Sarah is 36 years old and saw me today after her recent lumpectomy. She initially came to see me a few weeks ago with a very painful and very large left breast swelling.
It’s a terrifying heart sink moment for any woman to feel a breast lump.
Of course, naturally, you think of your grandmother who had breast cancer and that work colleague still on sick leave battling chemo side effects and that poor Mum in your daughter’s school year taken by breast cancer still in her 30’s… We have all been touched by Breast Cancer inv some direct or indirect way.
Knowing that 1 in 8 women will develop breast cancer in their lifetime means in my General Practice, every breast lump should be considered as cancer until proven otherwise. Taking the emotion out of it, while the priority for ALL breast lumps is to exclude breast cancer, many more lumps are in fact benign.
Hi, I’m Dr. Suzie. I am a Sydney-based practicing GP. BTW, If you think you have a breast lump, don’t be complacent, make an appointment with your GP and get it checked because yes, breast cancer can strike anyone, even young mums!
In Sarah’s case, she didn’t have breast cancer!🙏 Her ultrasound actually showed a complicated breast cyst.
So why did she have it removed surgically when we all know Breast Cysts are benign?
We often don’t spare a thought that non-cancerous breast lumps sometimes need to be cut out too!
Deciding if a lump needs to be cut out or monitored is often best handled by the expertise of a Specialist Breast Surgeon. Which is exactly why I asked Dr Michael Yunaev, Sydney Specialist Breast Surgeon from Breast and Body Clinic what signs, even in common benign breast conditions, like Sarah’s seemingly harmless breast cyst, would make him err on the side of caution and cut it out rather than observe it over time.
Here are 6 suspect breast signs a surgeon should be involved in your care:
1 – IT CHANGES SIZE:
When a benign breast lump being monitored over time changes in size, cutting it out to look at the whole lump under the microscope is often needed to confirm there is no cancer in there. This can often happen with fibroadenomas, which account for about 12% of all breast lumps (3) particularly in the 21–25 years age group.
They are a common finding during breast assessment and may even be picked up incidentally. “They can be managed conservatively most of the time,” says Dr Yunaev, “but if there is a progressive increase in the size of the lesion or if the lesion is greater than 2.5-3cm, excision should be considered (2). Also, multiple fibroadenomas are associated with some rare cancer syndromes, such as Maffucci syndrome, Cowden syndrome and Carney complex. Fibroadenomas that develop in these kindred should be excised too(1).”
2 – IT HAS ATYPICAL FEATURES
A super common ultrasound finding for a benign Breast lump is a Breast cyst. Normally these require reassurance only. However, specialist surgeons may decide to remove them surgically, particularly if women are bothered by their large and recurrent size or if the imaging and biopsy assessment indicates any “atypical features’”, which means cancer can’t be excluded, or like in the case of Sarah, complex cysts (which are not to be confused with simple cysts) may require surgical intervention, because of possibility of cancer in these lesions (4).
3- IT DISCHARGES
Nipples that discharge clear or bloody fluid should definitely be referred to Specialist Breast surgeons for assessment. Most of the time only a small proportion of papillomas have a risk of cancer associated with them.
These patients will need a surgical investigation of their symptoms to rule out the possibility of cancer and to excise the papillomas(4).
4 – IT BELONGS TO A MAN.
Man Boobs a.k.a Gynaecomastia, which you can read more about here is a highly embarrassing condition psychologically and hence does justify surgical intervention. Sometimes a breast lump in a man may be confused for Gynaecomastia, which is why all these patients require a full work up to exclude rare, but deadly male breast cancer.
5 – IT GROWS RAPIDLY.
Things that grow rapidly make everyone nervous. “ Lumps that are Pseudoangiomatous Hyperplasia (PASH) can often be fast growing. They are sometimes incidentally discovered on a biopsy performed for another reason or could be the cause of the large new lump. While generally benign, they can mimic fibroadenomas, phylloides tumour or even angiosarcomas (cancer). They also can be rapidly growing to a large size and therefore can cause a lot of distress to the patient and sometimes this means they are better cut out.”
6 – IT IS SYMPTOMATIC
Sometimes the lumps may be proven to be benign, but nevertheless cause a significant amount of discomfort or even pain, particularly in association with menstrual cycles. This alone is often enough of a reason to have them removed. No one wants to put up with painful, tender lumps on a daily basis for years upon years.
For Sarah, the pathology results today of her complex large breast cyst with atypical features removed at surgery was fortunately benign 🙂 However, she didn’t for one second regret the lump being excised. She was relieved.
Dr Yunaev and I both recommend to our patients that any woman, uncertain or concerned about features of a benign breast condition growing suspiciously or causing discomfort should consider referral to a Specialist Breast Surgeon to help them make the decision about whether it’s safer to simply cut it out or safe to leave it alone.
(1) Jayasinghe Y, Simmons PS. Fibroadenomas in adolescence. Curr Opin Obstet Gynecol 2009;21(5):402–6.
(2) Management of benign breast conditions – painful breasts, M. Brennan, N.Houssami, J.French, Australian Family Physician, 03/2005, Volume 34, Issue 3
(3) Management of benign breast conditions -breast lumps and lesions, M. Brennan, N.Houssami, J.French, Australian Family Physician, 04/2005, Volume 34, Issue 4
(4) Benign breast disease, Amin, Amanda L, Purdy, Anna C, Mattingly, Joanne D, The Surgical clinics of North America, 04/2013, Volume 93, Issue 2