What is the treatment for a lump in the breast?

Q: My wife is 37 years old. Seven months back she developed a large moving lump in her left breast just after her monthly period. We got a mammography done, but the results were negative. The doctor advised some hormonal medicines and all was ok. Last month my wife took some medicines to postpone her periods. Just a day after her period this time, the same lump appeared. There is water discharge from the nipple (no blood). The doctor advised a needle biopsy test. She was in pain just after her periods but now it is receding. Is it possible that the mammogram could not detect malignancy in case the lumps are large? Can we wait till next month for the needle test? This is because I want to get it done in Mumbai instead of Jamshedpur where I am now. Please advise.

A:Let me answer your question serially.

1. Mammography is used to detect small, impalpable (which cannot be felt) breast cancers. There is no way, at least there are no published reports, that mammography can miss large breast tumours.
2. Going by the history of your wife, the lump does not appear to be malignant because breast cancers are almost always painless to start with. However, there is no harm in getting a FNAC (needle test) done. You can also repeat a mammography supplemented by an USG of the breasts. Since there is a nipple discharge, a cytology of the fluid can also be done before a needle test is performed.

Most likely your wife is having fibroadenoma of the breast, which is essentially benign, but can turn malignant in rare cases. If a fibroadenoma is diagnosed and she is symptomatic, then it can be surgically removed and the lump can be subjected to pathological examination.