Breast cancer is now the most common cancer among Indian women, and it tends to present at a younger age and at a later stage than in Western countries. Late presentation is the main reason outcomes lag, and that is a problem of awareness rather than of medicine.
Most lumps are benign. All new ones should be checked.
Knowing What Is Normal for You
Formal monthly self examination with a rigid technique has fallen out of favour as a screening method. What replaced it is more useful: breast awareness, meaning familiarity with how your own breasts normally look and feel.
Breasts change through the cycle, becoming lumpier and more tender before a period. The best time to check is a few days after your period ends. After menopause, any time of the month is fine.
Look in a mirror with arms down and then raised, and feel with the flat of the fingers in a systematic pattern covering the whole breast, up into the armpit and the collarbone area.
Changes That Need Assessment
See a doctor for any of these, without waiting to see if they resolve.
- A new lump or thickening in the breast or armpit
- A change in size or shape of one breast
- Dimpling or puckering of the skin
- Skin that looks like orange peel
- A nipple newly turned inward
- Discharge from the nipple, particularly if bloodstained or from one duct
- A persistent rash or scaling on the nipple
- Persistent pain in one specific area
- Redness or swelling of the whole breast, which can indicate an aggressive form
Painless lumps are more concerning than painful ones, which is the opposite of what most people assume and a common reason for delay.
Most Lumps Are Not Cancer
The majority of breast lumps assessed turn out to be benign, and knowing the common ones reduces unnecessary fear.
- Fibroadenoma: smooth, firm, mobile, common in women under thirty
- Cysts: fluid filled, often appearing suddenly and sometimes tender, common in the forties
- Fibrocystic change: generalised lumpiness varying with the cycle
- Fat necrosis: a firm lump following injury
- Breast abscess: a painful, red, hot swelling, often during breastfeeding
None of these becomes cancer. But they cannot be distinguished from cancer by feel alone, which is precisely why assessment is needed rather than reassurance from a friend.
What Triple Assessment Means
Any significant breast lump is assessed in three ways, and the combination is far more accurate than any single element.
- Clinical examination by a doctor experienced in breast disease
- Imaging: ultrasound for women under about thirty five, since younger breast tissue is dense, and mammography with or without ultrasound for older women
- Tissue sampling: a core needle biopsy where imaging or examination raises concern
A core biopsy is done under local anaesthetic and takes a small cylinder of tissue, which gives far more information than a fine needle sample. It is uncomfortable rather than painful.
When to Start Mammography
Screening recommendations vary, and Indian guidance reflects the younger age at presentation here.
- From 40 to 74: mammography every one to two years is widely recommended
- From 30 to 39: clinical breast examination, with imaging where there are symptoms or high risk
- High risk women: earlier and more frequent screening, sometimes with MRI, beginning ten years before the age at which a close relative was diagnosed
- Any age with symptoms: diagnostic imaging, which is different from screening and is not age restricted
Mammography is uncomfortable for a few seconds because compression is necessary to spread the tissue. The radiation dose is very small and the benefit substantially outweighs it in the screened age group.
Who Is at Higher Risk
Most women who develop breast cancer have no identifiable risk factor beyond being female and getting older. Some factors do raise risk meaningfully.
- A mother, sister or daughter with breast or ovarian cancer, particularly diagnosed young
- A known BRCA1 or BRCA2 mutation in the family
- Early first period or late menopause
- No pregnancies, or a first pregnancy after thirty
- Not having breastfed
- Obesity after menopause
- Regular alcohol intake
- Previous chest radiation
A strong family history warrants a formal risk assessment rather than simply worrying about it, since it changes the age at which screening should begin.
What Genuinely Reduces Risk
Several of these are within your control and have reasonable evidence behind them.
- Maintaining a healthy weight, particularly after menopause
- Regular physical activity, which reduces risk independently of weight
- Limiting alcohol
- Breastfeeding, which is modestly protective and cumulative over months
- Not smoking
Underwire bras, deodorants and mobile phones in pockets do not cause breast cancer. These persistent claims distract from the measures that actually work.
Breast Problems During Breastfeeding
Lumps during lactation are usually blocked ducts or mastitis, and they respond to continued feeding, massage and antibiotics where infection is present.
The important caveat is that a lump which does not resolve within a couple of weeks of appropriate treatment still needs imaging. Pregnancy and lactation associated breast cancer is uncommon but is frequently diagnosed late because symptoms are attributed to feeding.
Our feeding support service can distinguish the common problems, and refer onward where a lump persists.
The single most useful thing you can do for your breast health is to know what is normal for you, and to act promptly when something changes. Most changes are benign, and the ones that are not are far more treatable when found early.
For a breast examination or to arrange mammography, contact our gynaecology department or radiology team at T. Nagar, Chennai.
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