Health – Breast check

Not all breast problems indicate the presence of cancer. Here are four common ones to look out for.

Women have two big misconceptions about breasts: first, that the only breast illness that exists is cancer, and second, that all lumps are cancerous. But it’s not so. Breast problems are common. Although frightening when discovered, most of these problems will not give rise to panic, according to the World Health Organisation, because more than 70% of all patients with breast problems don’t have cancer.

However, these problems can cause symptoms akin to those of breast cancer. Joburgbased breast specialist Dr Sarah Rayne says: “The most common symptoms that women notice are lumps, pain, a nipple discharge and changes in the skin of the breast.”

We speak to experts about these four symptoms and how to handle them.

SUSPICIOUS LUMPS

Most breast lumps are benign, meaning they aren’t cancerous. The lumps usually have smooth edges, can move slightly when you push against them and are often found in both breasts. Refiloe, 25, a student, developed a lump in her left breast two years ago. “I was fitting a new bra when I noticed a lump in my left breast,” she says. “It was painless – that’s what made me concerned that it

might be breast cancer. I saw a doctor, who did a breast examination and, thankfully, found it was a benign tumour.” Dr Rayne says: “The most important thing to know when you feel a lump in your breast, is that most of these are not breast cancer. They’re present in 25% of all women, usually from ages 15 to 35. They can be in one breast or both, single or multiple. It’s normal breast tissue that has become enlarged by hormones.”

Still, she advises going for a breast examination if you notice a lump. “The best way to check out every new problem is by a physical examination, along with nonthreatening, painless investigations like ultrasound, a mammogram and biopsy.”

PAINFUL TOUCH

Pain in the breasts is a frequent complaint, and almost all women experience it at some stage. According to the Netcare Breast Care Centre, cancer only presents with pain in 10% of cases – and this is a constant pain, localised to tissue around a lump.

When social worker Zanele, 29, experienced pain in her breasts, she panicked. “I started feeling a burning pain in my breasts, especially the nipples,” she says. “They felt heavy, like I needed to breastfeed a baby. I was certain it was cancer – only to find it was pain caused by stress!”

Dr Rayne adds: “It’s rare for pain alone to be the first sign of breast cancer, but it is always wise to get any changes in your breasts checked out.”

The pain can be difficult to treat because there are several reasons pain can occur. “Cyclical breast pain is most common in women in their 20s and 30s,” Dr Rayne explains, “and it may get better during pregnancy or menopause. It’s related to the monthly hormonal balance in the body throughout your ovulation cycle, and it’s also associated with increased levels of anxiety and depression. It presents as heavy, aching or uncomfortable breasts. “The second type of pain is non-cyclical mastalgia. There are many reasons this type occurs. It may have a hormonal cause like cyclical pain, if the breasts have become sensitised to the levels of hormones circulating, or it can be associated with hormone replacement therapy (HRT). It may have an anatomical origin, such as cysts, or it could be caused by what’s medically termed ‘dilatation’ of the breast ducts – stretching beyond their normal limits.

“The resultant complaint is called duct ectasia – typically, a burning, shooting pain around the nipples.”

NIPPLE DISCHARGE

Katlego, 30, an accountant, had a watery and milky discharge when she pressed on her nipple. “I was surprised as I wasn’t breastfeeding,” she says.

Nipple discharges are classified according to colour and the number of ducts involved. Like other ducts in the body, breast ducts make and carry a variety of secretions. Many women can squeeze out a small amount of milky yellowish, greenish or brownish discharge, without it necessarily being an indication of a problem.

Surgeon and author Dr Valerie L Staradub writes in her book, Patient Education: Common Breast Problems: “This is often called ‘physiologic’ discharge and is not a cause for concern if it is not bloody.” The treatment entails cutting out the involved duct with microsurgery. Some of the tissue must then be sent for histology (the study of the microscopic structure of tissues) to confirm that it is benign, or to prompt further treatment if it is cancerous.

SKIN CHANGES

Skin problems that can develop on or near the breasts include itching, crusting, dimpling, swelling, redness or changes in skin colour. For some people, breasts become darker and the skin rougher – but after a few days, this disappears. While most of these changes are not caused by a serious problem, the USA’s National Cancer Institute advises that you get a skin condition on your breasts evaluated if it does not clear up within a few days.

Most women experience breast changes in their lifetime. Many of these changes are caused by hormones or the normal ageing process, and most are not cancer. But early detection remains key to fighting the disease, so any time you notice any change in your breasts, don’t wait until your next mammogram – make an appointment as soon as possible and get it checked.

“THE MOST IMPORTANT THING TO KNOW WHEN YOU FEEL A LUMP IN YOUR BREAST IS THAT MOST LUMPS ARE NOT BREAST CANCER.”