Breast awareness at Bath Clinic

Chrissie Laban is an Oncoplastic breast surgeon with a background in research associated with the growth of breast cancer cells. Her practice is based at the Bath Clinic in Combe Down and she is well placed to guide women through what to look for and how to become ‘breast aware.’

Many of Miss Laban’s patients come to her clinics with benign breast related problems. Miss Laban said, ‘When I see these women in breast clinic, I take a full history, examine them, arrange breast imaging plus or minus breast biopsy and they can often be reassured that they do not have breast cancer and discharged from breast clinic that day.’ However, being aware of the most common problems and what to look for is a key part of raising awareness amongst women. Below, Miss Laban explains five common breast related problems. 

1. Mastalgia, more commonly known as breast pain, is not a sign of breast cancer. It affects many women at different points in their life and is due to female hormones and stress. The breast pain tends to be in the upper outer quadrant of the breast radiating up to the armpit and down to the base of the breast. Breast pain can be due to a breast cyst, or hormonal change.
2. Breast cysts are round or oval structures filled with fluid. About 25% of all breast masses turn out to be cysts. These are benign and do not increase the risk of developing breast cancer. They can be very small or large enough to feel through the skin. Cysts can occur at any age, they’re most common for women in their 40s. They can cause pain, tenderness or lumpiness in the breast which may worsen and get better at different points in the menstrual cycle.
3. Fibroadenoma is the most common type of benign breast lump. They do not increase your risk of developing breast cancer. They usually occur in young, premenopausal women and has a well-defined round or oval shape and a rubbery feeling. When you touch it, it’s easy to move it around the breast as opposed to being stuck in one place. Higher oestrogen levels due to pregnancy or hormone therapy can cause a fibroadenoma to get bigger, while menopause often causes it to get smaller.
4. Breast abscess can occur in any women but are more common in women who are breast feeding. It also occurs in smokers. Women present with a red-hot painful lump in the breast. They are treated with antibiotic tablets, a breast ultrasound scan and drainage of the abscess. They often need a few ultrasound scans to complete the treatment. Surgery is rarely needed.
5. Eczema of the nipple occurs when an itchy, scaly, irritated rash develops in the areola (area of dark skin surrounding the nipple). It can occur on one or both nipples. Usually, it is caused by irritation so choosing hypoallergenic soaps and detergents free of perfumes and dyes often helps or you may need a short course of topical steroids to treat the eczema. If you have redness or soreness around the nipple that looks like eczema and does not go away with treatment, your doctor should rule out another uncommon type of breast cancer, Paget’s disease of the nipple. Paget’s disease typically presents as redness, soreness, and flaking that affects the nipple and can be mistaken for eczema or infection.

Most patients who visit the breast clinics are fit, healthy and lead active lifestyles. Breast health is an important part of everyday health. Being aware of even subtle changes to your health is important as the earlier you have something checked, even if it is benign, the better the peace of mind and the faster the problem can be treated.

Being active in this way is especially important for younger women who can also develop breast cancer. In the case of Sarah Harding, she noticed a pain and lump in her breast which she thought was a breast cyst. She had been playing the guitar a lot and thought the guitar strap had irritated the breast cyst and that was the cause of the pain. She ignored the problem but the pain got worse. She could not sleep due to it and was taking regular painkillers. Eventually she was diagnosed with breast cancer aged 38 in August 2020. Sadly, she died a year later. Sarah’s story shows how important it is to get any and all irregularities checked out by a doctor, no matter how small you think the matter may be.

Miss Laban is passionate about removing the potential stigma or awkwardness associated with talking about breast health. She said, “I often have patients apologising to me in the breast clinic and feeling that they are wasting my time. This is not true, speaking to a doctor about changes you have noticed in your breast is the easiest way of diagnosing any breast problem early. Besides, it is my job to see any woman with a breast problem, no matter how small the problem or change may be. The more women I see the more women become aware of what to look for.”

Breast cancer is unfortunately very common and usually appears out of the blue. Miss Laban stresses that it is important women do not blame themselves. She said, “many of my patients question why they have breast cancer. They tell me they are fit and well, do not smoke and do not consume alcohol regularly.”

Miss Laban emphasises that, “no one should blame themselves; Breast cancer risks are multifactorial. It happens because they are female and is more common in postmenopausal women. But it is very treatable and the sooner a diagnosis is made the more options are available to the patient.”

10% of women have a genetic risk of getting breast cancer, so raising awareness of what to look for, and knowing your family history of breast cancer is incredibly important. The genetic risk occurs in women with the BRCA 1 and BRCA 2 gene mutation.

An important example that illustrates the power of proactive breast awareness is Angelina Jolie. Jolie did not have breast cancer; however, her mother developed both breast and ovarian cancer at 49 and sadly passed away at 56. For this reason, Jolie had a blood test which showed she had a BRCA1 mutation. This mutation gave Jolie an 80% risk of developing breast cancer and a 60% risk of ovarian cancer. Jolie made the decision to have a risk reducing procedure and went ahead with a bilateral mastectomy, followed by breast reconstruction.

In the years that followed she went ahead and had her ovaries removed. Jolie was very public about her journey and used her experience to educate women about the options available to them when faced with the prospect of breast cancer. Miss Laban cites this as an example of showing women that they can take autonomy over their health and that being breast aware in this way is not something to be nervous about. Miss Laban said, “Angelina Jolie’s story showed that the breast can be removed and reconstructed successfully. Risk reducing procedures are an impactful way of preventing cancer, in women with a positive family history of breast cancer.”

She went onto say, “the more women discuss their experiences openly and are aware that there are options for treatment, the better chance there is of beating the cancer early. I encourage all of my patients to explore the options that works best for them.”