Malignant (Cancerous)
       a.    Breast cancer

2)    Non-malignant (Benign, not cancerous)
        a.    Breast cyst
        b.    Fibroadenoma
        c.    Breast abscess
        d.    Fibroadenosis

All women need to examine their breasts regularly, at least once a month, and ideally at about the same time during their menstrual (period) cycle. In this way, women get to know how their breasts feel, as well as what is normal for them, so any new changes to the breast (such as a new breast lump) will become apparent as soon as possible. Every new breast lump needs to be fully and appropriately investigated by a doctor who specialises in breast disease. In most developed countries this is done in a dedicated breast clinic, where a woman can see a general surgeon (usually with breast sub-specialisation) who examines her. He or she will need to examine both of her breasts, as well as both of her axilla (armpits). This is the first part of the so-called Triple Assessment, which also consists of radiological imaging and a biopsy.

An inflammed breast (red, hot and painful). This is called mastitis and is usually due to an infection of the breast. Inflammatory breast cancer can also present in a similar way

Triple Assessment

1) Clinical examination
The doctor will be looking and feeling for any breast lumps, as well as for any other skin changes, which may provide clues to the underlying diagnosis (problem). These include changes of the shape of the nipple (such as nipple flattening or nipple inversion), changes of the skin of the breast (such as Peau d’orange, where the skin looks like the skin of an orange; tethering of the breast skin, where the skin becomes wrinkly over a specific area of the breast), or evidence of breast infection or inflammation, where the breast becomes hot, red and inflammed.
A breast with the sign of peau d'orange (orange's skin). This is caused when the breast becomes oedematous, and may be a sign of an underlying malignancy (breast cancer)

In the armits the doctor will be looking for any enlarged, palpable lymph nodes. These may be enlarged in breast cancer, but there are other benign causes of axillary lymphadenopathy (enlarged armpit lymph nodes), such as an infection of the hand or arm, following a small injury and/ or cut.

Examination of the axillary (armpit) lymph nodes
If there is suspicion of breast carcinoma, or of an alternative diagnosis (such as generalised lymphadenopathy), the doctor may wish to also examine your neck and your groin lymph nodes, as well as your chest and abdomen (tummy).

2) Radiological Imaging

For women over the age of 35 years old, this usually consists of a mammogram of both breasts, together with a focal ultrasound scan (USS) of the area of concern. This area is usually marked by the doctor who examines you, so that the ultrasonographer who performs the USS can find and look at the right spot. If the doctor has identified any other areas in either of your breasts that need further investigations, he or she will usually mark these sites too, so that an USS can be performed for all these areas at the same time.


3) Biopsy

If a solid breast lump is found either on clinical examination and/ or on imaging, then a biopsy will usually be performed. This can either be an FNAC (Fine Needle Aspiration and Cytology) or a Core biopsy. Areas with abnormal-looking microcalcifications in the mammogram are also biopsied under mammographic guidance. Core biopsies and FNACs can also be performed under ultrsound guidance. In this way, it is ensured that the biopsies have taken samples from the correct area, and are therefore representative of the abnormal breast area.