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Strict judge Shirley Ballas revealed last week that she “worries every time the phone rings” as she awaits the results of a biopsy on her left breast.
Shirley, 63, has revealed that a routine mammogram detected abnormalities in her left breast, and when a further mammogram detected “lumpy tissue”, doctors decided to investigate further with a biopsy.
Shirley only went ahead with the mammogram, she says, after strictly professional dancer Amy Dowden, 33, who was diagnosed with breast cancer last year, asked her to.
Shirley Ballas posted on Instagram about the importance of getting a mammogram
Around 55,000 women are diagnosed with the condition each year in the UK and, in 90 per cent of cases, it can be treated successfully if caught early.
Many women may believe they only need to watch out for lumps, but breast cancer can cause other symptoms, such as dimpling or a rash on the breast, nipple discharge, or a change in the size and shape of the breast, explains Lester Barr. . Breast cancer surgeon at Manchester’s Christie Private Hospital, who is also founder and chairman of the Prevent Breast Cancer charity.
“The existence of a lump alone may not be cancer,” says Mr. Barr. “If ten women come to a breast clinic with a lump, nine are likely due to something other than the disease.
“The key is not to rule out anything new or unusual.”
Any woman who finds a lump in her breast should seek medical attention if it is still present after a fortnight (or sooner, if she is concerned).
But while it is natural to fear that a lump in the breast means cancer, this is true in only a minority of cases. And today, modern scans often make it possible to quickly determine whether it is a life-threatening cancer or a harmless cyst.
Here, Mr. Barr explains what else lumps found in the breast may be.
Hard lump after an injury, perhaps with bruising
POSSIBLE CAUSE: Hardened fat.
If you have received a blow to the chest area, for example caused by a seat belt pull or a blow to the area, it can lead to swelling known as fat necrosis or hardened fat, especially if there is also bruising.
As the swelling of the hematoma decreases, the underlying fatty tissue hardens and forms a lump, usually about 2 to 3 cm in diameter, which can sometimes be painful.
TREATMENT: Fat necrosis may look like cancer on a mammogram, so a core biopsy (a procedure in which a needle is passed through the skin to remove a sample of tissue from a mass or lump) is usually performed. “However, once fat necrosis is confirmed, no further treatment is necessary,” says Mr Barr. “The lump can be left alone as it will gradually disappear, although it may take months to fully settle.”
Suddenly a painful, soft lump appears.
POSSIBLE CAUSE: A breast cyst.
These are tender fluid-filled sacs (the surrounding skin may look a little red) and the cyst may appear suddenly during the night. These are most common in women aged 40 to 60 and are thought to be due to changes in hormonal levels.
In nursing mothers, another form of this type of lump may occur, which, rather than being filled with fluid, is filled with milk. This is called a lactate cyst or galactocele.
TREATMENT: It is a matter of choice, explains Mr Barr. “The fluid can be drained with a small needle, but some patients prefer not to, possibly because they don’t like needles.”
Left alone, he adds, about a third of the cysts will get smaller, a third will stay the same size, and a third will grow larger within a few months.
Cysts are less common in women over 70 years of age. However, if they occur at this age, the fluid may be sent for testing.
“Sometimes a cyst in this age group can hide a small cancer caused by the fluid,” explains Mr Barr.
Soft lump measuring no more than 5-6 cm wide
POSSIBLE CAUSE: A hamartoma.
This is a benign growth of all types of normal breast tissue that has grown in a disorganized manner (compared to cancer, which is an overgrowth of abnormal cells). It will feel like normal breast tissue.
These lumps, which can appear anywhere on the body, can be hereditary. The exact cause is unknown.
TREATMENT: “There is no need to do anything,” says Mr. Barr, “unless the hamartoma becomes very large and painful, in which case it can be removed surgically.”
Hot, painful lump when breastfeeding
POSSIBLE CAUSE: A breast abscess.
When a baby feeds, bacteria from the mouth can enter the breast tissue and cause an infection. This can cause an abscess, a small pus-filled pocket that can grow 5 to 10 cm.
TREATMENT: The pus can be drawn out with a syringe after the area has been numbed with local anesthetic in a clinic, combined with a course of antibiotics.
‘Abscesses tend to reappear after a few days, so the process may need to be repeated several times before they disappear. However, breastfeeding also has a protective effect against cancer,” says Mr Barr.
Oval-shaped lump that moves
POSSIBLE CAUSE: Fibroadenoma.
Most common in women ages 20 to 30, although it can occur at any stage of life, a fibroadenoma forms when healthy glands and connective tissue in the breast clump together. This causes a lump, about 1 to 2 cm wide, that can move within a small area of the breast.
(When they occur in women in their late teens or early 20s, these lumps can develop as a “giant” fibroadenoma, which can measure 8 to 12 cm or larger.)
A fibroadenoma may feel like crowded peas. There is no clear reason why they occur, although it may be that some women have so-called “sensitive” breast tissue, which reacts to changes in hormone levels, and this can trigger the growth of fibroadenomas.
“In some patients, they can grow quite large,” adds Mr. Barr.
TREATMENT: “Fibroadenomas don’t increase the risk of cancer, so we tend to leave them alone,” says Mr. Barr, “although we will remove them surgically if they are very large or start to grow.”
Small lump that moves
POSSIBLE CAUSE: A lipoma.
They occur when fat cells clump together under the skin. The cause is unknown (it is not related to weight), but they may be hereditary.
These painless lumps, which feel soft and squishy, can be found all over the body except the palms and soles of the feet (because there is no fat in these areas).
TREATMENT: Small lipomas of 1-2 cm may remain, as they are harmless. The largest ones can be removed, because if they grow (they can grow up to about 18 cm) they can put pressure on other surrounding structures and cause discomfort or pain. This can almost always be done with local anesthesia.
Firm, round lump that moves
POSSIBLE CAUSE: Phyllodes tumor.
Similar to fibroadenomas, but much rarer, these tend to grow larger, up to 2-5 cm on average. They are made up of glandular and connective tissue of the breast, which helps support the breast and give it shape.
They are rare and can occur anywhere in the breast.
‘The vast majority of these types of lumps are harmless [benign]but around 10 per cent may be cancerous, known as malignant phyllodes tumours,’ says Mr Barr.
TREATMENT: The lump is usually removed surgically and then tested for cancer, since core biopsies cannot always determine whether a phyllodes tumor is cancerous.
Small lump under the nipple
POSSIBLE CAUSE: A papilloma in the breast.
They are made up of a group of glandular cells. The glands are located just behind the nipple and produce milk during breastfeeding.
The lumps feel soft and round, like fibroadenomas, but they are not motile, meaning they do not move.
There is often discharge, which may be clear or even bloody, that is not specifically related to breastfeeding.
They usually grow no larger than the size of a marble and can occasionally be painful.
TREATMENT: A core biopsy will be needed to prove that they are benign, although it is not always easy to tell.
“If there are any question marks, they are surgically removed,” Barr says.
SYMPTOMS TO LOOK FOR
■ New lump or thickening in the breast or armpit.
■ A change in the size, shape, or feel of your breast.
■ Changes in the skin of the breast, such as wrinkles, dimples, rash, or redness of the skin.
■ Nipple leakage in a woman who is not pregnant or breastfeeding.
■ Changes in the position of the nipple.
Source: Cancer Research UK
