Tuesday 22 October 2019

Dear Dr Nina: Two separate consultants said they were not worried, but should my breast lump be rechecked?

Regular self-exams and attending for age-appropriate screening are important measures
Regular self-exams and attending for age-appropriate screening are important measures

Q A year ago I had investigations done for a lump in my breast that ended up with me being discharged from the BreastCheck service, after a few follow-up ultrasounds to check on the calcification of the breast. Two separate consultants said they were not worried about the lump. I never had a biopsy. The lump is still there - quite noticeable as it's about the size of a 5c piece, but mobile and I regularly get twinges of sharp pain in the area of the lump and, sometimes, under my arm near the lump. Should I go back to my GP? I'm in my early 40s with no history of breast cancer in the family. I breastfed three children in my 30s; would this have anything to do with the lump forming?

Dr Nina replies: Breast lumps always strike fear in women and it is important to get any lump checked out but it is also important to know there are many causes of breast lumps and pain for which there are simple, benign explanations. One of the most common benign breast lumps in women below 30 is a fibroadenoma. Adenosis is general thickening in the breast tissue, which may be painful. It is due to enlarged lobules (milk-producing glands) and may be particularly sensitive to hormonal flux during the menstrual cycle.

Fat necrosis is a localised thickening in the tissue or a lump that can occur in areas of previous trauma or injury. It can be painful in some people. Fluid-filled cysts can appear and enlarge quickly. They can be very painful and may require draining. The fluid from cysts is often sent to the lab for analysis but these are virtually always benign.

Wart-like growths in the milk ducts close to the nipple are called intraductal papillomas. They can cause discharge from the nipple along with pain or a lump and are most common in women aged 35 to 55. Some lumps show precancerous change.

The change in these lumps is very localised within the breast. They are very treatable. If diagnosed, regular follow up is required. The outlook with these conditions is very good.

Mastalgia (breast pain) is a common complaint in premenopausal women. This often is worse premenstrually. It can be present in both breasts. It is a benign condition and often responds to checking that bras fit correctly, using evening primrose oil and/or simple analgesia such as ibuprofen.

Women worry that any breast lump may be cancer. While it is a relatively common cancer, occurring in approximately one in 12 women at some stage in their life, 80pc of these cancers occur in those over 50 years of age.

People also worry about their genetic risk, but the truth is that only about 5pc to 10pc of breast cancers have a genetic basis and 85pc of breast cancers occur in those who didn't have a family member with a history of the disease.

It sounds like you acted appropriately and that you have been thoroughly checked out. It may be worth trying to take something like evening primrose oil or simple over-the-counter painkillers to see if it helps the pain and discomfort.

However, if you feel the lump has changed since last checked or if you have new symptoms, then it is worth reviewing with your GP to see if another hospital review is appropriate.

The most important thing is to modify the risks you can, do regular self-exams and attend for age-appropriate screening.

If you have any queries, email askthedoctor@independent.ie

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