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Benign (non-cancerous) tumour of the breast - fibroadenoma

Fibroadenomas are found in 10% of all women and most commonly in young women between the ages of 15 and 30. Fibroadenomas can be described as hard marble-like round lumps that sometimes move around when felt. They usually measure between 1 to 5 cm in diameter; however, they can become quite large. Approximately 10 – 15% of women with a fibroadenoma will develop more than one. The cause of breast fibroadenomas is unknown but they are usually found in premenopausal women or women taking oestrogen and they may often grow rapidly in pregnant women.

What are the common symptoms?

The following symptoms listed are typical; however, the degree of severity is subjective and personal:

• Pain
• Discomfort
• Tenderness
• Tightness/tension
• Hard or palpable lump (s) that grows larger over time

How do I know if I have a Fibroadenoma?

Breast lumps are often discovered during breast self-examination, or during a routine check-up. If you feel something abnormal or concerning, you should notify your doctor immediately. If a breast lump is discovered, your doctor may perform some or all of the following exams to determine if the lump is benign or malignant.

• Physical examination
• Mammography (x-ray of the breast)
• Breast ultrasound
• Breast biopsy

Today there are minimally invasive options for dealing with your fibroadenomas.

What do I do if I am diagnosed with a Fibroadenoma?

Today, there are multiple treatment options, including non-surgical options. In the past women were offered only two choices; wait and do nothing or have the lump surgically removed.

Observation or waiting may be the right choice in certain circumstances. Often when this option is chosen your doctor will follow up with you within a 6 month period to see if there was any growth or change in the breast tumour.

Excision – small fibroadenomas may be excised using minimal invasive techniques under local anesthesia (see mammotome). Larger fibroadenomas (>1.8cm) will require an excision biopsy.

Breast Cancer

Breast cancer is the most common cancer among women in Singapore. About 1,100 women are diagnosed with breast cancer each year. In the USA, one woman in eight either has or will develop breast cancer in her lifetime. Through regular screening, breast cancer can be detected early where treatment is generally more successful. If detected early, the five-year survival rate for breast cancer exceeds 95%.

What is Breast Cancer?

Our human body is made up of billions of cells. Each cell reproduces by division (cell division) and this process normally occurs in an orderly manner. If the cells divide in an uncontrolled manner and invade the surrounding tissues, a cancer or malignant lump is formed.

Breast cancer usually originates from the cells lining the milk ducts and glands. Ductal cancer (i.e. arising from the ducts) is more common than lobular cancer (i.e. arising from the lobules). In the early period of cancer growth, the malignant cells are confined within the milk ducts and glands and have not invaded into the surrounding tissue known as the stroma. When breast cancer is detected at this stage, it is known as non-invasive or in-situ cancer. Treatment is easier and patients live longer.

However, when cancer cells have broken out of the milk ducts and lobules and invaded the surrounding stroma, the cancer is called an invasive cancer. In the stroma are found blood and lymphatic vessels. Hence an invasive cancer can enter into the lymphatic system and spread to the lymph grands (called nodes) in the armpit. Likewise, the cancer cells can enter the bloodstream and sprea to other organs in the body. When these cells reach a new site, they may form a new tumor, often referred to as a secondary or a metastasis. The organs most commonly affected are the lungs, bones, liver and brain. In this advanced stage breast cancer is usually incurable and patients’ life expectancy decreases.

Early breast cancer

The earliest form of breast cancer is known as ductal carcinoma in-situ (DCIS). These cancer cells are confined within the milk duct and there is very little potential for spread to lymph nodes and other parts of the body. Breast cancer at this stage is classified as stage 0 (non-invasive) and the five year survival rate is 99%.

Invasive cancer

Breast cancer is termed as invasive cancer when it is classified into stage 1 to 4. The cancer cells at the later stage would have spread to affect the lymph nodes and other parts of the body. The 5-year survival rate decreases as the stage of the cancer increases.

The key to a better survival is early detection of breast cancer through regular screening.

Who is at risk of breast cancer?

All women are at risk of developing breast cancer. Inherited cases account for only a small proportion, perhaps 5-10% of breast cancer. However, those at risk in families may especially benefit from screening and early diagnosis particularly as they are at risk of developing the disease at a much younger age. Despite the intensive search for the cause of breast cancer, the exact cause remains unknown. In many of our breast cancer patients, there are no identifiable risk factors. However, lifestyle factors including stress, dietary risk factors (such as excess fat intake), excess body weight and lack of physical activity, and intake of hormones may contribute.

Other risk factors include:

• Family history
• Previous abnormal breast biopsy

Previous abnormal breast biopsy

A few types of breast biopsies are known to have an increased risk of breast cancer, namely: atypical ductal hyperplasia, atypical lobular hyperplasia. Women with such breast biopsy reports should be closely monitored.

How to discover breast cancer?

The most effective method to detect breast cancer early is through screening. This includes a physical examination, ultrasonography and mammography. However, many women are not coming forth for screening mammography as they think that they are free from breast cancer when they do not feel any lump in their breasts. At times, there could be signs of breast cancer such as:

• A painless lump
• Persistent rash around the nipple
• Bleeding or any unusual discharge from the nipple
• Swollen and thickened skin
• Dimpled or puckered skin
• Retracted nipple

If you notice any of the above signs, you are advised to consult a doctor as soon as possible.

However, with early breast cancer, there are no signs.

Besides routine screening, you should also practice regular Breast Self-Examination(BSE). By practicing BSE monthly and being more familiar with the look and feel of your breasts, you should be able to observe any changes in your breasts in the interval between your regular screenings. Screening must be repeated at regular intervals to ensure it’s effectiveness as the risk of developing breast cancer increases with rate and the growth age of the disease is variable.

How can we fight breast cancer?

There are 3 methods of fighting breast cancer:

• Prevention is possible only by elimination of known risk factors and this is both a challenging and long term goal requiring self discipline, e.g. change of diet and lifestyle habits
• Early detection is currently the most promising method to fight breast cancer. The main advantages are (a) improved survival (b) less mutilating surgery (c) less toxic drug therapy.
• Better treatments, drugs, novel therapies with biological/targeted agents, and technologies are constantly being introduced in the areas of surgery, chemotherapy and hormonal therapy and radio therapy.

Breast Cancer Myths

1. Deodorants cause breast cancer.

To date, there is no hard evidence to prove or disprove this myth, which has caused unnecessary distress for a lot of women.

2. Underwired bras cause breast cancer.

There is no evidence to suggest wearing a tight fitting bra or an underwired bra can cause breast cancer.

3. Bruising the breast causes breast cancer

There is no evidence that injury or trauma to the breast causes or increases the risk of breast cancer.

4. Breast pain means breast cancer

Breast pain(or mastalgia) is quite common: about two thirds of pre-menopausal women will experience some degree of breast pain during their lives. Breast pain may be cyclical (related to the menstrual cycle) or non-cyclical and does not mean breast cancer is present.