Breast Lumps: Types, Diagnosis, and Treatment

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Breast lumps are growths in the breast tissue. Although they are often benign (noncancerous), it is important to know the warning signs of cancer. As breast cancer is the most common cancer among Singaporean women, all women from age 18 to 80 are encouraged to do monthly breast self-examinations to identify signs of abnormalities in their breasts.

Differentiating Benign and Cancerous Lumps

How a breast mass feels may give a hint as to whether a lump is a cancer tumour (malignant or cancerous lump) or a benign mass (non-cancerous lump). However, a specialist will do additional tests to verify this.

Cancerous breast masses are usually hard and have an irregular shape and size. They may be attached to the skin or nearby tissue. You may not be able to move them around. They are also unlikely to be painful. Pain is another very common symptom, and may be due to hormonal changes, muscle spasms, poorly-fitting bras or infections. Pain and cancer may co-exist at the same time, but they are usually not directly related. Other changes may be present, including:

  • Skin dimpling (skin looks like the pitting and uneven skin of an orange)
  • Nipple retraction (pulling in of the nipple)
  • Swollen lymph nodes in the armpit (not the hairy area, but behind the muscle)

Inflammatory breast cancer is an extremely rare type of breast cancer that does not usually cause a lump. Instead, you may see swelling, redness, and sometimes a skin rash around the breast area.

In contrast, benign lumps are usually squishy, feeling like a soft rubber ball with well-defined edges. They are often easy to move around.

Mammograms and ultrasounds will give the doctor additional information about the lump, before they recommend any further tests, such as a biopsy.

When to Consult a Breast Cancer Doctor

Regular self-breast examinations could greatly help you to stay alert to new changes in your breasts, and prompt you to seek medical care. Knowing how your breasts feels like normally, will make it easier for you to detect when there is a change. Here are the symptoms that require immediate professional help:

  • A new breast lump or thickening that feels different from the surrounding tissue or the other breast
  • A change in size, shape, or appearance from previously
  • Skin changes on your breast like redness, itchiness, scaling, or dimpling
  • A newly inverted nipple
  • Nipple discharge

What to Expect During a Clinical Breast Examination

Clinical breast examination is usually the first step in evaluating a breast lump. During this examination, the doctor will likely:

  • Ask about prevailing symptoms and risk factors
  • Examine your breast and lymph nodes in your armpit, feeling for lumps or any other irregularity
  • Inspect the skin texture of your breasts
  • Check for nipple problems like discharge or inversion

Diagnosing Breast Lumps

After the doctor obtains your medical history and performs a physical examination, you may be requested to undergo any of the following tests. This is to confirm whether the breast lump is benign or cancerous.

A mammogram is considered the most reliable screening tool for breast cancer. It can detect the presence of cancerous (malignant) changes before they can be felt by hand. This technology uses X-ray images to detect cancer. These early cancerous changes causes abnormal calcium deposits which show up on the mammogram.

Breast ultrasound may be performed as an additional check, with mammograms and uses sound waves to evaluate lumps. This is performed if the woman has dense breasts, feels a lump or experiences nipple discharge, or an abnormality is detected in the screening mammograms.

A biopsy is a procedure to remove several samples of the breast lump to determine if it is benign or cancerous.

Treating Breast Lumps: Lumpectomy & Mastectomy

For benign lumps, the surgery done is called an excision biopsy, where the lump is removed through a cut, and sent for testing. This is a minor day surgery.

A lumpectomy is a surgery meant to treat small breast cancers. It is a breast-conserving surgical procedure that includes a small margin of healthy tissue around the cancer to ensure all of the abnormal cells (or cancer cells) have been removed. This is the preferred treatment option when the tumour is small compared to the size of your breast and when only one area has cancer.

Mastectomy, on the other hand, is the procedure of removing all breast tissue. This may be done if the area of cancer is too large (for cancerous lumps) or if there are multiple tumours that cannot be removed.

There are more techniques available, so do speak to an experienced doctor to confirm which options are suitable for you.

Conclusion

Early detection of breast cancer gives better chances of quality of life, treatment, and recovery. Having annual mammograms and other imaging tests like ultrasound, in addition to frequent self-breast examinations, could be greatly beneficial as these tests can help detect any irregularity early, even before you develop any symptoms.

References

  • https://www.breastfriendsurgery.com.sg/breast-cancer/
  • https://www.mountelizabeth.com.sg/healthplus/article/finding-breast-lumps
  • https://www.parkwayeast.com.sg/healthplus/article/breast-lumps
  • https://www.verywellhealth.com/breast-cancer-tumors-or-benign-masses-430277#:~:text=There%20are%20often%20differences%20in,may%20look%20different%20around%20them.
  • https://www.parkwayeast.com.sg/healthplus/article/lumpectomy
  • https://www.gleneagles.com.sg/healthplus/article/breast-lump-cancer
  • https://www.singhealth.com.sg/patient-care/conditions-treatments/fibrocystic-change
  • https://www.singhealth.com.sg/patient-care/conditions- breast specialist doctor singapores/breast-ultrasound
  • https://www.mountsinai.org/health-library/surgery/breast-lump-removal#:~:text=This%20surgery%20is%20called%20an,breast%20biopsy%2C%20or%20a%20lumpectomy.

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Breast & General Surgeon
Dr Tan Yia Swam has more than 15 years of experience in patient care. She is a specialist in General Surgery, with an interest in Breast Surgery. Her experience encompasses a wide range of breast conditions such as lumps, pain, nipple discharge, cancers, abnormal imaging, and believes in personalized treatment recommendations that respect patients’ needs and concerns.
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