Dear doctor;

How best can one spot breast cancer lump during self-test? A woman’s breast usually has some lumps, more so for one breast feeding. Is only painful lumps that can be spotted?

Lucky, 33.

Dear Lucky,

Breast cancer can be spotted easily by self-examination of the breasts. It is for this reason women are encouraged to do self examination of the breasts. This is more useful for women with risk factors for breast cancer. These are those  who have a family history of breast cancer, no children or  few children, advancing age, taking birth control pills for long time or estrogen replacement therapy after menopause, obesity, consumption of alcohol, among others. There are other causes of breast lumps also. But a hard, painless lump is always highly suggestive of breast cancer, unless proved otherwise by a biopsy examination.

Lumps which occur in a lactating mother are usually soft to firm and slightly painful, due to engorgement of the milk ducts. In case of infection and inflammation of the milk ducts, there would be a swollen, painful lump that would be tender to touch.

Middle-aged women experience pain and heaviness over breasts particularly around menstruation which occurs due to hormonal changes in the body. Fibroadenomas are benign tumors of the breast, which are diagnosed by biopsy.

But a hard painless  lump, howsoever small, is more likely a breast cancer. One can stand in front of the mirror keeping hands on the hips. Any change in nipple if it is puckered or scarred, any change in skin color or contour over the breasts, any discharge can also be noted, because they are also early signs of malignancy. Then one by one all 4 quadrants of the breast, should be palpated by flat of the hand. It can also be done while lying down. If any lump is felt even if doubtful, one should go for mammography, that is, special X-ray of the breast with a dye. If a lump is confirmed, a timely biopsy examination can confirm or exclude the diagnosis If the lump is cancerous, early surgery can cure it and prevent further spread.