Beyond the Lump: Essential questions women should ask about breast health

Breast cancer may present in different ways, individual risk varies from one woman to another, and screening recommendations are not necessarily the same for everyone.

This Breast Cancer Awareness Month, specialists across Breast Surgery, Obstetrics & Gynaecology and Oncology answer some of the most important questions women should be asking about breast health, screening, diagnosis and treatment. Because awareness should go beyond knowing breast cancer exists.

It should help women understand when to seek medical advice and what happens next.

“NO LUMP = NOTHING TO WORRY ABOUT… RIGHT?”

Not necessarily. A new breast lump is one of the most recognised symptoms associated with breast cancer, but it is not the only change that requires medical assessment.

Women should also seek medical advice if they notice:

• A new lump or area of thickening in the breast or underarm

• A persistent change in breast size, shape or symmetry

• Skin dimpling, puckering or thickening

• Persistent redness or swelling

• New nipple inversion or change in nipple position

• Spontaneous or unusual nipple discharge, particularly if bloody

• Changes in the nipple or surrounding skin

• A persistent focal breast change that is unusual for you

Importantly, many breast symptoms are caused by benign conditions, including cysts, fibroadenomas, hormonal changes and infections.

However, symptoms cannot always be distinguished reliably by touch or appearance alone.

WHAT HAPPENS WHEN A BREAST CHANGE IS FOUND?

Assessment usually starts with a detailed medical history and clinical breast examination.

Depending on the woman’s age, symptoms and examination findings, the doctor may recommend imaging such as a breast ultrasound or mammogram.

If imaging identifies a suspicious abnormality, further investigation - including a core needle biopsy - may be required to establish a tissue diagnosis.

This combination of clinical assessment, imaging and, when indicated, tissue sampling allows specialists to determine what the abnormality actually represents.

THE QUESTION TO ASK YOURSELF

• Is this new? Is it different for me? Is it persistent?

• If the answer is yes, arrange a medical assessment rather than waiting for the change to disappear.

“I FOUND A LUMP. WHAT HAPPENS NEXT?”

If you notice a lump in your breast, try not to panic. Most breast lumps are not cancerous, but any new or unusual lump should be assessed by a healthcare professional.

The first step is to make an appointment with your doctor or a breast specialist. They will perform a clinical examination and, depending on your age and the characteristics of the lump, may recommend an ultrasound, mammogram, or both. If the imaging suggests that a tissue sample is needed, an image-guided core needle biopsy may be performed for histopathological examination.

Your doctor will consider the clinical examination, imaging, and pathology results together to determine the most accurate diagnosis, identify the nature of the lump, and assess any associated risk. Based on these findings, they will recommend the most appropriate next step, whether that involves routine monitoring, further investigation, or treatment.

The key is to have it assessed without assuming the worst. Once all the information is available, you and your doctor can decide on the right plan together.

IF I HAVE BREAST CANCER, WILL I HAVE TO LOSE MY BREAST?”

Not necessarily.

Breast cancer surgery is individualised.

For selected patients, breast-conserving surgery, where the tumour is removed while preserving most of the breast, may be appropriate.

For others, a mastectomy may be recommended based on the characteristics and extent of the disease, individual risk factors and other clinical considerations.

Doctors may also assess the lymph nodes, particularly the sentinel lymph nodes, to determine whether cancer cells have spread beyond the breast.

Where appropriate, breast reconstruction may be discussed as part of the overall surgical plan.

The objective is not simply to “remove a lump.”

The aim is cancer control while considering breast preservation, function, reconstruction and individual circumstances.

“BREAST CANCER DOESN’T RUN IN MY FAMILY. DOES THAT MEAN I’M LOW RISK?”

Family history is important, but it is only one part of breast cancer risk assessment.

When assessing an individual’s risk and appropriate screening approach, doctors may consider several factors, including:

• Age

• Personal history of breast disease or breast cancer

• Family history of breast and ovarian cancers

• Known inherited genetic mutations or hereditary cancer syndromes

• Breast density

• Reproductive and hormonal history

• Previous exposure to chest radiotherapy

A strong family history may mean that a woman requires a more individualised risk assessment and potentially a different surveillance strategy.

But having no known family history does not eliminate the possibility of developing breast cancer. That is why the more useful conversation with your doctor isn’t simply: “Do I need a mammogram?” It is: Based on my age, history and invidual risk, what screening is appropriate for me.

“BUT WOULDN’T BREAST CANCER HURT?”

Not necessarily. Breast cancer can be painless, particularly in its earlier stages. Waiting for pain or another obvious symptom before seeking medical advice can therefore be misleading.

Screening is different from investigating symptoms: screening is intended for women without symptoms, while a new breast symptom requires clinical assessment regardless of when your routine screening is due.

BREAST SCREENING: WHAT’S THE DIFFERENCE?

Mammography uses low-dose X-rays to identify abnormalities within breast tissue, including changes that may not be palpable.

Breast ultrasound uses sound waves to assess areas of concern, including distinguishing some fluid-filled cysts from solid masses. It is often used to investigate breast symptoms.

“I’VE BEEN DIAGNOSED WITH BREAST CANCER. WHAT HAPPENS NOW?”

A breast cancer diagnosis begins a detailed medical assessment as the treatment can vary between patients.

Doctors evaluate several characteristics such as:

• Tumour type

• Tumour size and grade

• Lymph node involvement

• If the disease has spread elsewhere in the body

• Estrogen and progesterone receptor status

• HER2 status and also tumour and patient-specific factors. These findings help determine the stage and biological subtype.

“DOES EVERYONE NEED HEMOTHERAPY?”

No. Treatment is based on the biology and stage of each patient’s cancer.

Depending on the diagnosis, treatment may include:

Surgery: Removes the tumour and, when appropriate, assesses nearby lymph nodes.

Radiotherapy: Reduces the risk of cancer returning in the breast or surrounding tissues.

Chemotherapy: May be given before or after surgery, depending on cancer type and stage.

Endocrine (Hormone) Therapy: Reduces hormonal stimulation in hormone-receptor-positive cancers.

Targeted Therapy: Certain breast cancers have specific molecular targets. i.e., HER2-positive breast cancers may be treated with HER2-directed therapies.

Immunotherapy: May be good for selected patients depending on the breast cancer subtype, stage and other clinical factors.

Systemic treatment may be given before surgery (neoadjuvant therapy) to shrink the tumour and assess response, or afterwards (adjuvant therapy) to reduce recurrence risk.

THIS IS WHY MULTIDISCIPLINARY CARE MATTERS

Breast cancer management can involve breast surgeons, medical oncologists, radiation oncologists, radiologists, pathologists and other specialists working together to develop an individualised treatment plan.