Breast Lump, Is this Cancer?

Breast cancer is the second leading cause of cancer deaths especially among women around the world. The development of breast cancer is a multi-step process involving multiple cell types, and its prevention remains challenging in the world. In general, breast cancer results from abnormal and uncontrolled division of the cells in the lobules (milk producing glands) or the ducts (11).

 

Breast cancer is the most common cancer affecting women in Malaysia. One in 19 women in Malaysia are at risk compared to one in eight in Europe and the United States. According to Malaysia Breast Cancer Foundation, female breast cancer cases reported 65% of women were between age of 40 to 60 years old whereas a total number of incidents with 59.7 Chinese women, 55.8 Indian women and 33.9 Malay women per 100,000 respectively. Unfortunately, 40% of the reported new cases were already in the very advanced stages of the disease (4).

However, of all breast disorders, palpable breast lump is the second most common presentation and important cause of anxiety and fear of cancer (8). Breast lump often found during breast self-exam or breast exam by medical professional. Lumps found one of these ways are called palpable masses or palpable lesions where something that you can touch or feel (11).   

 

How to know if a breast lump is normal or abnormal? 

 

By comparison to breast cancer (carcinomas), benign breast lump often smooth, well demarcated dominant masses that are mobile whilst breast cancer is more likely to be malignant include firmness with poorly defined margins, irregular edges, immobility, or fixation to the surrounding tissues (3,10).

 

“The most common causes of breast lump or palpable masses can be cysts, fibroadenomas, and carcinomas. Breast cysts is a fluid filled sacs or a water- filled balloon inside the breasts. Cysts are normally round or oval which has distinct edges, smooth, firm, and mobile (9). Meanwhile, fibroadenomas commonly found in women in their 20’s and 30’s, but they can be found in women at any age. They tend to shrink after a woman goes through menopause (2). Both cysts and fibroadenomas are generally benign or harmless but it is important for women to have regular breast exams or imaging test before any symptoms appear. Of all breast disorders, carcinomas are a type of malignant breast lump where a tumor or mass start in the epithelial cells that line organtissues such as adenocarcinoma (3).” 

  

In short, breast self-exam, or regularly examining your breasts on your own, can be an important way to find a breast cancer early, when it is more likely to be treated successfully.

 

If a breast lump or palpable mass is found, doctor will do a mammogram or ultrasound (or both) to evaluate the mass. A biopsy may then be done to figure out if the mass is cancer. However, if a mammogram or ultrasound shows a palpable mass is benign, regular medical exams and mammograms is reasonable and safe alternative to immediately biopsy the mass (6).

Sign and Symptoms of Breast Cancer (1)

The most common symptom breast cancer is a new lump or mass that is painless, hard and has irregular edges. However, it can also be tender, soft, or round and can even be painful.

Women need to be aware of changes in your breast and to know signs and symptoms of breast cancer. This is because sometimes mammograms or regular breasts check do not find every breast cancer.

Other possible symptoms of breast cancer may include:

  • Skin dimpling
  • Breast or nipple pain
  • Nipple retraction or inverted
  • Red or pitted skin over your breast
  • Change of the appearance of the skin on your breast.
  • Nipple discharge (other than breast milk)
  • Swollen lymph nodes (sometimes breast cancer can spread to lymph nodes under the arm or around the collar bone and cause a lump

Although some of the symptoms may be caused by things other than breast cancer, if you have them, they should be reported to health care professional and have screening tests.

 

 

Source: Breast Cancer Foundation

 

Risk Factors of Breast Cancer (5,11)

No one knows for certain what causes breast cancer. However, a number of risk factors are known to increase the chance of developing breast cancer. Some of the risk factors are beyond control, while some are linked to cancer-causing factors in the environment or due to lifestyle and personal choices such as pregnancy, smoking and drinking.

  • Gender

Woman is the most significant risk factor for developing breast cancer. This is due to women’s breast cells are constantly changing and growing as a results of the activity of the female hormones estrogen and progesterone.

  • Age

As we age, you could be at higher risk of getting breast cancer. From age 30 to 39, the risk is 1 in 228, or .44%. That jumps to 1 in 29, or just under 3.5%, by the time you are in your 60s.

  • Family history of breast cancer

If you have a first-degree relative (mother, daughter, sister) or multiple relatives affected by breast or ovarian cancer (especially before they turned age 50), you could be at higher risk of getting breast cancer.

  • Not having children (parity) or late pregnancies

Women who have no children (nulliparity) or who had their first child after age 35 have a higher breast cancer risk.

  • Breastfeeding

Multiple pregnancy or become pregnant at an early age reduces breast cancer as breastfeeding will reduce their estrogen level and hence reduce the possibility of breast cancer risk.

Pregnancy changes the lobules inside the breast and that the lobules of women who have carried a pregnancy to term differ from those of a woman has not been pregnant. Thus, it may be that breast-feeding reduces breast cancer risk by changing the mammary gland in specific ways.

  • Oral contraceptive use

Women using oral contraceptive have a slightly greater risk of breast cancer than women who have never used them.

  • Hormone replacement therapy 

Long-term use of hormone replacement therapy (HRT) after menopause, particularly oestrogen and progesterone combined, may slightly increase your risk of breast cancer. 

  • Alcohol

Use of alcohol slightly increased risk of developing breast cancer.

  • Obesity and high-fat diets

Obesity has been found to be a breast cancer risk factor especially for women after menopause. Having more fat tissue can increase your estrogen levels and increase your likelihood of developing breast cancer as fat tissues will produce estrogens as well.

Studies of fat in the diet have not clearly shown that this is a breast cancer risk factor. However, most studies found that breast cancer is less common in countries where the typical diet is low in total fat, low in polyunsaturated fat, and low in saturated fat.

 

REFERENCES

  1. American Cancer Society. 2019. Breast Cancer Signs and Symptoms [online]. Available from https://www.cancer.org/cancer/breast-cancer/about/breast-cancer-signs-and-symptoms.html [Accessed on 13 April 2020].
  2. American Cancer Society. 2019. Fibroadenomas of the Breast. Available from https://www.cancer.org/cancer/breast-cancer/non-cancerous-breast-conditions/fibroadenomas-of-the-breast.html [Accessed on 13 April 2020].
  3. American Cancer Society. 2019. Type of Breast Cancer [online]. Available from https://www.cancer.org/cancer/breast-cancer/understanding-a-breast-cancer-diagnosis/types-of-breast-cancer.html [Accessed on 13 April 2020].
  4. Breast Cancer Foundation. (n.d). About Breast Cancer [online]. Available from https://www.breastcancerfoundation.org.my/about-breast-cancer [Accessed on 13 April 2020].
  5. Breast Cancer Organization. 2016. Breast Cancer Risk Factors [online]. Available from https://www.breastcancer.org/symptoms/understand_bc/risk/factors [Accessed on 13 April 2020].
  6. Breast Cancer Organization. 2019. Keep an Eye on Benign Breast Lumps is Safe Alternative to Immediate Biopsy [online]. Available from https://www.breastcancer.org/research-news/20091120 [Accessed on 13 April 2020].
  7. Jaime, H. and Kimberly, H. 2019. A Comprehensive Guide to Breast Cancer: Breast cancer overview [online]. Available from https://www.healthline.com/health/breast-cancer#types [Accessed on 13 April 2020].
  8. Kumar, A., Vohra, L., S., Bhargava, S. and Reddy, P., S. 2017. INVESTIGATION OF BREAST LUMP: AN EVALUATION. Medical Journal Armed Forces India 55(4): 299-302.
  9. Mayo Clinic. 2018. Breast cysts [online]. Available from https://www.mayoclinic.org/diseases-conditions/breast-cysts/symptoms-causes/syc-20370284 [Accessed on 13 April 2020].
  10. Sandhya, P. 2001. Detection and Evaluation of a Palpable Breast Mass. Mayo Clinic Proceedings 76 (6): 641-648.
  11. Sun, Y., S., Zhao, Z., Zhang, N., Y., Fang, X., Hang, J., L., Zhi, Y., Z, Wen, S., Jiang, J., M., Yao, P., P. and Han, P., Z. 2017. Risk Factors and Preventions of Breast Cancer. International Journal of Biological Sciences. 13 (11): 1387-1397.