Q  Beberapa bulan yang lepas puting payudara saya sedikit bengkak dan mengeluarkan nanah dan darah. Apakah ini tand-tanda barah?

NT, 10 Okt 2002

A Ada beberapa sebab terdapatnya lelehan puting, dan ini juga termasuk kelainan yang bukan kanser. Kemungkinan juga ini merupakan infeksi. Tetapi tanpa pemeriksaan, ini tidak dapat dipastikan. Saudari disyorkan berjumpa dengan doktor untuk pemeriksaan yang teliti. Kemungkinan besar, saudari juga akan memerlukan pemeriksaan radiologi.  

Pengarang
 

Q I am 32 yrs old. Last year I had a breast lump which I found myself through breast self examination. It turned out to be a lipoma, which I have been told is completely harmless. Is it a precursor to anything more serious? The doctor couldn't tell me exactly what caused it. They took quite a large lump out of my left breast. It can be quite tender in this area. I have noticed a small pea sized lump where the lipoma was taken out, I'm not sure if this is scar tissue or not. I will go to my doctor if it remains, though I will feel a fool if that is all it is. Any advice? 

MF  4 Oct 2002

A A lipoma is a tumour made up of fat and it is benign (non-cancerous). Since it has been removed, there is no need to worry. However you should continue to perform regular self breast examination with the correct technique (detailed in the section on SBE) as we need to continue to be aware of our breast and its changes. 

You report possibility of a pea sized lump and if you never noticed it before much earlier on after your surgery, you should immediately seek the advice of your doctor. You should not feel “silly” at all for getting any symptoms or signs in your breasts checked out by your doctor. It is exactly what we are trying to encourage, that the moment any unusual changes (which may not mean just lumps, it could be skin thickening, skin dimpling or “hardening” of an area of the breast) are detected, you should see your doctor or breast care nurse immediately.  

If what you feel turns out to be most likely scar tissue, at least you would have had a professional opinion and examination to check it out. 

Editor
 

Q I fear that there are lumps in my breast. And recently it started to feel uncomfortable. I really want to see a doctor. Anyway, the clinic that I usually visit only has male doctors. And this makes me feel quite uncomfortable and shy to talk to him about this matter. I would be grateful if you could advice me what to do next. 

RAR 14 Sep 2002

A Bravo! It’s good to hear that you want to see a doctor about what worries you in your breasts. That’s the message we want to give to everyone. Any abnormality that you think is outside the “normal” for your breast texture warrants a visit to the doctor.  

As a female myself, I understand why you would feel uncomfortable seeking consultation with a male doctor. Perhaps, you could go to another clinic where there is a female doctor although it may not be your regular clinic. Otherwise, you may try the Breast Clinics in Hospital Universiti Kebangsaan (Cheras, Kuala Lumpur), University Malaya Medical Centre, Hospital Kuala Lumpur (Jalan Pahang, Kuala Lumpur) and Hospital Putrajaya. If you are from outside of Selangor/Federal Territory, you could enquire with the general hospitals in each respective state.   

Even at the breast clinics, not all doctors attending to you will be female. However, there will be a female chaperon (normally the attending nurse) to ensure you will not be too uncomfortable. The same applies at the private clinics/centres too, where there will be a female chaperon present when the male doctor needs to examine your breasts. 

Finally, if you still cannot find a suitable clinic with a female doctor, perhaps, you could go with your mother or friend to give you support and be present in the examining room with you to make you less shy. 

Editor
 

Q Saya berusia 25 tahun dan mempunyai seorang anak berusia 1 setengah tahun.  Sebelum saya bersalin anak pertama, permukaan puting sebelah kiri tidak pecah tetapi selepas bersalin saya sedari bahawa puting payudara di sebelah kiri di bahagian atas seperti pecah, tidak padat permukaannya. Saya ingin tahu adakah itu salah satu simpton kanser payudara? Bagaimana prosedurnya, jika saya ingin melakukan pemeriksaan di Hospital Putrajaya? Bolehkah pemerikasan ini dilakukan di klinik-klinik swasta?

KZ 12 Sep 2002

A Ada pelbagai sebab kenapa kulit di sekeliling puting atau dipanggil "areolar" pecah. Adakah Puan menyusukan anak? Jika ya, sebab utama mungkin sekali adalah akibat gigitan dari anak semasa penyusuan. Kulit di bahagian areolar amat sensitif dan dengan hanya gurisan atan luka kecil akibat gigitan semasa penyusuan boleh menyebabkannya pecah.  

Sebab-sebab lain termasuk, jangkitan pada kulit, alergi, ekzema dan juga tanda bagi kanser payudara (Paget's disease). Pada usia yang muda ini kemungkinan sekali disebabkan oleh bukan kanser tetapi puan dinasihatkan untuk berjumpa dengan doktor pakar dengan segera untuk pemeriksaan lanjut.  

Rawatan boleh didapati pada mana-mana hospital kerajaan yang mempunyai pakar bedah. Klinik Payudara dan Pakar Payudara boleh didapati di Hospital Kuala Lumpur, Hospital Putrajaya, Hospital Universiti Kebangsaan dan Pusat Perubatan Universiti Malaya (dulu dikenali sebagai Hospital Universiti). Secara amnya, puan boleh pergi ke mana-mana klinik pesakit luar kerajaan untuk mendapatkan surat rujukan ke Klinik Payudara dan membuat temujanji.  

Rawatan di klinik-klinik swasta boleh didapati, tetapi puan disyorkan untuk memastikan bahawa doktor yang merawat puan adalah yang arif mengenai masalah-masalah berkenaan dengan payudara. 

Dr Nor Aina Emran
Pakar Bedah, Unit Payudara dan Endokrin,Hospital Putrajaya
 

Q I'm having two lumps in my left breast and after going through the mammogram and biopsy, they are not cancerous. So I decided to just let it be until lately when one of my aunties was diagnosed of having breast cancer after she discover that she had a lump in late March this year. Much earlier she had two lumps which were not cancerous removed. Now I'm getting worried if my lumps could turn to be cancerous later? Anyway I've decided that I would want to remove them ASAP but how and where could I do it? The thought of my situation turning out to be like my aunty's case really scares me off. Unlike my aunty who is in her 60s, my children are still young and needs my attention still. Therefore I've decided that I have to get the lumps removed even though I've had a follow up check up early this year on the lumps in the Breast Clinic.  I was told the lumps have not changed, were still mobile and told not to worry. I do my own self breast examination regularly too.  Thanks for your advise. Please advise. 

RZ 13 August 2002

A Please do go ahead and get your anxieties allayed via another opinion. Even though the diagnosis is non-cancerous thus far, I am sure your doctor must have asked you to follow up at least once a year. See what the breast specialist says. It is not uncommon to have a patient prefer to have her non cancerous lumps removed to allay anxiety or to be absolutely sure. When you discuss this with your doctor, all factors are taken into account and you are encouraged to convey your anxiety to your doctor.  

Remember, just because you have non-cancerous lumps, it does not mean you cannot develop another "lesion" in the breast that may be cancerous. That is why we recommend self breast examination, regular clinical breast examination by your doctor or trained nurse as well as regular follow up mammography (with or without ultrasound) for early detection.  

It is much less common for a proven benign lump to “turn” malignant. However, proven benign breast disease is known to be associated with a slight increased risk for breast cancer. Please read: http://www.radiologymalaysia.org/breasthealth/About/bcriskfactors01.htm 

It is also a known fact that what appears benign and well defined on imaging on the breast has a small percentage that it may be a well defined cancer (2-10% chance).  That is why the direction is for histopathology confirmation using techniques that are less invasive (needle techniques compared to open surgery) or close follow up is done. 

Editor
 

Randy, 1 July 2002

A Unequal right and left breasts size is quite common. Most times, as long as the difference is not too great, most people are not too bothered. Just like our right and left hands is not always the same size. For right handed people, the right hand tends to be slightly larger than the left.  

You have not mentioned the degree of difference. Grossly unequal breast sizes can be due to breast feeding only on one side. There is another condition that is known as benign hypertrophy of the breast. In this situation, one or both breasts begins to grow and can reach a disproportionate size, resulting in difficulty buying a bra as well as having to tailor special clothes to fit. This is not a dangerous condition but the discomfort (the breast can become very heavy and large) and inconvenience, not to mention the self esteem can be dented by this “lop-sidedness”.

Fortunately, there is treatment available (normally surgical) but most women do not seek treatment early enough because of shame or fear. Please do not hesitate to see a breast surgeon or the plastic surgeon for a consultation first. Depending on the asymmetry in your breasts size, the doctor will be able to advise and discuss options with you. There is no need to feel ashamed seeking treatment. Non surgical treatments include external breast prostheses (made of silicone or foam) that can fitted inside special bras (now available from over the counter brands like Skiva and Wacoal) to “pad” up the smaller breast and therefore match the size of the larger breast.

Editor
 

Q I'm 25 years old. Last Year November, I did a SBE myself after the period, I noticed a very small lump near my nipple on the right breast. I went for a check up in Assunta Hospital and a doctor asked me to go for an ultrasound. When the report comes out, the doctor told me the lump is more likely a fibroadenoma, it's very small in size (in mm), and she asked me to go for check up again on Feb 2002.

Last Feb18th, I went for check up, the doctor told me it's still very small size (I didn’t do ultrasound last month) and asked me to come again in May.

I asked her if I should I go for operation or not, she said it's better to wait for the lump to grow bigger then the operation will be easier. I saw from a medical website saying that the risk of surgery is that scarring could
occur that could distort the shape and texture of the breast and make future physical examination and mammography more difficult to interpret. So I couldn't decide if I should go for operation or not.

Yesterday, I did a SBE again after my period is over, I found out that the size is bigger, today , I check again, its smaller, actually I don’t know what exactly is the size of the lump. I would like to go for another doctor's advice, may I know which hospital should I go for? My friend suggested me to University Hospital coz there it is cheaper, but I don’t know which department should I look for.

ALCW, 26 March 2002

A Some of the issues you have raised are addressed here in various articles in the Breast Health Section. We encourage you to read through them to get an overview of the whole picture in the management of breast conditions. 

If your doctor or was it your radiologist (doctor doing the ultrasound of the breasts) mentioned fibroadenoma, that means this is most likely a benign (non-cancerous) lesion. As the lesion is small, then, follow up is acceptable and normally a follow ultrasound is also done to continue to evaluate the characteristics of this lump. A fibroadenoma means a benign fleshy lump as opposed to a cyst, which is a fluid filled sac. The frequency of follow up will depend on the findings at each ultrasound.  

It is not always necessary to remove the whole lump surgically. It is possible to test the tissue in the lump using needle biopsy techniques. However, if your doctors are confident this is most likely benign, then, it may not be necessary to perform a needle biopsy. 

Please read the articles at:

www.radiologymalaysia.org\breasthealth\YoungerWomen\index.htm  

www.radiologymalaysia.org\breasthealth\BreastImaging\abnormal.htm 

www.radiologymalaysia.org\breasthealth\BreastImaging\howoften.htm 

and also some of the Q & A in the Talkback/Q & A section here. 

As for surgery causing scarring and distortion, it is true that it may make interpretation of mammography and ultrasound difficult. However, a good history of events, a pre-surgery mammogram and/or ultrasound as well as in some cases, a baseline investigation again after surgery would be helpful.

In women above the age of 40 years, regardless of breast symptoms and signs, a mammogram should be done first before any surgery. For any person with a breast lump, normally at least an ultrasound is done to confirm and evaluate the presence of the lump, and also to look for other lesions that may not be palpable to the fingers/hands. Often, a person has a lumpy breast but may not actually have any “true” lumps on the ultrasound.  

You seem to be doing SBE too often. Please read the section on SBE, www.radiologymalaysia.org\breasthealth\SBE\index.htm and find out why performing SBE too often may actually work against you!  

In addition, if the article is not clear enough, free self breast examination workshops are available now as part of the NCWO Breast Cancer Awareness Campaign 2002. Please look at the following section for the Klang Valley workshops: 

www.radiologymalaysia.org\breasthealth\Workshops\klangvalley.htm 

For second opinion, there are several government and university hospital Breast Clinics available. These would be at 

www.radiologymalaysia.org\breasthealth\BreastImaging\breastclinic.htm 

Editor

Q I am 40yrs old, married with 3 children. Early this year I noticed a lump appeared at the side of my left breast and shortly after that I had a mammogram and an ultrasound to check out the lump at a private hospital. After they did a test on some sample of cells extracted from the lump, I was informed that the lump is harmless. In fact there is another smaller one quite near to the first lump. So now, what is the right thing that I should do? Should I remove them immediately or should I just monitor them until there are signs of pain etc. then only I go for the surgery? The doctor told me that it's up to me to decide. Please advise. 

RZ  10^th October 2001 

A Basically, you should not worry since the needling for cells has already been done and it was harmless. The majority of breast lesions that are found are usually harmless (80-90%). Whatever the case, your doctor would have given you alternatives, such as you face now.

If you look at the article in the Breast Info Centre for What HAPPENS if my mammogram is abnormal etc, it will give you an idea what are the options for the various scenarios.

I cannot advise you specifically because there are many factors, which only your doctors including radiologist/pathologist would know, that will help decide what is the best for you in your situation and of course, you are also part of the team that makes the decision. Whenever in doubt, please discuss/check with your doctor, especially if you discover new changes in your self breast examination. - Editor
 

Q Homepage ini agak menarik tetapi maklumat dan tanda tanda tentang kanser agak tidak terlalu detail. Namun ianya amat berguna. Lebih kurang lagi seminggu saya akan datang bulan, di bawah ketiak kanan saya akan ada satu ketulan kecil lebih kurang 0.7 cm. Ianya agak sakit kalau dipicit. Namun apabila datang bulan ianya akan hilang dengan sendirinya. Untuk pengetahuan pihak tuan, setiapkali saya datang bulan, hari pertama dan kedua saya pasti akan diserang senggugut yang agak teruk dan terpaksa dihilangkan dengan mengambil Ponstan. Saya juga pernah membuat pemeriksaan di Subang Jaya Medical Centre, hasil scan menyatakan saya mempunyai cyst bersaiz 2.5mm. Adakan ianya berkaitan dengan sebarang kanser?  

N. Ela 25hb Okt 2001

A Selalunya, sista payudara tidak merbahaya dan bukanlah kanser. Anda tidak menyebut umur anda dan juga scan jenis apa yang anda melalui tetapi diagnosa sista selalunya dibuat selepas scan ultrasound. Ini adalah kaedah yang menggunakan “sound waves” untuk pengimejan. Ultrasound menghampiri ketepatan 99% untuk diagnosa sista apabila dibuat oleh pakar radiologi ataupun “sonographer” yang terlatih dan dengan mesin serta “probe” ultrasound yang baik. 

Berkaitan dengan ketulan yang “datang dan pergi” setiap putaran haid, anda juga tidak menyebut adakah sista yang dijumpai pada scan adalah tepat di mana anda terasa ketulan tersebut. Kalaulah, ia di tempat yang sama, kemungkinan besar, sista membesar sedikit apabila menghampiri haid akibat tindakan hormon. Apabila sudah datang haid, ia akan menjadi lebih kecil. Selalunya, sista sebesar 2.5mm susah dirasai oleh tapak jari.  

Ramai wanita merasai “kesakitan” dan/ataupun textur payudara berubah menjadi lebih berketul-ketul apabila menghampiri haid dan ia adalah kerana tindakan hormon anda (cyclical mastalgia). Selalunya, selepas datang haid, payudara akan terasa lega. Setengah wanita pula, mempunyai kesakitan yang datang dan pergi tetapi tidak mengikuti putaran haid. (non-cyclical mastalgia). Setengah wanita pula mempunyai textur payudara yang tidak rata, “berketul-ketul” (lumpy) akibat keadaan fibroadenosis. Ini just bukanlah kanser payudara.  

Walaubagaimanapun, adalah merupai tabiat yang baik untuk melakukan PSP, iaitu pemeriksaan sendiri payudara. Jangan lupa membuat PSP hanya selepas datang haid (2-3 hari selepas berhenti haid) setiap bulan. Ini membolehkan anda membuat perbandingan yang lebih tepat.

Kalau anda terasa sebarang simptom/tanda yang baru, yang kekal untuk 2 putaran haid ( 2 menstrual cycles), teruslah pergi berjumpa doktor anda. 

Mengenai laman web, kami terus berusaha untuk meninggikan mutu dan menambahkan artikel di seksyen Bahasa Inggeris dan Bahasa Malaysia. Kami juga mengambil perhatian terhadap komen dan cadangan yang diterima daripada pengguna laman web seperti anda. - Pengarang

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