A few months ago, I noticed a dull pain in my right breast. Maybe it’s the chest press machine at the gym, I thought at first. But eventually, I noticed something lumpy. That’s when I decided to visit my doctor. A few sonograms later, I was cleared; it was just a fibroadenoma. But the days leading up to that were harrowing. The one thought that kept me up at night was “is every breast lump cancerous?”

Breast cancer is fast becoming a frightening reality today. In the 1990s, it was the fourth commonest cancer in India. As of today, breast cancer has claimed the first position. Thankfully, awareness about breast cancer has also risen significantly today. It has entered into our public consciousness so much that every woman knows that a lump in the breast needs to be treated with immediate attention. However, there are many questions we as women may have in our mind such as, “is every breast lump cancerous?”, “should I take every breast lump seriously?, “does breast cancer hurt?” and many more.

In this interview, Dr. Niharika Rajan Garach, Senior Oncologist, SSO Cancer Hospital addresses dome common queries about breast cancer.  

1. Is every lump in the breast cancerous?

All breast lumps are not cancerous. As a matter of fact, most breast lumps are benign, that is, they are not cancerous, and do not pose any threat to life. Breast tissue varies during the lifetime of a woman because of hormonal variations, menstruation period, pregnancy and old age. These changes of nature can occasionally result in development of cysts, fibroadenomas or foci of fibrocystic tissue which can be experienced as lumps. 

Nevertheless, a medical specialist must always examine any new or suspicious lump. Most of the lumps are benign but a small percentage of them may be a sign of early breast cancer. The point is not to be panicking, but neither to disregard it. Early medical check up and diagnostic tests may aid in recognition of the nature of the lump and proper care.

Read: Can bras cause breast cancer? Q&A with Dr Sydney Ross Singer

2. What are some of the non-cancerous types of breast lumps?

Women normally have several forms of benign (non-cancerous) breast lumps:

• Fibroadenomas: These are hard, smooth and squishy masses which can easily move around the skin. They are predominant in women, below 35 years of age and they are mostly painless.
• Breast cysts: Cysts are fluid-filled sacs found in the breast tissue and cysts can either be small or large and can be soft or hard. They tend to be associated with hormonal variation, and might vary depending on the menstrual cycle.
• Fibrocystic changes: This is a generalized term that is used to describe lumpiness or thickening due to the presence of fibrous tissue and cysts. Breast can be tender or swollen with a particular premenstrual tender swelling.
• Intraductal papillomas: These are tiny tumors present in the milk ducts, most often around the nipple, and this can also lead to a discharge of the nipple.
• Fat necrosis: Sometimes, fatty tissue in the breast may be damaged as a result of injury or surgery, and this produces firm lumps that could be confused with cancer but are non-cancerous.

Although these benign lumps are not harmful, they may resemble the appearance of cancerous lumps during physical examination. Therefore, the diagnosis of this disease requires an evaluation of a doctor and the use of image tests, including ultrasound or mammography.

Read: Breast cancer diet: What to eat and what to avoid — An expert’s guide

3. What should I do if I find a lump in my breast?

When you find the lump in your breast, the first thing that you should not do is to overlook it.. Here’s what you should do:

1. Stay calm. Do not assume the worst. Breast lumps are frequent and harmless.
2. Monitor the lump. Record the size, the texture, and the presence of change throughout your menstrual period.
3. Make an appointment with a doctor. A clinical breast examination should be performed as soon as possible.
4. Get recommended tests. Your doctor can recommend a mammogram, breast ultrasound, or MRI depending on your age and symptoms.
5. Follow up regularly. Although this lump may be benign, your doctor will advise biopsy or further scans to take further course of action.  

Quick intervention would help to maintain peace of mind and early detection in the event that something suspicious is detected. The early diagnosis has a great impact on the treatment results of breast cancer cases.

4. When should I take breast lumps seriously?

Although benign lumps are common in the breast, there are certain appearances that would result in an instant medical intervention. You must not think lightly of a lump because:

• It is not painful but chronic and does not disappear postmenstrual.
• They present palpable alterations in breast form, size or skin feel (dimpling, puckering, or erythema).
• You observe discharge of nipples, more so when it is bloody or comes in the absence of squeezing.
• Swelling in the armpit or collarbone.
• The lump has thickened scaly, or ulcerated skin on the skin above.

Pain does not consistently give a true representation. Certain cancers are painless whereas other benign lumps may be painful. Any form of lump should be shown  to a medical practitioner.

5. Are painful breast lumps more or less likely to be cancerous?

In the majority of instances, painful lumps in the breasts have lesser chances of being cancerous. Pain is usually related to hormonal changes, infections or benign causes like fibrocystic and cysts. As an example, numerous women can feel tenderness or swelling in the premenstrual period and it remedies on its own.

The fact that a lump is painless, however, does not imply that the lump is harmless. Most breast cancers do not even hurt at an early stage. Hence, pain can offer a useful indication, but it should not be applied as a single measure to determine risk. Any persistent lump, whether painful or not, needs to be assessed professionally to eliminate the possibility of malignancy.

6. What tests help determine whether a lump is benign or malignant?

There are a number of diagnostic tests that assist physicians in distinguishing between benign and malignant breast lumps: 

• Clinical Breast Examination (CBE): A physical examination conducted by a physician to determine the size, texture and mobility of the lump. 
• Mammography: A low dose X-ray that identifies abnormal masses or calcium that is found in the breast tissues. It is mostly a first-line imaging device in women aged more than 40. 
• Ultrasound: This image test can be used to see whether a lump is a solid lump or a fluid-filled one, and therefore, it is very helpful in young women with thick breast tissue. 
• Magnetic Resonance Imaging (MRI): MRI is a detailed procedure and is employed in complicated or inconclusive cases. 
• Core Needle Biopsy: It involves removing a small piece of tissue on the lump to test the presence of cancer cells. 

All these tests are combined to give a clear picture of the nature of the lump. Diagnosis and subsequent treatment planning should be done early and accurately.

Closing Thoughts from Dr. Niharika

“Consciousness and early intervention is a saver. It is important to make every woman familiar with the appearance and feel of her breasts and make them take regular self-examinations. It is not aimed at instilling fear, but it is intended to instill attentiveness. Early diagnosis is a great opportunity to achieve a successful recovery and treatment with the use of contemporary diagnostic equipment.”

Frequently Asked Questions 

Can you have breast lumps without cancer?

Yes. Some breast lumps are non-cancerous. These include cysts, fibroadenomas and many other conditions that could manifest as lumps in your breast such as Intraductal papillomas and fat necrosis. If you have doubts, visit your doctor at the earliest. 

How to know a lump isn’t cancer?

If you find a lump, be calm and visit your doctor for a clinical breast examination. You may have to get a mammography, ultrasound, MRI or a needle core biopsy to find out if breast lump is cancer. Usually, many of the breast lumps are benign if they are round or smooth, but only a test can positively tell you whether it is malignant or not. 

Can a doctor tell if a breast lump is cancerous by feeling it?

Many doctors can guess whether the lump is cancerous or not by feeling it due to their experience in dealing with the disease. But despite that, all doctors will prescribe tests to positively ascertain if the lump is malignant. 

What do breast cancer lumps feel like?

Breast cancer lumps are usually not painless; they don’t disappear after your menstrual cycle, they change the form, size and feel of your breast; they cause discharge from the nipples, and they cause swelling in the armpit or collarbone.

What are the five warning signs of breast cancer?

The five warning signs of breast cancer are: 

Unusual lump in the breast or underarm

Changes in the skin (dimpling or puckering)

Changes in the nipples (discharge or inversion)

Breast pain

Swollen lymph nodes