Breast lumps can be an indication of cancer, but they are actually very commen even among healthy women. Dr Patricia S Kho, a medical oncologist from Parkway Cancer Centre with sub-specialty interests in breast, lung and gastrointestinal cancers, explains what you should do if you discover a lump in your breast in this brief guide to diagnosis and treatment.
1. I have found a breast lump - now what?
First of all, do not panic. Breast lumps are actually very common, especially in premenopausal women and they normally vary with and go away by the end of the menstrual cycle. However, breast lumps or changes in the breast cannot be ignored either and one should seek medical attention.
2. What will a doctor do?
The doctor would ask about your personal and family medical history, and about the changes you have noticed in your breast. A doctor can tell a lot about a lump from its size, texture and the way it moves within the breast. Benign (non-cancerous) lumps often feel different from cancerous lumps. The doctor will then order some investigations such as a mammogram or ultrasound of the breasts.
3. What is a diagnostic mammogram or ultrasound?
A mammogram is an X-ray picture of the breast which is used to evaluate lumps or changes in the breast. Ultrasound is another way of looking inside the breast by using sound waves. It can tell the difference between a liquid-filled cyst and a solid mass and can help to tell the difference between normal and abnormal breast lumps. It is often used in addition to a mammogram when evaluating breast lumps.
4. What about Magnetic Resonance Imaging (MRI)?
MRI uses a large magnet and radio waves to create an image of the breast. It can sometimes detect cancers in dense breasts that are not seen on mammograms. MRI is often used with mammography for screening women at a high risk of breast cancer. If the tests confirm a suspicious abnormality, then a biopsy is needed to tell whether or not the breast change is due to cancer.
What to do if I'm diagnosed with cancer?
5. What is a biopsy?
The only way to diagnose breast cancer with certainty is to perform a biopsy on the tissue in question. Biopsy means to take a very small piece of tissue from the body for examination under a microscope and testing by a pathologist to determine if cancer is present. A number of biopsy techniques are available.
Fine-needle aspiration consists of placing a needle into the breast and sucking out some cells to be examined by a pathologist. Core-needle biopsy is performed with a special needle that takes a small piece of tissue for examination. Usually the needle is directed into the suspicious area with ultrasound guidance. This technique is gaining in popularity as it is less invasive than surgical biopsy. It obtains only a sample of tissue rather than removing an entire lump. Surgical biopsy is done by making an incision in the breast and removing the piece of tissue.
If a cancer is diagnosed, the tissue will be tested for hormone receptors. Receptors are sites on the surface of tumour cells that bind to estrogen or progesterone. Other tests, e.g. the measurement of HER-2/neu receptors, may also be performed to help characterise a tumour and determine the type of treatment that will be most effective for a given tumour.
6. If there is a diagnosis of cancer, what am I do?
Once again, there is no need for panic as many early-stage breast cancers can potentially be cured. Importantly, one should aim to seek to understand the aims and rationales behind the various treatment modalities offered.
Take time to learn about your type of breast cancer and your treatment options. It is important to make a decision about your treatment when you fully understand it and are ready. Ask your doctor(s) all your questions so that you may better understand your options. The doctor may also organise a few other tests to ensure that the cancer has not spread to other parts of the body.
Most women with breast cancer need to make decisions about which type of breast surgery to undergo; whether to undergo radiation therapy, chemotherapy or hormonal therapy; and whether to undergo breast reconstruction. All women with breast cancer should talk with a medical oncologist to discuss their specific treatment needs and construct a specific treatment plan. The medical team looking after you would usually include a breast surgeon, a medical oncologist and in certain cases, a radiation oncologist.
A diagnosis of breast cancer can evoke a wide range of emotions, from denial to fear, helplessness and anxiety. "Why me?" is a question that pops up all the time. It is indeed a very stressful time and many fear losing control. It is therefore helpful to build a strong support network of family and friends. Make time to share your feelings with others and share experiences with other breast cancer survivors. Many people also find strength in their spirituality and faith. A counsellor or support group can also help lend support, beginning from diagnosis through treatment and beyond.
What happens after treatment?
7. I am done with the treatment. What happens now?
Once you have had breast cancer, there is a higher risk for developing breast cancer again than someone who has never had the disease. That is why it is important to get the follow-up treatment and care your doctor recommends. With proper follow-up, your doctor can also keep track of how you are recovering and help take care of side effects.
In addition, if there is a recurrence of breast cancer in the breast, chest wall or lymph nodes, it can be detected early and treated effectively. Either the oncologist or surgeon can coordinate your follow-up medical care.
Apart from the medical follow-up, there is also strong evidence that maintaining a healthy lifestyle such as avoidance of weight gain, maintaining a healthy weight and a good level of physical activity can be protective in terms of preventing a recurrence of breast cancer.
Most importantly, do not be afraid of being left helpless or clueless, not knowing what to do or who to turn to once your treatments are completed. Your team of doctors and nurses will always be there for you.
Dr Patricia S Kho is a medical oncologist from Parkway Cancer Centre with sub-specialty interests in breast, lung and gastrointestinal cancers. She graduated from University of Newcastle Upon Tyne, UK (MBBS, 1995) and worked at Singapore's National University Hospital (NUH) before continuing her specialist postgraduate training in medical oncology at Sydney Cancer Centre, Royal Prince Alfred Hospital. She was accepted as Fellow of Royal Australasian College of Physicians (FRACP) in 2003.
Dr Kho was a Post Doctorate Fellow at the Genomic Institute, Singapore before her appointment as Associate Consultant in NUH's Department of Medical Oncology in 2003. In 2005, she was appointed as a Staff Specialist at Liverpool Hospital in Sydney and subsequently as Head of Department and Director of Clinical Trials Unit. In 2009, she joined the Northern Haematology and Oncology Group, a private practice group and continued to be a Visiting Scientist to the Garvan Institute of Research, Sydney.
Dr Kho is a member of American Society of Clinical Oncology, Medical Oncology Group, Australia, International Association of Lung Cancer, Australian Lung Trials Group and Australasian Gastrointestinal Trials Group. She remains actively involved in clinical research and trial participation and is currently pursuing a Masters degree in optimizing treatment for colorectal cancer. To find out more about Dr Kho, click here.