7 Answers to your questions about breast cancer

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by Professor Justus Apffelstaedt

Have you recently found a lump in your breast? While it’s advisable to see a doctor, Professor Justus Apffelstaedt, Head of the Breast Clinic, Tygerberg Hospital, offers answers for the questions about breast cancer that many people have after discovering a lump.

Q: Does this mean that I have breast cancer?

A: Not necessarily – actually the majority of lumps seen by doctors are not cancerous. Benign lumps are common in young women. In women above the age of 25 cancer, while still rare, must be excluded by needle biopsy before the lump can be accepted as benign.

Q: So what happens now? How do I find out whether the lump is benign or cancerous?

A: In women under the age of 35, a needle biopsy is sufficient to confirm the diagnosis of a benign lump. Above 35, a mammogram, ultrasound and needle biopsy are mandatory and in that order.

Q: What questions should I ask a mammography centre to make sure that they know what they’re doing?

A: You should ask how many mammograms do you do every year? Will your mammogram be done by a certified mammographer? Will your mammogram be read by two readers? How many cancers do you pick up per 1 000 mammograms? Do you do needle core biopsies?

Q: Do you think I need to have a biopsy? If no, why not?

A: See the first and second answers.

Q: Do I have to go to hospital to have a biopsy?

A: No. You should ask for the diagnosis to be established by needle core biopsy; if necessary under imaging (mammographic or ultrasound) guidance.

Q: What kinds of benign breast conditions are there?

A: Fibroadenomas are benign lumps in the breast. They are common in young women and often disappear spontaneously. They are sometimes (and rarely) removed because they are tender or keep on enlarging.

Q:  Does having a benign breast change mean I am at greater risk of developing cancer?

A: Yes and no. Most benign conditions do not signify an increased risk of breast cancer. Only what doctor’s call hyperplasia (a condition in which there is an increase in the number of normal cells in a tissue or organ), especially if coupled with atypia (atypical cells, or slightly abnormal), indicates an increased risk of breast cancer.

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