Breast Cancer Screening and Fibrocystic Breast

Breast cancer is the top cancer in women both in the developed and the developing world.

Therefore, early detection in order to improve breast cancer outcome and survival remains the cornerstone of breast cancer control. -WHO

What is Breast Cancer?

Breast cancer is a disease in which cells in the breast grow out of control.

There are different types of breast cancer.

Breast cancer can begin in different parts of the breast as breast is made up of three main parts: lobules, ducts, and connective tissue. 

  • The lobules are the glands that produce milk. 
  • The ducts are tubes that carry milk to the nipple.
  • The connective tissue (which consists of fibrous and fatty tissue) surrounds and holds everything together.

Most breast cancers begin in the ducts or lobules.

What are the warning signs of breast cancer?

Different people have different symptoms of breast cancer. There are cases where some woman does not have any signs and symptoms at all. Some warning signs of breast cancer are:

  • New lump in the breast or underarm
  • Pain in any area of the breast
  • Irritation or dimpling of breast skin
  • Changes in the size or the shape of the breast
  • Redness or flaky skin around the nipple area or the breast
  • Pulling in of the nipple or pain in the nipple area
  • Nipple discharge other than breast milk, including blood

What Do Lumps in My Breast Mean and are they always cancerous?

Anxiety and fear kick in when a woman feel a lump in the breast. Fortunately, not all breast lumps are malignant.
 
Many conditions can cause lumps in the breast, including cancer. The two most common causes of breast lumps are fibrocystic breast condition and simple cysts. 

  • Fibrocystic breast – Fibrosis refers to a large amount of fibrous tissue, the same tissue that ligaments and scar tissue are made of. Areas of fibrosis feel rubbery, firm, or hard to the touch.
  • Simple Cysts are small fluid-filled sacs that can develop in the breast. These can be felt easily and can be as large as 1 or 2 inches across.

Fibrocystic Breast

  • Many breast lumps turn out to be caused by fibrosis or simple cyst which are non-cancerous changes in breast tissue that many women get at some point in their lives.
  • Fibrosis and cysts are seen commonly in women of child-bearing age, but they can affect women of any age which tends to resolve after menopause.
  • The lumps in fibrocystic breast can also mimic and mask breast cancer.

What causes Fibrocystic or ‘lumpy’ breast?

The most significant contributing factor to fibrocystic breast is a woman`s hormonal variation. Hormones like oestrogen and progesterone which directly affects the breast tissues to multiply and grow.

How do we diagnose Fibrocystic Breast?

  • Fibrocystic changes are diagnosed based on symptoms.
  • You may feel breast lumps, swelling, or experience pain around the breast. These symptoms can be associated to menstrual cycle as the symptoms can change according to different stages of menstrual cycle. Some women also experience clear or slightly cloudy nipple discharge.
  • When this happens, it can lead to concern about cancer. Therefore, close monitoring and regular screening is recommended.
  • A simple ultrasound breast can be done to identify the lump and to see if it is solid or just filled with fluid (simple cyst). If the ultrasound shows a solid lump, a biopsy may be needed to ensure it is not malignant.

How do we treat Fibrocystic breast?

Simple cyst doesn’t need to be removed unless it causes discomfort. 
Cyst can be drained by inserting a thin, hollow needle into the cyst, which might be done to confirm the diagnosis. This can relieve pain and pressure.

If removed, the fluid might come back later, but cysts may also go away over time. For cysts that recur and cause symptoms, surgical intervention can be considered.

Most women with fibrocystic changes and without bothersome symptoms do not need treatment, but they should be watched closely.

If you have mild soreness due to fibrosis, you might find that it helps to:

  • wear well-fitted, supportive bra
  • apply gentle heat to the area

Talk to your GP about other possible treatments if these suggestions don’t help. Other treatments might include:

  • other painkillers
  • hormonal therapy

Screening for breast cancer

Imaging

Mammography

  • Recommended screening method for women ≥40 years old annually
  • Preferred initial evaluation for high-risk women starting at age >30years.

Ultrasound breast

  • Recommended initial test for women < 30years of age 
  • Will be able to determine the nature of the mass, and assess regional lymph nodes.
  • Comfortable as compared to mammography.

CT scan

  • Performed in patients with clinically advanced breast cancer to evaluate the possibilities of metastases to other organs.

Laboratory test

Biopsy

  • Breast tissue biopsy is recommended if mammogram /ultrasound findings are suspicious or suggestive of malignancy.

What are the screening recommendations for breast cancer?

For all women, screening recommendations for breast cancer from the American Cancer Society include having a baseline mammogram between the ages of 35 to 40 years and subsequently every year from age 40 onwards. 

Is mammogram painful?

Mammogram does compress the breasts and can sometimes cause slight discomfort for a very brief period of time. Patients who are sensitive should schedule their mammograms a week after their menstrual cycle so that the breasts are less tender. 

Breast cancer Myth

MYTH: Mammogram can cause breast cancer to spread.
FACT: According to National Cancer Institute, mammogram remains as the gold standard to detect breast cancer. Please take not that breast compression during mammogram cannot cause cancer to spread.

Do you know that mammogram reduces risk of breast cancer death by 28%?

A study of the impact of a breast screening programme in Norway has found that in every 10 000 women invited for mammography about 27 deaths from breast cancer might be avoided during their lifetime, giving a 28% lower risk of death among women who were screened.1. BMJ 2014;348: g4062.

How can you reduce the risk of breast cancer?

  • Maintain a healthy weight
  • Consume a balanced diet
  • Exercise regularly
  • Breastfeed your children
  • Limit alcohol intake
  • Do regular screening if you are at risk (family history of malignancy)
  • If you are on hormonal therapy/oral contraceptive do consult your doctor about the long-term side effects.
  • Start practising self-breast examination at an early age in a monthly basis.

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