Breast Lumps

Breast lumps are a common complaint among women. It constitutes about 60% of referrals to the breast specialist clinic. However, the good news is that up to 90% of breast lumps are non-cancerous. The common causes for breast lumps are: fibroadenomas, cysts, fibrocystic disease, lipomas, haematomas, abscesses and breast cancer.

Fibroadenomas are common in young women. It usually occurs in adolescence and up to early 30s. It is a benign (non-cancerous) condition and does not turn malignant (cancerous). A small fibroadenoma can be observed and treated conservatively while a palpable one can be surgically excised. The surgery is a minor one and takes less than 1 hour. It is usually done as a day case (no need for admission to hospital).

A breast cyst is a collection of fluid within the breast lobules. It usually occurs in premenopausal women. Clinically, smooth discrete lumps will be palpable. It is diagnosed by ultrasonography. The treatment of breast cyst is with simple aspiration of the cyst in the clinic.

Fibrocystic disease is the commonest cause of breast lumps. It consists of a spectrum of cysts, lobules and fibrous changes within the breast. Treatment is the same as for a fibroadenoma.

Lipomas are benign tumours which originate from fat cells. It presents as a soft, lobulated lump. Lipomas can also grow at other parts of our body as long as there are fat cells. The treatment of lipoma is surgical excision.

A haematoma is a collection of clotted blood. This is usually preceded by a history of trauma or occurs after a biopsy is taken from the breast.

An abscess is a localised collection of pus. This occurs more commonly in women who are diabetic or who are immunocompromised. It can also occur in an infected haematoma. A breast abscess can also form from an infection in the nipple. This condition usually occurs during breastfeeding (lactational mastitis). The treatment for breast abscess is antibiotics and aspiration of the abscess. If that does not work, a surgical drainage of the abscess would be necessary.

Breast cancers commonly occur in women aged 40 and above. The lifetime risk for a women to get breast cancer is 11%. Patients usually present with a breast lump, breast ulceration or incidentally detected on screening.

All patients with breast lumps should go through a triple assessment. This consists of:
- consultation and clinical examination by a doctor,
- radiological investigations (mammogram for women >40 years old and ultrasound for women <40),
- biopsy of the lump either with a Fine-Needle Aspiration Cytology (FNAC) or a core biopsy or with a surgical excision biopsy.

FNAC and core biopsies can be done in the clinic. A FNAC is a simple procedure where a needle is inserted into the breast lump and its cells are aspirated and sent for microscopic examination. The results will show if the lump is benign or malignant (cancerous).

A core biopsy is carried out with a bigger needle. It is called so because a core of tissue from the breast lump is taken out using the needle. This procedure is done in the clinic but local anaesthesia is usually given. There is a risk of bruising after the procedure. Core biopsies provide a piece (core) of tissue for histopathological examination. It can help determine if a lump is benign or malignant. It is also able to tell if the lump is an invasive cancer or early confined (in-situ) cancer. Hormonal receptor status of the lump can also be identified which will help in post-operative treatment of breast cancer.