BREAST LUMPS – DON’T PANIC AND DON’T NEGLECT

 

You're in the shower, checking your breasts, and suddenly your hands freeze – you've found a lump! What should you do now? First, don't panic and remember this important fact: 80% of lumps found in the breast are benign, meaning they do not destroy tissues, do not metastasize to distant organs, and have a very low potential to develop into a malignant and cancerous tumor.

If you are under 40, it's likely there's no reason to worry, and if you regularly undergo mammography screenings, as long as the results are negative, the chances are quite good that it’s not a cancerous lump. Still, with all this information, it’s hard not to worry when finding a lump in the breast – what is it and why does it happen, what distinguishes a cancerous lump from a benign one, and will the lump disappear on its own?  I ofen am in the receiving end of all these questions from my patients and will try to answer all these questions now.  

 

What does a lump in the breast feel like?

Different lumps have different textures, and even two lumps of the same type can feel somewhat different from each other. A cyst, for example, feels somewhat like a small water balloon in the breast, or it can be more firm – somewhat like a grape. On the other hand, a lump caused by breast inflammation (mastitis) may have a more pointed shape and feel warm to the touch. Other types of lumps can look like dimples in the skin, and some can even cause the nipple to retract inward. Ultimately, the person who needs to examine the lump after you find it is your doctor, who will know how to diagnose it correctly and send you for tests to help identify it. Please do not try to exchange notes with your friends who have had breast lumps. Your condition can be very different and so will be your management.

 

Common Signs of Benign Breast Lumps

The breast is composed of fat, blood vessels, fibrous connective tissues, and glands, and it also has a complex system that produces milk, including milk lobules and ducts that lead to the nipple. This anatomy itself is full of lumps in various places, and what complicates it further is that just like you, your breasts are also aging and from menarche through pregnancy, lactation, repeat pregnancy to finally menopause its size, shape and feel keeps on changing. So, when looking for a lump in the breast, the following signs should be considered

·        Size of the lump

·        Mobility of the lump

·        What type of edges the lump has

·        Whether the lump is painful and does it pain only on some days or always

·        Whether you have any nipple discharge staining your bra

·        Are there any lumps in axilla (underarm) too? 

A benign breast lump is usually one where you can clearly feel its edges and diagnose its shape, and it can also move slightly within the breast. This is actually the first thing that distinguishes it from a cancerous tumor, as a cancerous tumor does not have these characteristics. However, this is not a hard and fast rule because a cancerous tumor too, in its early stages, can move within the breast. The size of the lump can range from the size of a pea to the size of a golf ball, and it should "roll" between your fingers and not penetrate deeper into the breast tissues.   Another difference is that a cancerous lump usually does not cause pain, while a benign lump does, though there are exceptions. For example, a relatively rare form of breast cancer called "inflammatory breast cancer" can cause pain, tenderness, and a burning sensation in the breast. This is because this cancer can spread to the skin and lymph tissues in the chest, and the pain is felt from these tissues.  

The only way to know what type of lump it is through a medical examination and sunsequent investigations. Depending on your age, medical history, family history of breast disease, and physical exam findings, you may be referred for a mammogram, ultrasound, FNAC (Fine Needle Aspiration Cytology) or biopsy. It is important to note that not every lump requires advanced tests, at least not immediately. If you have, for example, a fluid-filled cyst during your menstrual cycle, your doctor will likely want to re-examine your breast after the cycle to see if the cyst has disappeared. If it has, the doctor will know that the lump was benign and related to the hormonal changes your body experiences during the cycle.

 

Benign Breast Lumps

Most benign breast lumps are related to the menstrual cycle and hormonal changes, or fluid accumulation that comes with the cycle. Other benign lumps are related to blocked milk ducts, infection, or even breast injury. The likelihood of developing a benign breast lump increases with hormonal imbalances in your body or if there is a family history of benign breast lumps or breast cancer. Here are 7 conditions that cause benign breast lumps that are not cancerous:

1. Fibroadenoma

These lumps usually develop in young women during their teenage years or twenties and during pregnancy, and they shrink during menopause. Their size ranges from a few millimeters to several centimeters and they can be very painful. The lump is usually round and well-defined, and it can move under the skin. To confirm the diagnosis, the doctor will perform a biopsy guided by ultrasound, and if necessary, surgical removal. If the lump shrinks or does not grow over time, the doctor may decide to just monitor it without removing it.

2. Cyst

This lump is round or oval and filled with fluid. It is soft to the touch and will be softer as it gets larger. A cyst may come and go with the menstrual cycle, usually becoming larger and softer at the beginning of the cycle and disappearing by the end. An ultrasound is the best way to determine if the lump is a simple cyst or a more complex one that requires further testing. If it is a large cyst, it may need to be drained of fluid, which can be sent to a lab for further testing if the doctor deems it necessary.

 3. Fibrocystic Breast Changes

Breast tissue may change over time, which happens in 30-60% of women, and at least 50% of women of childbearing age. Some studies even suggest the prevalence is higher – between 70-90%. The lump is characterized by a granular or smooth texture that moves freely in the breast, and additional symptoms may include tenderness, fibrous or rubber-like tissues, or a round fluid-filled cyst. Fibrocystic changes are related to hormonal changes, so they increase as menopause approaches but disappear during it. The doctor may recommend birth control pills to reduce the symptoms associated with this condition.

4. Nipple Discharge

Nipple discharge can accompany breast lumps, and the discharge itself can have various colors, including white, dark green, yellow, brown, or even clear. If the discharge is clear or contains blood, it is usually a sign that should raise a red flag and requires examination and imaging. Sudden discharge from one nipple alone is suspicious and requires a mammogram. If, on the other hand, the discharge comes from several ducts in the same nipple, it is not a cause for concern, unlike discharge from just one duct, which requires examination.

5. Mastitis

This inflammation is caused by an infection in the milk ducts, resulting in a lump in the breast accompanied by redness and warmth, as well as a high fever. It mainly occurs in breastfeeding women but can happen independently of breastfeeding and even in women who have passed menopause. Treatment includes cooling with ice, pain relievers, and antibiotics since the infection is bacterial.

6. Breast Abscess

Mostly seen in lactating women, this is an extremely painful condition accompanied with high fever. This usually needs high end antibiotics, analgesics and anti-inflammatory drugs, surgical drainage and stopping of lactation. The child has to be switched to top feed by the attending pediatrician.

7. Fat Necrosis

This occurs when breast fat tissue is damaged due to injury or post-surgery, such as breast reduction surgery. It results in a hard lump with an undefined shape that is quite sensitive to touch. Sometimes, such a lump can develop into a fatty cyst, which can be identified by a mammogram and is harmless.

8. Other Causes

There are various other medical conditions that can cause benign breast lumps, including

·        Hyperplasia: An increase in the amount of organic tissue in the breast due to trauma, chronic inflammation, or hormonal change.

·        Adenosis: Growth of the milk lobules in the breast.

·        Intraductal Papilloma: A growth resembling a polyp developing in the breast ducts.

·        Lipoma: A benign fatty tumor.

 

How to Know if a Lump Might Be Cancerous?

Although most breast lumps are benign, some indeed turn out to be cancerous. If a cancerous lump is not treated, it continues to grow and invade the healthy tissues nearby and can eventually reach other parts of the body. Therefore, it is always advisable to check lumps found in the breasts with a doctor as soon as they are noticed. Do not be afraid if the doctor refers you for additional tests, such as mammography, MRI, or ultrasound – additional tests do not automatically indicate a cancerous lump, and their purpose is to simply provide more information to the doctor.

Most cancerous lumps begin as single, hard lumps, and additional signs include:

·        Changes in the appearance of the nipple

·        Nipple discharge

·        Nipple tenderness

·        Puckered skin fixed to the lump

·        Dimpling or bumps on the skin – like an orange peel (Peau-de-orange) 

About half of the lumps appear in the upper part of the breast and the outer part, spreading toward the armpit. About 18% of lumps appear in the nipple area, about 11% in the lower part of the breast, and about 6% in the inner lower part.

 

What to Do If You Find a Lump?

First, don't panic! Most benign lumps can be treated, and some will even disappear on their own, but it is always recommended to see a doctor to diagnose the lump. The doctor will decide how to proceed and whether additional tests or treatments are needed. Since many lumps change due to hormonal changes, it is advisable to examine the breast at different times throughout the month, such as before the menstrual cycle, during it, after it ends, and at the beginning.

 

Breast Self Examination

Breast self-exam, or regularly examining your breasts on your own, can be an important way to find breast cancer early, when it’s more likely to be treated successfully. This self examination schedule has two parts – look and feel and click this hyperlink to understand how to exactly do it: https://www.moffitt.org/cancers/breast-cancer/faqs/how-to-do-a-self-breast-exam/

Prof. Anurag Srivastava of AIIMS New Delhi and his team have created a very useful public information video on Breast lumps in Hindi language which I would highly recommend: https://youtu.be/42G6uUncFHU?si=gyM_7hv0qc9XkOs3

BUYING TOYS IS A SERIOUS BUSINESS

 

Play has been considered the work of a child and in many ways play prepares children for life. In turn, toys are the building blocks of children’s play, and parents are the usual suppliers of toys for children. Toy play between parents and children makes up a large proportion of parent-child interaction. ​​Kids can have a lot of fun playing with their toys. However, it's important to keep in mind that safety should always come first. Each year thousands of children are injured by toys. Most injuries from toys are minor cuts, scrapes, and bruises. However, toys can cause serious injury or even death. This happens when toys are dangerous or used in the wrong way. It's also important to look out for button batteries or lithium coin batteries, high-powered magnets or other small objects that children might be tempted to put in their mouths, noses or ears.

 

Recently I had a patient who is a ranking officer in Funskool Toys, the largest toy manufacturer in India. We started talking about toys and he had such interesting stories to tell. The invention of toys in India took place during the Indus Valley Civilization, approximately 8,000 years ago. The original toys comprised whistle-shaped parrots, toy monkeys with long hands to slide down a rope or stick and miniature farm carts. All these toys were made from natural materials such as bamboo sticks, hay, and natural clay like soil, rocks, and fibre cloth. However, today, the advent of progressive technology and mechanism has stimulated companies to produce fresh and inventive toys.

 

The Indian toy sector is expanding on the shoulder of a growing young population, rising disposable incomes, and a slew of innovations for the junior population base. The industry stands on the cusp of significant opportunities in every toy segment such as electronic toys, puzzles, construction and building toys, dolls, ride-ons, sports and outdoor play toys, infant/pre-school toys, and activity toys. A very large unorganized sector harbours some outstandingly talented toy manufacturers, who are simply waiting to be discovered by the world.

Some iconic toys

Toys have a very old history and over the years a few of them have acquired iconic status. Mr. Potatohead was the first mass marketed toy on television and soon he was joined by Mrs. Potatohead. 100 million pieces were sold in 30 countries. Slinky was a steel spring coil that had a life of its own. An unique combination of simple and complexity, it mesmerized the children with its dynamics. G.I. Joe started as a military toy which later on became an adventure loving guy. With its own comic strips and TV shows it was a hit. Toy robot Transformers came in 28 different types and there was a frenzy to possess each and every one of them. They fired the imagination of the kids and they could do anything!

Yo-yo is a toy which traces its history to ancient China and every kid has played with it. They could keep on improving their skills and even become professionals. 45 million pieces are sold every year and it has even gone into outer space! NERF balls always impress the kids because they make them emulate their professional idols in sports. Super soaker water gun is a fun toy everywhere and in India it is particularly popular during the Holi festival. Play-doh is a low tech play thing which is a scented and multi-coloured putty like dough with which kids create their imaginary structures. 3 billion cans of Play-doh have been sold till date!

If one Rubik’s Cube has more than 43 quintillion possibilities and millions of Rubik’s Cubes are sold and solved every year, for the last 50 years! There are websites, clubs, championships held regularly and people are still reinventing ways to solve the mystery. Hot Wheels miniaturized care and introduced speed, style and design along with those iconic orange racing tracks. 4 billion pieces were sold and they have enamored three generation of kids now.

Barbie is a doll who has remained relevant for 63 years now and inspired three generation of girls by empowering them in their growing years. 500 dolls are sold every minute and she is everything – a President, an astronaut, a scientist, a doctor, a soldier, a banker………you name it. Her outfits can be purchased separately and so can be her boyfriend, Ken. In 1968 we had a black Barbie, and she is loved by 3 successive generations now.

Lego comes from the Greek word Legos, which means word or thought or rational divine intelligence. The Lego pieces, 400 billion sold worldwide, are a challenge to our intelligence, have countless possibilities, limited only by the child’s imagination. Till Lego had its own factory the moulded luggage manufacturer Samsonite manufactured the Lego pieces. They later introduced wheels and made Lego mobile. LEGO's enduring popularity and iconic status can be attributed to its timeless appeal, commitment to quality, endless creative possibilities, and its ability to bring joy and imagination to people of all ages. The LEGO Group was founded in Denmark in 1932 by Ole Kirk Kristiansen and has been appreciated by 3 generations now. 

 

Ten toy buying tips

Here are tips to help you choose safe and appropriate toys for your child.

1.      Read the label. Warning labels give important information about how to use a toy and what ages the toy is safe for. Be sure to show your child how to use the toy the right way.

2.      Think LARGE. Make sure all toys and parts are larger than your child's mouth to prevent choking.

3.      Avoid toys that shoot objects into the air. They can cause serious eye injuries or choking.

4.      Avoid toys that are loud to prevent damage to your child's hearing.

5.      Look for stuffed toys that are well made. Make sure all the parts are on tight and seams and edges are secure. It should also be machine washable. Take off any loose ribbons or strings to avoid strangulation. Avoid toys that have small bean-like pellets or stuffing that can cause choking or suffocation if swallowed.

6.      Buy plastic toys that are sturdy. Toys made from thin plastic may break easily into sharp pieces.

7.      Avoid toys with toxic materials that could cause poisoning. Make sure the label says "nontoxic."

8.      Avoid hobby kits and chemistry sets for any child younger than 12 years. They can cause fires or explosions and may contain dangerous chemicals. Make sure your older child knows how to safely handle these kinds of toys.

9.      ​Electric toys should be "UL (Underwriters Laboratories) Approved or have BIS Certification - ISI mark (in India)." Check the label to be sure. Toys that heat up are all right for children older than 8 years when used with an adult. Toys must also bear the “ISI Mark,” provided by the license from the Bureau of Indian Standards (BIS), to be sold in India. No person or entity is permitted to manufacture, import, sell, or distribute, store, hire, lease or exhibit for sale toys that do not conform to the BIS standards or do not possess the ISI Mark.

10. Be careful when buying crib toys. Soft objects, loose bedding, or any objects that could increase the risk of entrapment, suffocation, or strangulation should be kept out of the crib. Any hanging crib toy (mobiles, crib gyms) should be out of your baby's reach and must be removed when your baby first begins to push up on their hands and knees, or when the baby is 5 months old—whichever comes first. These toys can strangle a baby.

 

Toys should be age appropriate

Children love toys, but as parents, when we purchase toys for them, we want to ensure they will play with them for a long time and not get bored after a day. Additionally, it's important that the toy is not only fun but also aids in the child's development and is age-appropriate.

While age recommendations are listed on toy packaging, they do not always match the reality or individual development of each child. So, whether you want to buy toys for your children that will truly be worthwhile and suitable for them, or you are looking for a gift for another child and want to make sure it will be used and beneficial, here is a guide to buying children's gifts by age.    

Toys for Infants – Ages 0-12 Month

In the first three months, the baby can only look at their surroundings, and since their vision is blurred, they see bright colors and items with bold patterns better. The toys don’t have to be black and white as long as there is a sharp contrast between the colors. As the baby grows, they will need more toys that stimulate their other senses. Many toys encourage interaction, like toys that make sounds when pressed or shaken, or those with textured bumps in different formations. Soft dolls that can be cuddled are also good. Babies at this age often put their toys in their mouths and love teethers that help them deal with the pain of growing teeth.  

Recommended Toys:

·        Mobiles with different patterns and bright colors

·        Rattles

·        Simple unbreakable mirrors

·        Soft dolls with smiling faces (preferably colorful and washable)

·        Small, soft fabric balls

 

Toys for One-Year-Olds

At one year old, children are fascinated by anything that has a cause and effect, and they enjoy playing with toys that react to their actions and help them sharpen their motor skills. Such toys can sometimes come in two parts, like a hammer used to activate the toy or to hit a toy that produces sounds.   Some toys for this age group recite the names of letters, shapes, or numbers when buttons are pressed, but at this age, the baby is still too young to learn all of these. However, babies still enjoy the interaction with these toys because they make sounds and expose them to language and words, which is certainly beneficial.

Recommended Toys:

·        Ring stacking toys

·        Stacking cups

·        Toys that make noises or have pop-up figures

·        Durable musical instruments that are easy to use like drums

·        Shape sorter toys large toy cars

 

Toys for Toddlers Ages 2-3

At this age, children begin to look for more purpose in their games and have the motor skills needed to complete simple puzzles or build block towers. They start enjoying pretend play and mimic the behavior of people around them, so more advanced, sound-making technological toys are now suitable for them. They will likely still enjoy the toys they liked at one year old, and if you’re looking for a wonderful gift that can keep a child active outside, now is the time to get a ride-on toy. It’s important to ensure that both of the child's feet can be on the ground at all times when riding such a toy.  

Recommended Toys:

·        Pretend play toys (mobile phone, tea set, kitchen, baby stroller

·        Talking dolls (and those that don’t talk)

·        Tricycle or ride-on toy

·        Toy piano

·        Early childhood puzzles (less than 20 pieces)

·        Building sets (large Lego, magnets, etc.        

 

Toys for Children Ages 4-5

At this age, children go through a giant leap in learning abilities, making it a good time to introduce them to educational toys and games that teach language skills and even math, including apps for learning to read and write.   You must choose toys that give positive feedback to the child, like 'Good job, let's try again,' instead of those that give negative feedback or beep when the child makes a mistake. At this age, children also love to imagine they are other people, such as their teachers, characters from movies, professionals, fairy tale characters, and more, so any toy that encourages this is also welcome.

Recommended Toys:

·        Art supplies (craft kits, play dough, etc.)

·        Electronic toys Building sets (Lego, magnets, etc.)

·        More complex puzzles (up to 48 pieces)

·        Action figures (action figures – Spiberman, Superman, Phantom, Barbie, etc.)

·        Costumes Toy cars and related play sets like car parks

·        Board games that do not require reading or complicated rules (Snakes and Ladders)

·        Balls - football, basketball, etc.  

 

Toys for Children Ages 6-7

At this age, children start developing their own interests but are still heavily influenced by their parents, teachers, and classmates. Some children love to conduct scientific experiments at this age – burning carbon paper with sunlight through a convex lens, while others are drawn to arts and crafts, jewelry making, or playing with dolls. Friends become more important to them, and they might start asking for trendy toys they’ve seen others have just because "everyone has one." They also start enjoying video games and sports games, construction games, and board games they can play with friends. Many are also drawn to toys that help them create music, though they may still struggle to play real musical instruments.

Recommended Toys:

·        Basic science kits

·        Toys that encourage curiosity (magnifying glass, telescope)

·        Art and craft supplies

·        Gaming consoles/games for consoles (Nintendo Switch, PlayStation, or Xbox)

·        Tablet Sports equipment

·        Remote control car

·        Action figures (action figures, Barbie, etc.)

·        Building sets (Lego, magnets, etc.)

·        Games that require strategic thinking (checkers, Jenga, even chess)

·        Bike with training wheels or a small scooter

 

Toys for Children Ages 8 and Up

Even before this age, but especially now and later, children love playing outside and riding a scooter, bike, or rollerblades. At the same time, they start developing "adult hobbies," like collecting certain types of items. They usually enjoy crafts and all kinds of competitive games. At these ages, children love any activity that exposes them to mystery and gives them a sense of competence.  Through video games, they can challenge themselves to score more points than they did before, and they also enjoy competing with their.

Recommended Toys:

·        Complex science kits

·        Magic kits

·        Model building kits

·        Craft kits

·        Gaming consoles/games for consoles (Nintendo Switch, PlayStation, or Xbox)

·        Sports equipment – cricket, badminton, hockey

·        More complex board games (Monopoly, Scrabble, etc.)

·        Bike without training wheels or scooter (with parental approval)

Parents’ decisions about toy purchases has a large practical impact on children’s development. By having a solid knowledge base of what types of information parents look for when giving toys to their children (e.g., educational value, safety) and where they try to find this information (e.g., from a pediatrician, online reviews), as well as where parents purchase their toys (e.g., online, in a store, secondhand), it makes toy manufacturers, retailers, and child development professionals aware of the information parents seek and the most efficacious channels for spreading this material. In addition, knowledge about what parents think about a manufacturers’ suggested age can have large consequences on their ability to choose safe toys for their child and avoid hazards.