Dear Doctor,

My breasts sometimes get lumpy and itchy a few days before my periods. The lumps have become persistent but I’m told that they could mean different things and that I should not be worried of cancer.  What should I do whenever I find lumps and how can I tell if I have a problem? Aisha

Dear Aisha,

Whatis your age at present? Since how many days you have this feeling of a lump around periods? It is true that cancer of the breast presents as a lump. However more than 90% of breast lumps are benign and are harmless.

Fibrocystic disease of the breasts is a benign condition, where the breasts feel heavy and lumpy.  A vague lump may be felt which may not be fixed and moves freely. There may be associated pain. But it is a harmless condition. Many women experience some heaviness over breasts and even swelling over feet before menses. This occurs due to the increased levels of progesterone, Due to effect of progesterone, there is fluid retention.  It may be more pronounced around menopause and may disappear after menopause. Progesterone containing hormonal pills may also sometimes produce this feeling.

One may have a lump over the breast, simply due to a lipoma, which is just a deposition of fat. It forms a soft painless swelling, which can occur anywhere over the body including the breasts.  Recent gain in weight can also give a lumpy feeling to the breasts, as breasts are composed of fatty tissue.

Fibroadenoma is a benign tumor of the breast and would feel like a firm swelling over any part of the breast. A biopsy confirms its presence and it can be cured by surgical removal.  Another benign tumor which can occur in the breast is an intraductal papilloma. It is a non-cancerous growth that occurs in one of the milk ducts. It usually occurs in women of ages around 35 to 50 years. It gives rise to feeling of a lump in the breast. Some women may experience discomfort over the breast and a discharge from the nipple.

In contrast, breast cancer occurs commonly in women over 50 years. There is a hard, fixed and painless lump, which is very clearly demarcated. In addition, if it has spread to surrounding tissues and lymph nodes, small swellings may be felt in the armpit or below the shoulder bone as well. Diagnosis can be confirmed by imaging techniques like mammography and a biopsy taken from the lump. Treatment depends on the stage of the cancer and could be surgery, chemo or radiotherapy or a combination of these.

Itching over the breasts can be due to multiple reasons. It may be simply due to dryness of the skin. Allergy to any body care product used or the material of brassiere worn can cause itchiness. One may also have it due to eczema.

If the lump is persistent or changes its texture, I suggest that you seek medical advice and undergo tests to exclude any harmful condition.

Dr. Rachna Pande is a specialist in internal medicine.