Breast awareness

Does a breast lump necessarily mean cancer is present? This is a frequently asked question, the answer to which is no. Breast lumps in 70% of cases are harmless or benign (not malignant or cancerous) and occur due to the breast tissue being sensitive to changes in body chemicals such as hormones. For instance, these can occur if a hormone is taken by mouth in the form of an oral contraceptives or HRT.

There are three commonly occuring benign lumps:

• A cyst
• A blocked milk duct
• A fibroadenoma which is a fibrous swelling

Breast cancer is the most common type of cancer occuring in women. One in twelve women will develop it at some time in their life.

Each woman has a risk of 1 in 12 of contracting breast cancer during their lifetime. There are a number of factors increasing the risk of contracting the illness. Breast cancer is rare under the age of 30 and the incidence doubles approximately every ten years until the menopause when the rate of incidence slows down. Three quarters of breast cancers occur in women over 50 whilst the risk is highest of all in women over the age of 65.

A small number, 5%, of breast cancers may run in families due to an inherited gene. If a first degree relative (that is mother, sister or daughter) contracted breast cancer under the age of 40 then the woman is at a higher than average risk of developing the illness.

Women who delay becoming pregnant until after the age of 35 have three times the risk of developing breast cancer compared to women who are pregnant before the age of 20.

Similarly women who start periods early (about 10 years old) have 3 times the risk of those who begin menstruating at 15 years old. Similarly women whose periods stop at the age of 55 years have twice the risk of developing breast cancer compared to those that stop at the age of 45. The reason for this is not proven but the suggestion is that the body hormone oestrogen may be responsible if it is present in the body for a very long period in the lifetime of a woman.

Over 90% of breast cancers are found by women themselves so one of the best methods of detecting breast cancer at an early stage is for women to be 'breast aware'. This means that women, especially those over the age of 40, should become aware of the normal feel and appearance of their breasts in everyday activities such as bathing, showering and dressing. As a result they are more likely to notice any changes to their breasts sooner rather than later.

The main changes to look out for are:

• Changes in the outline or shape of the breast especially any puckering or dimpling of the skin.
• Discomfort or pain especially if it is only in one breast, or it is new or persistent.
• Any lumps, thickening or bumpy areas especially if they are new or are different from the same part of the other breast.
• Any changes in the nipples. This includes discharge or bleeding from a nipple or a rash around the nipple which is slow to heal and also any change in nipple position especially if it becomes pulled in or points differently to normal.
• If one or more of these changes is noticed or any other changes are found which the woman has not noted before, she should see the doctor as soon as possible. The chances are that there will be no serious cause found for her symptoms but, if there is an underlying problem, the sooner it is discovered the simpler the treatment is likely to be.

After seeing a doctor further tests may be necessary. Often the anxieties can be relieved by a diagnostic needle test which can be conveniently carried out by the doctor in the surgery. A needle is inserted into the swelling and any liquid sent off for tests. In many cases the lump disappears indicating that the lump was in fact a simple cyst.

A persistent solid swelling demands referral to a surgeon who will probably arrange a special breast x-ray (mammogram) and will consider further treatment, if necessary.

Mammography is a method of detecting breast cancer before there are any signs indicating that there is something wrong with the breast. It is a type of x-ray examination which is capable of showing very small changes in the breast tissue and if these are thought to be cancer then early treatment can be offered.

All women aged between 50 and 64 and who are registered with a physician will be invited to attend for screening. This age group is especially targetted as cancer occurs more commonly and because the breast tissue is generally less dense compared to those of a younger age group, so making the interpretation of the x-ray reading more accurate. Women over 64 may also be screened if they wish. In addition, younger women with a strong family history will be offered screening. This should be discussed with the physician who will advise on local policies.

The screening centre may be based at a hospital or mobile unit. On arrival a female radiographer will explain the procedure and ask for details on state of health. Women are asked to undress to the waist and will be positioned so as to compress one breast, and then the other, between two special x-ray plates. The x-ray is then taken.

The procedure can be a little uncomfortable particularly if breasts are already painful or during the premenstrual phase, but discomfort is usually felt momentarily. Mammography is not harmful and there are no side effects.

The test results will arrive about one week after the screening, which for most women indicates that the result is normal. Women are then recalled for another test every three years. In some cases the test has to be repeated for technical reasons, such as, there has been a problem with the x-ray film or its interpretation.