Breast Screening

Many women find at some time in their lives that their breasts give them cause for concern. Breasts may become tender, painful, or have an obvious change such as a lump or a discharging nipple. Most breast problems are not caused by cancer.

Benign (harmless) breast problems are very common. Most women notice cyclical changes in their breast tissue and seek help only if that normal pattern changes. Here women discuss their experiences of common breast problems, most of which occurred before they were old enough to be invited for regular screening.

Breast pain is experienced by two out of three women. Some of the women we spoke with said they'd had breast pain at some time in their lives. One said she sometimes had breast pain when she was tired. Another, who'd had some ongoing breast pain, was referred by her GP to hospital, where a consultant examined her. She was told the pain was harmless and it went away by itself.

Breast lumps are also common, and the type of lump varies with age. In younger women, the most common type of breast lump is a fibroadenoma. A fibroadenoma is a single lump of fibrous breast tissue usually found in women aged under 35. It can be quite large and feels firm yet mobile. Although benign, it may have to be removed surgically. Several women we spoke with had had a fibroadenoma in the past, and many could not remember much about it. One said she'd had several benign lumps at a younger age, some of which had been fibroadenomas.

Some women had had breast lumps at a younger age that they didn't know the names of, only that they were benign. One of these women said that finding a lump frightened her but her GP dismissed it. She was afraid to do anything about it for a year until a friend persuaded her to go to hospital. A new GP referred her to hospital, where the lump was removed and found to be benign. Like many other women, she found waiting for results extremely worrying. Several women had had breast lumps removed and regular mammograms afterwards to make sure there were no further problems. One woman said a breast lump she found when she was in her twenties turned out to be an in-growing follicle and totally harmless.

In women approaching the menopause, the most common breast lump is a fluid-filled sac called a cyst. Cysts may feel soft or firm and can sometimes be quite painful. Women are usually checked by a consultant who 'aspirates' or draws off the fluid using a syringe with a very fine needle. The fluid is usually only sent to a laboratory for testing if the fluid is blood-stained. Cysts do return but can always be treated in the same way. Some women we spoke with discussed having cysts. 

One woman had found a lump which turned out to be a cyst. It was aspirated, and then returned a few times, and was aspirated again. Another woman had a cyst which got inflamed. She received antibiotics on several occasions and it was eventually removed surgically. One woman discussed her anxiety when she found a breast lump because she thought it could be cancerous. It turned out to be a cyst and was removed surgically. A few women had had breast lumps that went away on their own.

Nipple changes can manifest as a discharge, nipple retraction or skin change. Some women said they'd had nipple changes that turned out to be harmless. One woman, whose mother had died of cancer said a bleeding nipple was examined in case it was something serious. It was found to be harmless and the bleeding stopped of its own accord. Another woman had a benign polyp which caused bleeding from the nipple.

One woman who was recalled for further tests after screening had white dots (microcalcifications) on her mammogram, which she was told were harmless. Another, in whom screening identified an early form of breast cancer, had several benign lumps removed at the same time as her cancer. Other benign breast problems include:

• duct ectasia (ducts under the nipple can become inflamed, cause nipple discharge and sometimes lumps and inverted nipples. It is non-cancerous)
• periductal mastitis (when the ducts under the nipple become inflamed and infected)
• fat necrosis (a lump can form if fatty breast tissue is damaged – a bruise or injury to the breast)
• hyperplasia (sometimes normal cells within the breast grow bigger and increase in number- it doesn't produce any symptoms or cause pain and is non- cancerous).

Although benign breast conditions are more common than breast cancer, breast symptoms can be worrying because women often associate them with cancer. Waiting for test results or analysis of lumps removed surgically can be agonising, and some women said they had little support in this situation. However, one woman said she became blasé because she'd had so many lumps removed that were all benign. Another did not worry about her lump because she knew it was behaving like a benign cyst.

A couple of women who had a breast lump removed were asked to give written consent before their operation to removal of their whole breast if cancer was found during the operation. One refused, but the other agreed and said the first thing she did on waking was to feel for her breast, which was still there.