When to worry about
ou are in the shower, conducting monthly breast self exam, ( examining your breasts on your own) suddenly your hand freezes. You have found a breast lump.
A lump in the breast is experienced by the patient with the phobia of cancer, this is due to lack of awareness, shyness on part of patient as its perceived as social stigma, financial constraints, or some women are reluctant to consult male doctors.
Breast Lump Investigation:
TRIPLE ASSESSMENT test is used as GOLD STANDARD in diagnosing all palpable breast lumps.
It Includes combination of three tests: • Clinical examination • Radiological Imaging (Mammography,
Ultrasonography) • Pathology (FNAC, Core needle biopsy)
Clinical Examination • A detailed history and examination are
performed by a breast surgeon . • In the history, clinical details of presenting complaint, any potential risk factors are identified, including family history and current medications. • The full breast examination is done, including breast palpation and assessment of the axillary nodes.
Radiological Imaging • The mainstay of imaging during the triple assessment is based around either mammography or ultrasound investigations: • Mammography is an X ray of breast, is a preffered screening method for breast cancer. It shows compression views of the breast across two views (oblique and craniocaudal), allowing for the detection of mass lesions or microcalcifications. • Ultrasound scanning is more useful in women <35 years and in men, due to the density of the breast tissue in identifying anomalies. This form of imaging is also routinely used during core biopsies.
Pathology • FNAC is now being superseded by
core needle biopsy. • A core biopsy is required of any suspicious mass or lesion presenting to the clinic. A core biopsy provides full histology ( as opposed to fine needle aspiration ( FNA) which only provides cytology), allowing differentiation between invasive and in-situ carcinoma. • This test gives important information about tumour grading and staging, and has a higher sensitivity and specificity than FNA for detecting breast cancer. Triple Assessment is very useful diagnostic tool to evaluate patients with breast lumps and rule out cancer. The individual case will then be discussed at a Multi- Disciplinary Team ( MDT) meeting where a treatment plan will be developed. Triple assessment donot require hospitalisation and is performed on OPD basis.
A Variety of Benign Breast Lumps: Most benign breast lumps are directly related to your menstrual cycle, to fluctuations in your hormones and to the fluid buildup that comes with monthly period.
Other benign breast lumps may be related to plugged milk ducts, infections, or even breast injuries.
Most common benign conditions are:
Fibrocystic Changes: A general lumpiness that can be described as “ropy” or “granular,” these lumps are the most commonly seen benign breast condition, affecting at least half of all women. Symptoms of fibrocystic change include tender,fibrous, rubbery tissue; a thickening of tissue; or a round, fluidfilled cyst. These changes, related to hormone fluctuation, may increase as you approach middle age and then disappear with menopause.
Breast Cysts A cyst is a common discrete mass found in patients presenting to a breast clinic. They are tender to the touch and filled with fluid. They may come and go with menstrual period, becoming larger and more tender at the beginning of your period and disappearing at the end.
This tumor is the most commonly diagnosed benign breast lump. Occurring in young girls and women in their teens and 20s. About 10% of patients have multiple fibroadenomas on presentation.
Giant Fibroadenoma is a breast fibroadenoma more than 5 cm occurring in young women and manifesting as breast asymmetry or deformity. It has a bimodal age of presentation , may also occur in 45- 50 age groups. Diagnosis is made by core biopsy . Surgical excision is done by cosmetic incision.
Suspicious/cancerous Lump: A cancerous breast lump will have an irregular shape (though at times it can be round) with a pebbly surface, somewhat like a golf ball. It is often very hard, like a slice of raw carrot. It may not be movable during a breast self- exam. Most often breast cancer is painless, though breast cancer can sometimes cause breast pain.
Symptoms of Breast Cancer: • Painless , hard lump • An unexplained change in the size or
shape of breast. • Skin dimpling or puckering (sometimes
looking like an orange peel) • Nipple retraction (turning inward) • Redness, scaliness, or thickening of
the nipple or breast skin • Nipple discharge ( other than breast
So if you find a Breast Lump: Your first priority is to take care of yourself — which means “go see a Breast Surgeon.”
All breast lumps should be evaluated by a breast specialist, who can help you decide how to proceed. Most benign breast conditions are treatable, and some will even go away on their own, but it's best to let your doctor be the one to tell you that.
Despite most cases of breast lumps being non cancerous, breast cancer still remains the most common cancer and leading cause of death in women and therefore a diagnosis should not be ignored.
her, like the friends and their phone numbers for one thing or the fact that she had frequently missed attending her classes as whispered to her by one of the well-wishers.
he first night was blissful. Mythili stretched like a cat lazily watched by Surya and she blushed. His eyes said that it was special for him too. The stolen kisses in the theatre or in the public park though very exciting never equaled the real thing. He had taken her to a small getaway on the outskirts of the city as they had just the weekend for themselves. He promised her exotic holidays, later on when he could accumulate some leave. The small room was not a kind she was accustomed to on holidays but she accepted that getting a better room on little notice was not easy. He gave her some gifts. She attributed the garishness of the gifts to lack of taste. Her gifts to him appeared lavish and expensive. Her tentative query regarding getting in touch with her parents were brushed aside and he told her that he wanted her to himself for just this weekend and she succumbed to his charming assertiveness.
The house of the Krishnans was like a tomb. There was a hollowness that both Sita and her husband Anantha Krishnan could not evade from. There were no more tears left and the worry lines were etched all over their visage. The police were of little help. They very kindly alluded to the fact that being an adult their only daughter could have eloped with her paramour. They also said that there were hundreds of cases like this and begged their forgiveness for not giving the matter the attention the parents might feel it deserved. It was more than two days since their beloved daughter Mythili’s disappearance. Anantha simply could not accept that his beloved daughter who was named after his mother could do any wrong. He felt that the police was wrong and his wife could not bring herself to tell him about the missing clothing, the few pieces of family heirloom and the passbook. She knew she had to but she wept afresh at the agony her daughter had heaped on them. She wondered for the umpteenth time, ‘Where had they gone wrong? ‘
“Could the police be right?” Anantha asked Sita at one in the morning. He knew she was as awake as he. Their going to bed was just to stretch themselves and give their aching backs some rest and also strength to face the next day. The agony of the daughter’s disappearance was compounded by the fact that she was engaged to a young doctor who was well respected in the small town where he was serving. He had been on extended leave and he also knew that being a Senior VicePresident of a company, he could ill afford to do so for a stretch of time. The entire office knew that he had performed his daughter’s engagement and the marriage was to be six months away. He had distributed sweets the day he had come back from the groom’s town. Some of his close friends had also accompanied him for the same and they had been all praise for the newly engaged couple. They felt that the match was perfect.
The engagement ceremony was done in style with the boy’s parents not sparing any thought to expenses. As they said, “My son deserves this and much more.” Anantha Krishnan and Sita wondered with great deal of trepidation how they would face them. Both of them squirmed when they thought of the manner their daughter let all of them down. Even the doting father in him had to concede that his daughter was terribly willful and he knew he was to be blamed to a large extent. He stretched out a hand to his suffering wife and both wept in each other’s arms for what appeared to be hours. They were not sure what was the greater evil; the possibility of an accident seemed a better option than an elopement. They also knew that she wouldn’t have made a good match if there was a need to elope.
The stark bareness of the single room and the narrow cot with its lumpy bed did not deter the newlywed from having the most wonderful time on their first night home, though she must admit that she was more than a little flustered when she entered the room. Surya had always been honest. He had told her that he had a humble abode in the topmost floor of the building. He had told her that he used to sit by the window on days he could not meet her, dreaming about her while looking at the blueness of the water. She had imagined a onebedroom house overlooking a lake to say the least and hardly expected to be led to a dingy building in a narrow alley. If she had been shocked by the approach, the stinking stairway leading to their one- room tenement was a major cultural shock. Then he had enveloped her in a bear hug and she had forgotten it all. Now, she moved to the window to see for herself the water body of which he had spoken of at length, only to see the bare face of another equally dingy apartment building. She froze.
ythili knew that she must confront him, but suddenly she was scared. The madness of the entire elopement, the secret marriage, the side of Surya that she had never imagined was brought home with a harsh reality. She also knew that she had let down her parents very badly. She felt embarrassed by the fact that she had allowed Surya to talk her into entering an engagement with another
Mythili knew that she must confront him, but suddenly she was scared. The madness of the entire elopement, the secret marriage, the side of Surya that she had never imagined was brought home with a harsh reality.
man knowing very well that she was planning on eloping soon after. His reasoning had appeared solid then. He had told her that he needed to make arrangement for the marriage and as her parents had insisted on the engagement there was no harm in pleasing them. She felt guilty and ashamed at the agony she had caused them. She started sobbing uncontrollably, for she knew that they would have been mad with worry.
urya gave her permission to contact her parents that day. He wasn’t worried about the police as he very well knew that she was above the legal age. “We will go to your place this evening. Call them so that they can prepare for the grand arrival of their daughter and son-in-law.” The tone in his voice caught her attention. She looked at him suspiciously as he whistled nonchalantly as he dressed himself. He picked up his overalls stained with oil and suddenly she was afraid to ask him what he did for his living.
“Sita…our daughter is on the phone,” Anantha’s voice cracked with emotions. Switching on the speaker phone for both of them to hear, he continued, “Kanna, where are you? Are you all right? What did you do…we were so worried. Are you hurt?” Sita sobbed, “We won’t scold you…..please tell us where you are , We will come and pick you up.”
“Amma, Appa….i am married.” Mythilis voice cracked. She had practised this line so many times and each time it had come out joyous, but now it sounded so bland bereft of emotions and suddenly she realized the magnanimity of her actions. She had burnt her bridges and she knew that Surya would not take kindly to her change of mind even if she wanted to. She wanted to run to her parents and allow them to take charge like all the times before, but she knew that she had grown up in a hurry. She forced some happiness in her voice, “Surya and I will be coming this evening to meet you, appa.. Amma, are you there? Please speak up….. please……you will like Surya, he is wonderful” Suddenly she realised that this was what was wrong with her love, the reason for elopement, for she knew that her parents would be aghast with her choice and they would never accept him even in hundred years and Surya was once again wrong. It had nothing to do with the caste, but… “Amma,” her voice was hesitant, “Appa,….” She sobbed and their heart melted despite all the agony she had caused by her actions.
“Come home…. with him.” Anantha whispered and cut the call. Both he and his wife were brokenhearted. They cried for their lost child, they cried for the agony, they cried for the sleepless nights worrying about her fate and now they cried for the mistake they knew that she had committed. They knew her voice, there was no joy, there was hesitancy and fear and they cried for the irrevocable damage she had obviously done to her life.
“Amma,” Mythili hugged her mother suddenly looking at the aged, frail person. Her father too looked older and suddenly Mythili realised with a pang what she had done to them. She had been inordinately proud of her distinguished father and here she was seeing a broken man. He asked her then, “Why did you get engaged to another man? Are we that much of your enemy that you need to not only hurt us but also break our respect in the society?” His voice rose steadily and his famous anger at any kind of wrongdoing was making itself visible. Mythili was rarely at the receiving end of his famous ire, but today she knew that there would be no stopping him and Sita tried ineffectively to calm him down. She knew that the neighbours would be all ears to know what was happening. “Is this the reason we educated you? If you had been certain of your love, why did you not have the courage to come out with it?”
Both he and his wife were brokenhearted. They cried for their lost child, they cried for the agony, they cried for the sleepless nights worrying about her fate and now they cried for the mistake they knew that she had committed. “Amma,” Mythili hugged her mother suddenly looking at the aged, frail person. Her father too looked older and suddenly Mythili realised with a pang what she had done to them. She had been inordinately proud of her distinguished father and here she was seeing a broken man.