Is it breast cancer, fibrocystic mastopathy or benign nodules?

Breast screening aims at early diagnosis and prompt treatment and therefore improves prognosis and outcome. [iStockhoto]

A self-breast exam might reveal a lump or lumps, causing worry about the possibility of breast cancer. It’s crucial to understand the different conditions associated with these lumps. Experts advise seeing medical professionals for screening and effective examination of our breasts.

Breast cancer is a malignant tumour that can spread to other parts of the body if not detected early. According to Professor Belén Merck, a surgeon and Head of the Department of Surgery and Medicine at the University of CEU Cardenal Herrera, breast cancer is the most frequent tumour in women globally.

The International Agency for Research on Cancer (IARC) estimates ranks female breast cancer as the second most occurring cancer worldwide and the number one cancer in women, with 2.3 million cases and 670, 000 deaths.

In Kenya, according to the National Cancer Registry Data for 2021/2022 reported breast cancer as the most common cancer, accounting for 12.5 per cent of cases. Along with cervical cancer, it contributes to 23 per cent of cancer-related deaths.

Symptoms of breast cancer may include; a lump or mass in the breast that feels different from the surrounding tissue, a change in the size, shape or appearance of the breast, nipple discharge or inversion and skin changes on the breast, such as dimpling or redness.

“However, not all nodules that appear in the breasts are cancer. It often takes years for a malignant tumour to actually appear, though it may be slowly growing without symptoms. Pain or enlargement of the breast is rarely related to malignancy,” says Prof Merck.

Early detection is key. “The best method for the early detection of breast cancer is a mammogram,” emphasises Prof Merck. Other diagnostic tools include ultrasound, MRI and biopsy.

Treatment depends on the stage and type of breast cancer but may include surgery, radiation therapy, chemotherapy, hormone therapy and targeted therapy. Multidisciplinary care involving surgeons, oncologists, radiologists and nurses ensures the best treatment plan.

Fibrocystic mastopathy is a common condition and is not considered a disease. “Fibrocystic mastopathy is not a disease. It’s like something that is not functioning adequately, but it is not a disease,” explains Prof Merck.

It is a general term for a group of benign changes in breast tissues, characterised by multiple cysts, fibrous tissue, lumps and tender breasts, especially before menstruation. It is common in women between 30 and 50 years old.

A physical exam and sometimes an ultrasound are used to diagnose fibrocystic mastopathy. “When we make a breast biopsy, what we find are benign changes,” says Prof Merck. This means the lumps are not cancerous.

Usually, no treatment is needed, but regular check-ups are recommended to monitor the condition. Hormonal changes typically cause fibrocystic mastopathy, which may fluctuate with menstrual cycles and improve after menopause.

According to Dr Ezekiel Mecha, a reproductive endocrinologist and a senior lecturer at the Department of Biochemistry, University of Nairobi, the response to normal hormonal alterations women experience now and then are presented by numerous nodules and small liquid cysts in the breast that can grow rapidly.

“The condition resolves itself after menopause since the hormonal stimulation disappears. It does not predispose anyone to breast cancer” explains Dr Mecha.

Benign nodules are non-cancerous lumps that can appear in the breast. Prof Merck highlights, “When a woman goes to the office of a breast surgeon with a lump, it is probably benign.”

According to studies, a wide spectrum of breast lesions was established in Kenya, with benign lesions being the most common, particularly affecting women aged 16-49 years.

Characterised with single or multiple lumps that are usually painless, lumps that feel firm or rubbery or that move easily under the skin. A combination of a physical exam, ultrasound and mammogram is often used to diagnose benign nodules. In some cases, a biopsy is performed to ensure the lump is non-cancerous.

Most benign nodules do not require treatment. However, if they are large or cause discomfort, surgical removal might be considered. Regular monitoring with mammograms or ultrasounds may be recommended.

Understanding the differences between breast cancer, fibrocystic mastopathy and benign nodules can alleviate some of the fear associated with discovering a breast lump. Regular check-ups, a healthy lifestyle and awareness of changes in your breasts are essential steps in maintaining breast health.

If you find a lump, don’t panic. Consult with your healthcare provider to determine the best course of action. “Information is good for women so that they lose the fear for disease or for going to the physician,” advises Prof Merck.